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1.
Clin Nucl Med ; 49(5): 481-483, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38389203

RESUMO

ABSTRACT: Prostate-specific membrane antigen (PSMA) PET/CT has revolutionized the imaging of prostate cancer. Historically, prostate cancer metastasis to thyroid and cricoid cartilages was thought to be exceedingly rare, with only a few reported cases in the literature. Prostate cancer metastasis to the laryngeal cartilages was detected in 4 of 221 patients who underwent imaging with 18 F-PSMA (Pylarify) or 68 Ga-PSMA (Illuccix) PET/CT for initial staging of high-risk prostate cancer or restaging evaluation in the setting of biochemical recurrence from April 2022 through October 2023. The increased sensitivity and specificity of PSMA PET/CT allow for the detection of previously occult metastatic disease.


Assuntos
Neoplasias dos Genitais Femininos , Neoplasias da Próstata , Masculino , Feminino , Humanos , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Próstata/patologia , Glândula Tireoide/patologia , Cartilagem Cricoide/diagnóstico por imagem , Cartilagem Cricoide/patologia , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia , Radioisótopos de Gálio , Neoplasias dos Genitais Femininos/patologia , Antígeno Prostático Específico
2.
Adv Gerontol ; 36(2): 227-233, 2023.
Artigo em Russo | MEDLINE | ID: mdl-37356099

RESUMO

The paper presents the results of a histomorphometric study of age-related changes in hyaline cartilage tissue by the example of studying cricoid cartilage from 88 corpses of males of various ages. A comparative assessment of the parameters between the groups was carried out and the dynamics of age-related changes in the main ones was studied. As a result of the studies, the greatest correlation with age was recorded in the following indicators: length (r=0,88) and width (r=0,89) of the ossification zone, the area of bone (r=0,87), adipose (r=0,77) and reticular tissue (r=0,86), the number of chondroblasts (r=-0,7). It was found that the transformations of cricoid cartilage occurring with age are characterized by a decrease in the area of cartilage tissue, the average number of chondrocytes and chondroblasts also tends to decrease steadily with increasing age. Age-related bone tissue transformations are characterized by an increase in the area of bone tissue and the transformation of the tissue structure itself: the number of bone beams and their dimensional characteristics (length and width) change. The results of the study allow us to evaluate the age dynamics of quantitative markers of involution processes of hyaline cartilage tissue in men by the example of studying cricoid cartilage and supplement the existing ideas about the pathogenesis of age-associated cartilage diseases.


Assuntos
Osso e Ossos , Cartilagem Cricoide , Masculino , Humanos , Cartilagem Cricoide/patologia , Condrócitos
3.
Int J Pediatr Otorhinolaryngol ; 162: 111293, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36044795

RESUMO

OBJECTIVES: It is thought that many infants have a prominent venous plexus of the postcricoid area. In the past this entity had occasionally been reported as a postcricoid hemangioma or even a postcricoid mass. The term postcricoid cushion is now gaining acceptance to describe the prominent venous plexus of the posterior cricoid area. Although it rarely causes symptoms, it should be considered when patients present with symptoms of obstruction. Differentiating between normal variant postcricoid prominent venous plexuses, hemangiomas, and vascular malformations can be difficult and cannot be confirmed without immunohistochemistry. The objective of this systematic review is to describe current practices, clinical symptoms, management and outcomes of pediatric postcricoid lesions including postcricoid cushion. METHODS: A systemic review of the literature was done using the PRISMA (Preferred Reporting Items for Systemic Reviews and Meta-Analyses) guidelines to investigate postcricoid lesions. The following terms: Postcricoid, Postcricoid lesions, Postcricoid mass, Posterior cricoid, Pressure-dependent postcricoid mass, postcricoid prolapse, postcricoid hemangiomas, postcricoid vascular malformations, and postcricoid cushion were searched in PubMed and Google Scholar. Articles that were within the inclusion criteria were reviewed. Demographics, past medical and birth histories, clinical symptoms, evaluations, biopsy results, treatments, and outcomes were included. For the purposes of this review, postcricoid cushions, pressure-dependent postcricoid mass, and postcricoid prolapse will be group under normal variant postcricoid cushion. RESULTS: 15 articles with 42 distinct cases were included in this systemic review. 21/42 of the patients were female, the age ranged from 2 days to 18 years, the median age was 6.5 months, and 39/42 of patients were under the age of 2 years. 17/42 patients were diagnosed "hemangiomas" in the papers with only 1 case confirming the diagnosis of hemangioma with immunohistochemistry. 7/42 were diagnosed vascular malformations with 3 cases confirming the diagnosis of with immunohistochemistry. 17/42 of cases were normal variant postcricoid cushions. Most commonly, patients had a history of laryngomalacia (14/33) followed by no other medical history (9/33). The most common clinical symptoms were stridor, dysphonia, or weak cry in 30/42, dysphagia in 20/42, sleep disordered breathing in 9/42, and regurgitation or aspiration in 9/42.8/38 of patients diagnosed with postcricoid cushion did not have visualization of the lesion until a Valsalva maneuver was performed. The most common management for "hemangiomas" was observation (8/17), for "vascular malformations" was laser therapy (3/7), and for normal variant postcricoid cushions was observation (8/17). The most common outcome was complete resolution (14/30) followed by improvement of symptoms (9/30), and residual complications (4/30) The median time to follow-up was 12 months. CONCLUSION: Due to the relatively new "discovery" of the normal variant postcricoid cushion, including postcricoid cushion, pressure-dependent postcricoid mass, and postcricoid prolapse, the majority of the literature are case reports. Although it is theorized that many children under the age of 2 have a prominent venous plexus, in some cases it could cause symptoms of obstruction. Because immunohistochemistry is rarely done and reported in the literature, many case reports may have misdiagnosed the postcricoid lesions. Also, in many cases visualizing the normal variant postcricoid cushion requires that the patients have increased intrathoracic pressure; therefore, if no postcricoid prominence is seen initially or when the patient is under general anesthesia and a postcricoid lesion is suspected, the patient should receive a Valsalva maneuver or be placed in Trendelenburg position. Most cases of normal variant postcricoid cushions can be managed with observation. Due to the rarity and novelty of the discovery, more research needs to be done on the management of symptomatic postcricoid lesions and differentiating between normal variants and pathological vascular lesions.


Assuntos
Transtornos de Deglutição , Hemangioma , Terapia a Laser , Criança , Cartilagem Cricoide/patologia , Transtornos de Deglutição/etiologia , Feminino , Hemangioma/diagnóstico , Hemangioma/terapia , Humanos , Lactente , Recém-Nascido , Terapia a Laser/efeitos adversos , Masculino , Prolapso
4.
J Feline Med Surg ; 24(4): 373-380, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-34236002

RESUMO

OBJECTIVES: Partial laryngectomy is an organ-sparing surgical procedure for the removal of laryngeal masses which has not been described in cats. The aim of this study was to report on the surgical procedure and the short- and long-term clinical outcomes of cats that underwent partial laryngectomy. METHODS: Medical records were retrospectively collected over a 4-year period in two institutions. The following data were retrieved: signalment, history, clinical signs, diagnostic test results, surgical procedure, postoperative management, complications and outcome. RESULTS: Six cats underwent partial laryngectomy. The most common clinical signs in cats with laryngeal masses were stridor (n = 4) and dyspnoea (n = 4). In all cats, a full-thickness portion of one or several laryngeal cartilages was resected, including thyroid cartilage alone (n = 2), thyroid cartilage and arytenoid (n = 2), and arytenoid cartilage and epiglottis (n = 2). The resected laryngeal masses were reported to be lymphoma (n = 3), carcinoma (n = 1), laryngeal cyst (n = 1) and inflammatory laryngeal disease (n = 1). All cats survived the surgical intervention of partial laryngectomy. Four cats showed varying degrees of respiratory distress in the short-term postoperative period. A temporary tracheostomy tube was placed in two cats. No other postoperative complications were noted in the short- or long-term. Four cats were still alive at the time of writing. These cats survived at least 252 days. CONCLUSIONS AND RELEVANCE: In a small number of cases, our results show that successful long-term outcomes after partial laryngectomy are achievable, with longer survival times than previously reported. Therefore, partial laryngectomy should be considered as a viable treatment option in cats with laryngeal masses.


Assuntos
Carcinoma de Células Escamosas , Doenças do Gato , Neoplasias Laríngeas , Animais , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/veterinária , Doenças do Gato/cirurgia , Gatos , Cartilagem Cricoide/patologia , Cartilagem Cricoide/cirurgia , Neoplasias Laríngeas/cirurgia , Neoplasias Laríngeas/veterinária , Laringectomia/métodos , Laringectomia/veterinária , Estudos Retrospectivos , Resultado do Tratamento
5.
Laryngoscope ; 132(1): 169-176, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34291467

RESUMO

OBJECTIVES/HYPOTHESIS: Laryngeal chondrosarcomas are rare malignancies with a spectrum of presentations due to varying size, local extension, and biological behavior. Moreover, these neoplasms have differing effects on respiration, phonation, and deglutition. Consequently, it is valuable to assess endoscopic and transcervical treatment strategies. STUDY DESIGN: Retrospective case series. METHODS: A retrospective review was done from 2001 to 2020; 25 patients were identified with laryngeal chondrosarcomas. Their tumor pathology and treatment were analyzed. RESULTS: All 25 chondrosarcomas were in the posterior cricoid and arose in proximity to at least one cricoarytenoid joint: 23 of 25 grade I-II (low-mid), one of 25 grade II-III (mid-high), and one of 25 grade III (high). Some tumor was left in 23 of 25 to preserve cricoarytenoid-joint function. There were no known disease-specific deaths (~8-year median follow-up). Final surgical treatment in 24 of 25 was: 13 of 25 transcervical partial laryngectomy, 7 of 25 transoral-endoscopic removal, 4 of 25 total laryngectomy, and 1 of 25 observation. CONCLUSIONS: In this series, unresected intercurrent disease with laryngeal chondrosarcomas was not life-threatening. Therefore, disease was typically left in the posterior cricoid region to preserve mobility of at least one cricoarytenoid joint. This philosophy employed an ultra-function-sparing conservation approach that preserved and/or restored optimal voice, airway patency and swallowing. LEVEL OF EVIDENCE: 4 Laryngoscope, 132:169-176, 2022.


Assuntos
Condrossarcoma/cirurgia , Neoplasias Laríngeas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Condrossarcoma/patologia , Cartilagem Cricoide/patologia , Cartilagem Cricoide/cirurgia , Feminino , Humanos , Neoplasias Laríngeas/patologia , Laringectomia/métodos , Laringe/patologia , Laringe/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
7.
Laryngoscope ; 131(5): 967-974, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-32557663

RESUMO

OBJECTIVES: Laryngotracheal stenosis (LTS) is a fibrotic condition of the upper airway. Recent evidence suggests dysregulated host immunity plays a role in LTS development and progression. The programmed death-1 (PD-1)/programmed death-ligand 1 (PD-L1) axis, targeted by paradigm-shifting immunotherapies for cancer treatment, has also recently been implicated in the pathogenesis of fibrotic pulmonary disease. However, a role for the PD-1/PD-L1 axis in the proximal airway fibrosis seen in LTS patients has not been explored. STUDY DESIGN: Controlled ex vivo study. METHODS: Expression of PD-1, PD-L1, CD4, and CD8 were evaluated using immunohistochemical staining of cricotracheal resection specimens from postintubation iatrogenic laryngotracheal stenosis (iLTS), idiopathic subglottic stenosis (iSGS) patients, and normal controls derived from rapid autopsy (n = 8 per group). Fibroblasts derived from iLTS scar were also treated with transforming growth factor beta 1 (TGFß1) and analyzed for PD-L1 expression by quantitative real-time polymerase chain reaction (n = 6). RESULTS: iLTS specimens exhibited increased expression of PD-1, PD-L1, and CD4 (all P < .0167) compared to controls, whereas iSGS specimens exhibited increased expression of PD-1 and CD4 (P < .0167) compared to controls. PD-1, PD-L1, and CD4 showed periepithelial patterns of expression in both disease cohorts. TGFß1 treatment of iLTS fibroblasts increased expression of PD-L1 (the cognate ligand for PD-1). CONCLUSION: Expression of both PD-1 and its ligand PD-L1 are significantly greater in patients with iLTS compared to controls, and PD-1 expression is also elevated in patients with iSGS. Given published evidence implicating the PD-1/PD-L1 axis in pulmonary fibrosis, this suggests a possible role for checkpoint inhibitors targeting the PD-1/PD-L1 axis for the treatment of LTS. LEVEL OF EVIDENCE: N/A Laryngoscope, 131:967-974, 2021.


Assuntos
Antígeno B7-H1/metabolismo , Laringoestenose/imunologia , Receptor de Morte Celular Programada 1/metabolismo , Estenose Traqueal/imunologia , Antígeno B7-H1/análise , Biópsia , Estudos de Casos e Controles , Células Cultivadas , Cartilagem Cricoide/imunologia , Cartilagem Cricoide/patologia , Cartilagem Cricoide/cirurgia , Feminino , Fibroblastos , Fibrose , Humanos , Imuno-Histoquímica , Laringoestenose/patologia , Laringoestenose/cirurgia , Masculino , Pessoa de Meia-Idade , Cultura Primária de Células , Receptor de Morte Celular Programada 1/análise , Traqueia/imunologia , Traqueia/patologia , Traqueia/cirurgia , Estenose Traqueal/patologia , Estenose Traqueal/cirurgia , Traqueostomia
9.
Pan Afr Med J ; 36: 74, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32774633

RESUMO

Cricoarytenoid joint arthritis is most frequently reported in Rheumatoid Arthritis and in other systemic diseases such as Sjogren's syndrome, Systemic Lupus Erythematosus, Ankylosing Arthritis, Juvenile Chronic Arthritis, and autoimmune hepatitis but it has not been reported in dermatomyositis. In this paper, we report the case of a 43 years-old woman treated for dermatomyositis who presented with hoarseness and severe odynophagia. The laryngoscopy revealed the presence of an extensive white swelling of the left cricoarytenoid joint with reduced mobility of the left vocal cord, consistent with left cricoarytenoid joint arthritis, which has not previously been described in dermatomyositis to our knowledge. Treatment with high doses of prednisone produced a complete resolution of the laryngeal symptoms.


Assuntos
Artrite/etiologia , Cartilagem Aritenoide/patologia , Cartilagem Cricoide/patologia , Dermatomiosite/complicações , Adulto , Artrite/tratamento farmacológico , Artrite/patologia , Dermatomiosite/tratamento farmacológico , Feminino , Glucocorticoides/administração & dosagem , Humanos , Laringoscopia , Prednisona/administração & dosagem
10.
Radiol Med ; 125(12): 1301-1310, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32415474

RESUMO

OBJECTIVES: To evaluate thyroid, arytenoid, and cricoid cartilage invasion on computed tomography (CT) imaging in patients undergoing total laryngectomy for both primary and recurrent laryngeal carcinoma. Secondary endpoint was to compare laryngeal cartilage invasion between primary and recurrent tumours. METHODS: Pre-treatment CT of 40 patients who had undergone total laryngectomy was retrospectively evaluated and compared with histology. Focal erosions of thyroid cartilage were accounted for neoplastic invasion of the inner cortex. Full-thickness thyroid cartilage invasion was defined as a tumour-like tissue replacing thyroid cartilage or extended in extra-laryngeal soft tissues. Sclerosis and erosion of arytenoid and cricoid cartilages were assessed as signs of neoplastic invasion. RESULTS: CT erosion showed perfect agreement for thyroid inner cortex and cricoid cartilage invasion and almost perfect agreement (87%) for arytenoid cartilage invasion. For tumours in contact with thyroid cartilages, the absence of CT erosion underestimated inner cortex infiltration. CT showed perfect agreement in predicting full-thickness thyroid cartilage invasion only in the case of extra-laryngeal neoplastic extension. Arytenoid sclerosis showed poor correlation with neoplastic invasion. For primary tumours, CT demonstrated good (inner cortex 75%; full-thickness 85%), substantial (67.5%), and perfect (100%) accuracy in thyroid, arytenoid, and cricoid cartilage invasion, respectively. No CT differences were observed between primary and recurrent laryngeal tumours. CONCLUSION: Tumour-like tissue extension in the extra-laryngeal soft tissues was accurate in predicting thyroid cartilage full-thickness invasion. Erosions of arytenoid, cricoid, and thyroid cartilages' inner cortex on CT were highly indicative of neoplastic infiltration. No CT difference in cartilage infiltration between primary and recurrent tumours was observed.


Assuntos
Cartilagens Laríngeas/diagnóstico por imagem , Neoplasias Laríngeas/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/métodos , Recidiva Local de Neoplasia/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Cartilagem Aritenoide/diagnóstico por imagem , Cartilagem Aritenoide/patologia , Meios de Contraste/administração & dosagem , Cartilagem Cricoide/diagnóstico por imagem , Cartilagem Cricoide/patologia , Feminino , Humanos , Iohexol/administração & dosagem , Iohexol/análogos & derivados , Cartilagens Laríngeas/patologia , Neoplasias Laríngeas/patologia , Neoplasias Laríngeas/cirurgia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Recidiva Local de Neoplasia/patologia , Estudos Retrospectivos , Sensibilidade e Especificidade , Cartilagem Tireóidea/diagnóstico por imagem , Cartilagem Tireóidea/patologia
11.
Ann Otol Rhinol Laryngol ; 129(7): 662-668, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32070112

RESUMO

OBJECTIVE: Cricoid chondronecrosis is a rare entity that has significant consequences for patients. Reports of its occurrence are scattered in the literature and currently there is no comprehensive review to help guide providers. METHODS: A case report from our institution is presented. A review of available literature is then provided with assessment of risk factors, signs and symptoms at presentation, laryngeal exam findings, radiologic findings, and surgical techniques. RESULTS: Twenty-four cases of cricoid chondronecrosis were reviewed from the literature. Patient age ranged from 8 months to 76 years. A history of endotracheal intubation for various reasons was present in all but two cases, and duration of intubation ranged from 6 hours to 28 days. Patients presented with airway compromise in all but two cases-one asymptomatic patient with prior tracheostomy and another with dysphagia after radiation. Dysphonia (n = 6) and dysphagia (n = 3) were less commonly present. Subglottic stenosis (n = 19) was the most common exam finding followed by vocal fold impairment (n = 11). When CT scan findings were reported, fragmentation of the cartilage and/or hypodensity of the central lamina were described in all but one case. Interventions ranged from observation on antibiotics and steroids to surgical therapies including tracheostomy, dilation, and posterior cricoid split, with or without stent placement. CONCLUSIONS: Cricoid chondronecrosis is a serious, rare entity that can occur even after a short period of endotracheal intubation. Providers must have a high level of suspicion in patients that present with upper airway dyspnea with a history of prior intubation. LEVEL OF EVIDENCE: Level 4.


Assuntos
Doenças das Cartilagens/diagnóstico , Cartilagem Cricoide/diagnóstico por imagem , Infecções por Haemophilus/diagnóstico , Laringoestenose/diagnóstico , Infecções Estreptocócicas/diagnóstico , Traqueostomia , Adulto , Alcoolismo/complicações , Antibacterianos/uso terapêutico , Doenças das Cartilagens/complicações , Doenças das Cartilagens/patologia , Doenças das Cartilagens/terapia , Cartilagem Cricoide/patologia , Depressão/complicações , Dispneia/etiologia , Infecções por Haemophilus/complicações , Infecções por Haemophilus/terapia , Humanos , Intubação Intratraqueal , Laringoscopia , Laringoestenose/etiologia , Masculino , Necrose , Procedimentos Cirúrgicos Otorrinolaringológicos , Sons Respiratórios/etiologia , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/terapia , Paralisia das Pregas Vocais/diagnóstico , Paralisia das Pregas Vocais/etiologia
14.
Laryngoscope ; 130(7): 1634-1639, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31498456

RESUMO

OBJECTIVES/HYPOTHESIS: Identify predictors of decannulation failure after cricotracheal resection (CTR) and thyrotracheal anastomosis (TTA) in patients with subglottic stenosis (SGS). STUDY DESIGN: Retrospective cohort study. METHODS: Charts of patients undergoing CTR and TTA for SGS at the University Health Network, Toronto, Ontario, Canada between 1988 and 2017 were reviewed. Patient, pathology, treatment, and outcome data were collected. The end points for statistical analysis were development of restenosis and permanent tracheostomy. RESULTS: One hundred fourteen patients (n = 114) were eligible for inclusion in this review. The mean age at primary resection was 46.9 years, 95 (83%) were females, and 19 (17%) were males. The rate of restenosis and permanent tracheostomy was 13% and 5%, respectively. Sixty-two patients (54%) underwent a CTR and TTA, and 52 patients (46%) underwent a CTR, laryngofissure, and TTA. Traumatic stenosis (odds ratio [OR] = 10.3, P = .017), longer T-tube duration (OR = 1.2, P = .011), combined glottic/subglottic stenosis (OR = 10.47, P = .010), start of the stenosis at the vocal cords (OR = 6.6, P = .029), postoperative minor complications (OR = 13.6, P = .028), and need for repeat surgery (OR = 44.1, P < .001) were associated with an increased risk of requiring permanent tracheostomy. CONCLUSIONS: CTR and TTA are excellent surgical approaches for adult patients with subglottic stenosis. In this study, 5% of patients required permanent tracheostomy. Factors predicting treatment failure include traumatic stenosis, longer T-tube duration, combined glottic/subglottic stenosis, start of stenosis at the level of vocal cords, postoperative minor complications, and need for repeat surgery. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:1634-1639, 2020.


Assuntos
Cartilagem Cricoide/cirurgia , Laringectomia/estatística & dados numéricos , Laringoestenose/cirurgia , Estenose Traqueal/cirurgia , Traqueostomia/estatística & dados numéricos , Adulto , Anastomose Cirúrgica , Cateterismo/estatística & dados numéricos , Cartilagem Cricoide/patologia , Feminino , Glote/patologia , Humanos , Laringectomia/métodos , Laringoestenose/patologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Recidiva , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Glândula Tireoide/cirurgia , Fatores de Tempo , Traqueia/cirurgia , Estenose Traqueal/patologia , Traqueostomia/métodos , Falha de Tratamento
15.
Medicine (Baltimore) ; 98(7): e14412, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30762745

RESUMO

RATIONALE: posterior pharyngeal wall carcinomas located at the level of the cricoid cartilage is a rare occurrence. Surgical treatment is a dilemma owing to the retention of laryngeal function PATIENT CONCERNS:: A 56-year-old man underwent a "resection of left cervical tumor" at another hospital. Postoperative pathological report noted a left metastatic squamous cell carcinoma of the neck. Neck-enhanced computed tomography (CT) revealed thickening of the right posterior pharyngeal wall, and an image of soft tissue density was present on the posterior pharyngeal wall with a size of approximately 1.0 × 1.5 cm. DIAGNOSIS: Hypopharyngeal carcinoma (T1N2M0). INTERVENTIONS: We performed operation on a patient who suffered from posterior pharyngeal wall carcinomas at the level of the cricoid cartilage. The postoperative defects were repaired with posterior pharyngeal flaps. OUTCOMES: The patient with posterior pharyngeal flap after operation survived without necrosis, the neck wounds of patient healed in 1 stage, and the phonation, swallowing and respiratory function was good. LESSONS: The application of posterior pharyngeal flap to repair defects due to posterior pharyngeal wall carcinomas that were located at the level of the cricoid cartilage after resection is an effective reconstruction method that is easy to use and has excellent repair effects.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Cartilagem Cricoide/cirurgia , Neoplasias Hipofaríngeas/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Retalhos Cirúrgicos , Carcinoma de Células Escamosas/patologia , Cartilagem Cricoide/patologia , Humanos , Neoplasias Hipofaríngeas/patologia , Masculino , Pessoa de Meia-Idade , Pescoço/patologia , Pescoço/cirurgia , Faringe/patologia , Faringe/cirurgia
16.
Medicine (Baltimore) ; 98(4): e14199, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30681591

RESUMO

RATIONALE: After total or near-total laryngectomy and resection of prelaryngeal skin, laryngeal defects and prelaryngeal skin defects often remain a great challenge for head and neck surgeons when considering simultaneous reconstruction of. In this case report, a free bipaddled anterolateral thigh (ALT) was used for such defects reconstruction. PATIENT CONCERNS: For this 50-year-old male patient whose recurrent tumor invaded the cricoid cartilage and the prelaryngeal skin, supracricoid partial laryngectomy with a cricohyoidepiglottopexy would no longer be an option. However, the patient had a strong requirement of preserving lung-power speech, making total laryngectomy and chemoradiotherapy not acceptable. DIAGNOSIS: Pathologic result demonstrated well-differentiated squamous cell carcinoma. A PET-CT of the whole body showed extralaryngeal extension of the tumor invading the cricoids cartilage and prelaryngeal ribbon muscles and skin. Meanwhile, the video-laryngoscpy showed smooth laryngeal mucosa. INTERVENTIONS: A near-total laryngectomy and resection of prelaryngeal skin were performed. The resultant defects were reconstructed with a free bipaddled ALT flap. OUTCOMES: The patient is 18 months postsurgery with no locoregion tumor recurrence, taking oral feeds, partial lung-power speech and not decannulated. Laryngostenosis was shown by the videolaryngoscopy, MRI and CT scan. LESSONS: A free bipaddled ALT flap could be utilized for simultaneous reconstruction of large larynx and prelaryngeal skin defects, and allows partial laryngeal function preservation in selected local recurrent laryngeal cancer invading the cricoid cartilage and prelaryngeal skin.


Assuntos
Cartilagem Cricoide/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Transplante de Pele/métodos , Retalhos Cirúrgicos/transplante , Cartilagem Cricoide/patologia , Humanos , Neoplasias Laríngeas/patologia , Neoplasias Laríngeas/cirurgia , Laringe/cirurgia , Masculino , Pessoa de Meia-Idade , Pescoço/cirurgia , Pele/patologia , Coxa da Perna
17.
Laryngoscope ; 129(11): 2588-2593, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30671968

RESUMO

OBJECTIVES: The clinical significance of the interarytenoid mucosal height (IAMH) in pediatric dysphagia, ranging from normal anatomy to a laryngeal cleft, is unknown. This study seeks to evaluate a cohort of patients who underwent evaluation of their IAMH during microdirect laryngoscopy (MDL) for associations between IAMH and dysphagia as diagnosed on preoperative videofluoroscopic swallow study (VFSS). METHODS: A retrospective case series of 1,351 patients who underwent MDL between 2011 and 2016 were reviewed for intraoperative evaluation of IAMH using our interarytenoid assessment protocol. After exclusions, 182 patients were divided into three groups: 1) thickened diet: VFSS with recommendation for thickened liquids (n = 82 of 182; 45.1%), 2) normal diet: VFSS with allowance of thin liquids (n = 19 of 182; 10.4%), and 3) control: no VFSS performed (n = 81 of 182; 44.5%). RESULTS: There was no difference in IAMH between groups (P = 0.35). Power analysis was able to achieve > 80% power to detect an effect size of ≥ 0.5 (1-5 mucosal height scale). The majority of patients in each group had an IAMH above the false vocal folds (thickened diet: 57.3%, normal diet: 57.9%, control: 64.2%). There were similar percentages of patients in each group with an IAMH at or below the true vocal folds (thickened diet: 4.9%, normal diet: 5.3%, control: 6.1%). CONCLUSION: There was no significant association between IAMH and preoperative thickened liquid recommendation in this cohort. This data fails to support the hypothesis that the IAMH is an independent etiological factor for pediatric pharyngeal dysphagia. Further studies comparing IAMH with outcomes after feeding therapy and surgery may better clarify this relationship between anatomy and physiology. LEVEL OF EVIDENCE: 4. Laryngoscope, 129:2588-2593, 2019.


Assuntos
Cartilagem Cricoide/patologia , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/patologia , Mucosa Laríngea/patologia , Fotofluorografia/estatística & dados numéricos , Estatura , Criança , Pré-Escolar , Anormalidades Congênitas/etiologia , Anormalidades Congênitas/patologia , Cartilagem Cricoide/diagnóstico por imagem , Transtornos de Deglutição/diagnóstico por imagem , Feminino , Humanos , Mucosa Laríngea/diagnóstico por imagem , Laringoscopia/métodos , Laringe/anormalidades , Laringe/patologia , Masculino , Microcirurgia/métodos , Período Pré-Operatório , Estudos Retrospectivos , Gravação em Vídeo
18.
Arch Argent Pediatr ; 116(6): 418-425, 2018 12 01.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30457724

RESUMO

Subglottic stenosis is a congenital or acquired disease characterized by the narrowing of the airways, from the vocal cords to the lower border of the cricoid cartilage. It is one of the main causes of stridor and respiratory distress in children. More than 90 % of laryngeal stenoses are acquired due to prolonged endotracheal intubation. The pediatric management of subglottic stenosis is complex and may be affected by different factors that have an impact on the final outcome. Treatment may involve endoscopic procedures and/or open surgeries. Here we describe our experience in 35 patients with acquired subglottic stenosis who underwent endoscopic treatment with rigid dilation and identify the potential predictors of success of this technique.


La estenosis subglótica es una enfermedad congènita o adquirida caracterizada por el estrechamiento de la vía aérea desde las cuerdas vocales hasta el borde inferior del cartílago cricoides. Es una de las principales causas de estridor y dificultad respiratoria en los niños. Más del 90 % de las estenosis laríngeas son adquiridas debido a la intubación endotraqueal prolongada. El manejo de la estenosis subglótica en pediatría es complejo y puede ser influenciado por distintos factores que pueden afectar el resultado final. El tratamiento puede involucrar procedimientos endoscópicos y/o cirugías abiertas. Se describe nuestra experiencia con 35 pacientes con estenosis subglótica adquirida tratados endoscópicamente con dilatación rígida y se identifican potenciales factores predictores del éxito de esta técnica.


Assuntos
Cartilagem Cricoide/patologia , Intubação Intratraqueal/efeitos adversos , Laringoscopia/métodos , Laringoestenose/terapia , Adolescente , Criança , Pré-Escolar , Dilatação , Feminino , Humanos , Lactente , Laringoestenose/etiologia , Masculino , Estudos Retrospectivos , Resultado do Tratamento
19.
Ear Nose Throat J ; 97(8): 244-256, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30138516

RESUMO

We conducted a retrospective chart review to compare four characteristics-cricoarytenoid joint ankylosis, narrowing, erosion, and density increases-in patients younger and older than 65 years. Our study population was made up of 100 patients, who were divided into two groups on the basis of age. The younger group (<65 yr) comprised 49 patients (27 men and 22 women), and the older group (≥65 yr) was made up of 51 patients (25 men and 26 women). Findings on computed tomography (CT) of the neck were used to determine whether each of the four characteristics was present or absent. Overall, we found only one statistically significant difference between the two groups: ankylosis was significantly more common in the older group (p = 0.036). When we looked further at the side of these anatomic changes, we found that the older group had significantly more right-sided and left-sided ankylosis than did the younger group (p = 0.026 for both), as well as significantly more left-sided narrowing (p = 0.028) (some patients had bilateral involvement). When we analyzed age as a continuous variable, older age was again associated with significantly more ankylosis (p = 0.047) and narrowing (p = 0.011). We conclude that CT can be useful for assessing radiologic changes in the cricoarytenoid joint in elderly patients during the workup of dysphonia and abnormal movement of the vocal folds.


Assuntos
Envelhecimento/patologia , Cartilagem Cricoide , Disfonia , Fatores Etários , Idoso , Cartilagem Aritenoide/diagnóstico por imagem , Cartilagem Aritenoide/patologia , Cartilagem Cricoide/diagnóstico por imagem , Cartilagem Cricoide/patologia , Disfonia/diagnóstico , Disfonia/etiologia , Feminino , Humanos , Masculino , Tomografia Computadorizada por Raios X/métodos
20.
Eur Arch Otorhinolaryngol ; 275(7): 1671-1680, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29713885

RESUMO

PURPOSE: The objective of the current systematic review with meta-analysis was to report the pooled survival outcomes of supracricoid partial laryngectomy in the setting of radiorecurrent laryngeal cancer to investigate if and when an organ-sparing surgical treatment is adequate. METHODS: The search included all original papers from 1990 to December 2017. The search terms included the following: cricohyoepiglottopexy; cricohyoidopexy; cricohyopexy; horizontal laryngectomy; and partial, subtotal, supracricoid, and supraglottic laryngectomy. Inclusion criteria were as follows: (1) data clearly distinguish results of partial laryngeal procedures; (2) clear description of tumor stage and selection criteria; (3) clear description or derivability of local control and survival rates. RESULTS: Eleven out of 270 papers were analyzed, and a total of 251 cases were included. Two-year LC, 3-year DFS, and 5-year OS were 92, 80, and 79%, respectively. Heterogenicity evaluated with the I2 parameter was 14, 0, 0%, respectively. The larynx preservation rate was 85.2%, the decannulation rate was 92.1%, and swallowing recovery was 96.5% (PEG dependence and the aspiration pneumonia rate were 3.5 and 6.4%, respectively). CONCLUSIONS: SCPL is oncologically sound, guaranteeing a high percentage of success. The homogeneity of data should encourage the use of SCPL as salvage treatment for recurrent LSCC.


Assuntos
Neoplasias Laríngeas/patologia , Neoplasias Laríngeas/cirurgia , Laringectomia , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Cartilagem Cricoide/patologia , Cartilagem Cricoide/cirurgia , Humanos , Neoplasias Laríngeas/mortalidade , Recidiva Local de Neoplasia/mortalidade , Terapia de Salvação , Taxa de Sobrevida , Resultado do Tratamento
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