[Etiology and diagnostic methods in vocal cord paralysis]. / Aetiologi og diagnostiske metoder ved stemmebåndsparese.

INTRODUCTION: The etiology of vocal cord paralysis (VCP) is varied. There is lack of consensus regarding the choice of investigations to be used in the evaluation of VCP. The aim of this study was to establish the etiology, assess the diagnostic methods used in the evaluation, and outline an algorithm for future evaluation of unilateral vocal cord paralysis (UVCP). MATERIAL AND METHODS: Charts of all patients (n = 94) with the diagnostic code of VCP were reviewed, and reexaminations were performed of patients in whom no etiology was found after the initial symptoms. RESULTS: The etiology of UVCP was neoplasm in 34%, surgical trauma in 12%, and miscellaneous causes in 54%. The etiology of bilateral vocal cord paralysis (BVCP) was neoplasm in 24%, surgical trauma in 24%, and miscellaneous causes in 52%. The reexaminations did not reveal any cancer diseases in the patients concerned. The most effective diagnostic method was CT-scanning while the least effective was thyroid scanning. DISCUSSION: Because cancer is a common cause of VCP a thorough evaluation is necessary. For UVCP we recommend history and physical examination, X-ray of the chest, ultrasonography of the neck, and CT-scanning of the superior mediastinum. If these prove negative, panendoscopy should be performed. Workup of patients with idiopathic VCP should include examination, X-ray of the chest at 6-month intervals, and annual CT-scanning for two years.

Evaluation of cervical lymphadenopathy in children: advantages and drawbacks of diagnostic methods.

INTRODUCTION: Cervical lymphadenopathy (LAP) in children is a common clinical diagnostic dilemma. The aim of our study was to analyse ultrasonography, fine needle aspiration biopsy, size and location on the neck to distinguish lymph nodes requiring excision from those that do not. MATERIAL AND METHODS: We retrospectively studied 43 cervical lymph nodes that were excised from 43 children aged 0-16 years. We studied the histology of the removed lymph nodes and compared them in terms of size, location, ultrasonography and fine needle aspiration biopsy. Patients were divided into four groups: reactive, malignant, granuloma and other. RESULTS: The cause of LAP was reactive in 30 patients (70%), malignant in five (12%) and granulomatous in six (14%) of the surgically removed lymph nodes. Size, age and ultrasonographic findings were not correlated with a higher risk of malignancy. However, the risk of malignancy was significantly higher when the LAP was located in the supraclavicular region than in other cervical regions (p = 0.008). Fine needle aspiration biopsy was made preoperatively in 27 cases (63%) and revealed five (19%) nodes to be malignant and 18 (67%) to be due to a reactive cause. The positive predictive value for benign and malignant cause was 91.3% and 75% (p = 0.01), respectively. CONCLUSION: We recommend excisional biopsy if LAP is suspected to be malignant or is located in the supraclavicular region. In case of chronic LAP with no obvious infectious cause or suspected mycobacteria, we recommend fine needle aspiration biopsy as a diagnostic tool. Clinical control and diagnosing of children with LAP should lie in few, skilled hands. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.

Adenosquamous carcinoma of the larynx associated with necrotizing sialometaplasia--a diagnostic challenge.

Necrotizing sialometaplasia is a benign, self-limiting, inflammatory process involving salivary glands, commonly associated with tissue ischemia. Clinically, necrotizing sialometaplasia is most often found in the hard palate as a deep ulcer with raised, indurated edges that can be indolent. This, as well as the histopathologic findings of necrotizing sialometaplasia, can be confused with those of a malignant neoplasm. We report a rare case of necrotizing sialometaplasia in the larynx, probably initiated by an underlying malignant process. We suggest an aggressive diagnostic approach, when necrotizing sialometaplasia involves the larynx and no recent exposure to radiation, surgery or trauma has been recorded. Necrotizing sialometaplasia of the larynx should be regarded as secondary to malignancy until proven otherwise.