Globus sensation as early presentation of hypopharyngeal cancer.

OBJECTIVES: To identify if patients with early hypopharyngeal carcinoma can present with only the single complaint of globus sensation. DESIGN: Retrospective case review. SETTING: Teaching Hospital in Scotland. PARTICIPANTS: Cohort of 23 patients with hypopharyngeal carcinoma. Retrospective review of their case notes with regards to their hospital pathway from initial referral from the General Practitioner to diagnosis. OUTCOME MEASURES: Symptoms & signs on presentation, subsequent investigations and time interval between initial presentation and diagnosis. RESULTS: We identified two patients (9%) who presented early with globus or other soft symptoms as the only complaint and with normal clinical findings. There was a 78%'pick up' rate of abnormalities in the barium swallow examination. CONCLUSION: We believe this can have important clinical implications in the screening & investigation of globus patients who represent a significant outpatient workload. We review the relevant literature.

Pre-treatment apparent diffusion coefficient mapping: differentiation of benign from malignant laryngeal lesions.

OBJECTIVE: To determine whether a threshold apparent diffusion coefficient value may help to differentiate laryngeal carcinomas from benign lesions. METHODS: Fifty-three patients with laryngeal masses were recruited; four of them were excluded because of susceptibility artefacts. In the remaining 49 patients, the pathological results showed 32 laryngeal carcinomas and 17 benign lesions. The diagnostic value of diffusion-weighted magnetic resonance imaging for the identification of malignant lesions was determined. In addition, the agreement between diffusion-weighted magnetic resonance imaging and histopathology was assessed. Moreover, the sensitivity, specificity, and negative and positive predictive values of the apparent diffusion coefficient in detecting benign and malignant lesions were analysed. An apparent diffusion coefficient histogram was also produced. RESULTS: An apparent diffusion coefficient value of 1.1 × 10-3 mm2/second produced the best result when used as the cut-off point to differentiate malignant from benign masses. CONCLUSION: An apparent diffusion coefficient threshold of 1.1 × 10-3 mm2/second is optimal for distinguishing laryngeal carcinomas from benign lesions. Apparent diffusion coefficient values were lower for patients with laryngeal carcinomas than for those with benign lesions.

Mechanism of glottic closure in a model of unilateral vocal fold palsy.

The effect of extrinsic laryngeal muscles on the position of the paralyzed vocal fold (VF) was analyzed in 13 adult human larynges. Fresh specimens were suspended within a specially constructed frame designed to reproduce the three-dimensional position of the VF, and to allow for simulation of laryngeal muscle action, in five successive experiments resembling: 1) complete vagal paralysis and contralateral adduction, 2) laryngeal elevation added, 3) vocal fold stretching added, 4) contralateral laryngeal tilting added, and 5) ipsilateral cricothyroid muscle activation added. We observed an incremental narrowing of the middle and posterior glottic gaps from 3.9 mm and 6.8 mm respectively in experiment 1 to 1.1 mm and 1.9 mm in experiment 5. Glottic closure in the final experiment was associated with rotation of the glottis to the "paralyzed" side in the axial plane, and contralateral laryngeal tilting in the coronal plane. We show that extrinsic laryngeal muscles can help to close a paralytic gap; crossing of the contralateral VF past the midline was not observed in any of the experiments.

Stylomandibular tenotomy in the transcervical removal of large benign parapharyngeal tumours.

We used a simple modification of the transcervical approach in a selected group of nine patients with large benign parapharyngeal space tumours, all of whom met the following inclusion criteria: The tumour was benign on fine needle aspiration, the encapsulated tumour was not attached to skull base or great vessels in the parapharyngeal space on imaging. Adequate exposure was achieved by just dividing the stylomandibular ligament and retracting the mandible anteriorly. It was possible to remove the tumours successfully and safely in all nine patients without the need for mandibulotomy or superficial parotidectomy. In seven cases, the tumour crossed the midline. There were no major perioperative neurological or vascular complications. On subsequent follow up, there were no clinical or radiological signs of residual or recurrent tumour.

Mucosal immunodeficiency in smokers, and in patients with epithelial head and neck tumours.

Cigarette smoking influences the risk of orogastrointestinal disease in both protective (ulcerative colitis), and inductive (squamous tumours of the head, neck and oesophagus) roles. In order to study the effects of smoking on mucosal immunity, salivary immunoglobulins were measured in pure parotid saliva from groups of healthy non-smokers, smokers, and exsmokers and from patients with epithelial head and neck tumours, both untreated and after radiotherapy. Of the healthy individuals, smokers had significantly lower salivary IgA and higher IgM concentrations than did non-smokers. The effect on IgA was dose related, and reversible after cessation of smoking. Likewise, in patients with head and neck tumours (the majority being smokers), salivary IgA concentration was reduced and IgM increased when compared with non-smoking controls. Results were similar before and after radiotherapy. This study provides evidence of the effects of smoking on mucosal immunity as evaluated by parotid salivary immunoglobulins. Further studies of the influence of smoking on secretory immunity are indicated.