Tobacco and otorhinolaryngology: epic and disaster.

More than 500 papers are retrieved from the PubMed database by the keywords "Tobacco" and "Otorhinolaryngology", none of which, however, is devoted to the history of a plant that has a major impact on our specialty and practice. The present report describes and analyzes how tobacco conquered the world, the conflicts it triggered and the impact it has had in our field over the past centuries.

Chemotherapy alone with curative intent in patients with invasive squamous cell carcinoma of the pharyngolarynx classified as T1-T4N0M0 complete clinical responders.

BACKGROUND: The current studies documented the results achieved with chemotherapy alone with curative intent in a series of 67 patients with invasive squamous cell carcinoma of the pharyngolarynx classified as T1-T4N0M0 complete clinical responders after a platin-based induction chemotherapy regimen. METHODS: Group I consisted of 36 patients with tumors originating from the glottis. Group II consisted of 31 patients with tumors originating from sites within the pharyngolarynx other than the glottis. A minimum of 3 years of follow-up was achieved. Statistical analyses of survival, local control, lymph node control, distant metastasis, and second primary tumor rates were based on the Kaplan-Meier life-table method. Laryngeal preservation rates and local control rates are presented. RESULTS: The 5-year actuarial survival estimate was 85.1% in Group I patients and 54.8% in Group II patients. Survival was statistically more likely to be reduced in Group II patients compared with Group I patients (P = 0.01). The 5-year actuarial local control estimate was 65.7% in Group I patients and 37.5% in Group II patients. Local failure was statistically more likely to occur in Group II patients compared with Group I patients (P = 0.02). Local control rates after salvage treatment were 100% in Group I patients and 83% in Group II patients. Laryngeal preservation rates after salvage treatment were 100% in Group I patients and 64% in Group II patients. The 5-year actuarial lymph node control estimate was 90% in Group I patients and 73.7% in Group II patients. Lymph node failure was statistically more likely to occur in Group II patients compared with Group I patients (P = 0.04). The 5-year actuarial estimate for patients without distant metastasis was 100% in Group I patients and 90% in Group II patients. Distant metastasis was statistically more likely to occur in Group II patients compared with Group I patients (P = 0.03). The 10-year actuarial estimate for patients without metachronous second primary tumors was 56.4% in Group I and 46.1% in Group II. CONCLUSIONS: The current report 1) contradicts the old dogma of nonchemocurability for invasive squamous cell carcinoma of the upper aerodigestive tract and 2) suggests that the use of a platin-based chemotherapy-alone regimen with curative intent in patients with invasive squamous cell carcinoma of the pharyngolarynx who are classified as T1-T4N0M0 complete clinical responders after receiving an induction chemotherapy regimen is best indicated when the tumor originates from the glottis.

Chemotherapy combined with conservation surgery in the treatment of early larynx cancer.

In the past 20 years, strategies based on the use of platinum-based induction chemotherapy regimens have been developed in an attempt to preserve the larynx, increase local control, and improve survival in patients with advanced laryngeal cancer. In patients with early-stage laryngeal cancer, it is commonly thought that there is no role for induction chemotherapy. In this review, we support the notion that there is growing evidence available in the literature documenting the need and the role for induction chemotherapy as well as the need and the role for the use of conservation laryngeal surgery after induction chemotherapy in early-stage laryngeal cancer (T1-2N0).

Complications and functional outcome after supracricoid partial laryngectomy with cricohyoidoepiglottopexy.

We present a review of the postoperative course, complications, and functional outcome of 190 patients consecutively treated with supracricoid partial laryngectomy with cricohyoidoepiglottopexy. The average times until removal of the tracheostomy and nasogastric feeding tubes were 9 and 16 days, respectively. The postoperative mortality rate was 1%. Major complications included pneumonia from aspiration, cervical wound infection, symptomatic laryngocele, ruptured pexis, laryngeal chondroradionecrosis, and laryngeal stenosis in 8.5%, 4.2%, 3.1%, 1%, 0.5%, and 0.5% of the patients, respectively. Completion total laryngectomy, permanent gastrostomy, and permanent tracheostomy were requested in 0.5% of the patients. Normal swallowing without gastrostomy and respiration without tracheostomy was achieved by the first postoperative year in 98.4% (187/190) of the patients. This article presents a univariate analysis of the potential correlation between various variables and the duration of tracheostomy and the length of time the nasogastric feeding tubes were inserted, the mortality incidence and causes, the incidence and type of the various complications, and the duration of hospitalization. Comparison of our data with the reported functional results after vertical partial laryngectomy suggested that supracricoid partial laryngectomy with cricohyoidoepiglottopexy does not result in an increased rate of postoperative complications.

Cricotracheal anastomosis for assisted ventilation-induced stenosis.

OBJECTIVE: To review the long-term results and our experience with cricotracheal anastomosis via a cervical approach for assisted ventilation-induced stenosis. DESIGN: A case series of 41 patients consecutively treated with cricotracheal anastomosis. SETTING: A tertiary care center and university teaching hospital. PATIENTS: Group 1 consisted of 22 patients with stenosis reaching the lower border of the cricoid cartilage that did not require resection of the cricoid cartilage. Group 2 consisted of 19 patients in whom correction of the stenosis required cricoid resection. MAIN OUTCOME MEASURES: Statistical analysis of airway patency was based on the Kaplan-Meier actuarial life table method. Incidence for the various postoperative complications was presented. Univariate analysis was performed to analyze the relationships between various factors, airway patency, and the incidence for the various complications encountered. RESULTS: The Kaplan-Meier 5-year airway patency estimate was 100% in group 1 patients and 82.5% in group 2 patients. In group 2 patients, complementary treatment with dilatations in 2 patients resulted in an overall 94.8% airway patency rate. In the last patient, the airway patency was not reestablished after cricotracheal anastomosis, and a Montgomery T tube was inserted. Postoperative complications included unilateral inferior laryngeal nerve paralysis (3 patients), cervical neck abscess (2 patients), pneumothorax (1 patient), and major subcutaneous emphysema (1 patient). None of the following variables was statistically related to the airway patency or to the various complications encountered: sex, age, cause for stenosis, delay from initial injury, prior treatment, presence of a tracheotomy, number of tracheal rings resected, type of sutures used, and type of anastomosis performed. CONCLUSIONS: The data reported reemphasized that cricotracheal anastomosis with or without cricoid resection is a safe and reliable procedure for assisted ventilation-induced upper tracheal stenosis reaching and/or involving the subglottis and/or cricoid cartilage.

Cricohyoidoepiglottopexy for glottic carcinoma with fixation or impaired motion of the true vocal cord: 5-year oncologic results with 112 patients.

The medical charts and operative files of 112 patients (combined inception cohort) with well to moderately differentiated invasive glottic squamous cell carcinoma presenting fixation (22) or impaired motion (90) of the true vocal cord (TVC) consecutively treated with cricohyoidoepiglottopexy (CHEP) at our institutions from 1972 to 1989 were retrospectively reviewed. A minimum 5-year follow-up was always achieved. The Kaplan-Meier 5-year actuarial survival, local recurrence, nodal recurrence, distant metastasis, and metachronous second primary tumor estimate for the entire group of patients were 84.7%, 5.4%, 6.4%, 1.2%, and 10.8%, respectively. The 5-year absolute and cause-specific survival rates were 85.5% and 94.1% for patients with fixation of the TVC and 81.3% and 96% for patients with impaired motion of the TVC. The 5-year actuarial local control rates for patients with fixation or impaired motion of the TVC were 95.4% and 94.4%, respectively. Local recurrence was statistically more likely in patients with positive margins (p = .007). Nodal recurrence was statistically more likely in patients with local recurrence (p = .005). Permanent tracheostomy related to postoperative laryngeal stenosis was requested in 2 patients. Aspiration-related completion total laryngectomy and/or permanent gastrostomy were never requested. Overall, local control and laryngeal preservation were achieved in 97.3%, and 95.5% of patients, respectively. At our institutions, the change from the conservative treatment modalities of radiotherapy and vertical partial laryngectomy to CHEP has brought about an increase in long-term survival, local control, and laryngeal preservation rates when compared to historical controls using vertical partial laryngectomy or radiotherapy.

Functional outcome and prognosis factors after supracricoid partial laryngectomy with cricohyoidopexy.

A retrospective analysis of the medical records and operative files of 124 patients who consecutively underwent supracricoid partial laryngectomy with cricohyoidopexy (SCPL-CHP) was undertaken. The objective of this study was to analyze the postoperative course and functional results of SCPL-CHP. The mean duration of follow-up was 7 years (range 1 to 20 years). The postoperative mortality was 1.6%. The average times until tracheostomy and nasogastric feeding tube removal were 8 and 22 days, respectively. All patients but 1 were decannulated. The rate of pneumonia from aspiration was 11.5%. Completion total laryngectomy and permanent gastrostomy were required in 2.5% and 2.5% of patients, respectively. Overall normal swallowing without permanent gastrostomy and respiration without tracheostomy were achieved by the first postoperative year in 91% and 99.1% of patients, respectively. Univariate analysis of the potential correlation between various variables and the duration of the tracheostomy and nasogastric feeding tube, the incidence and causes of mortality, the incidence and type of the various complications, the recovery of swallowing, and the length of hospitalization is presented. The report also discusses the management and follow-up care.

["Limited" cancers of the glottic stage of the larynx and exclusive chemotherapy--15 years of experience]. / Cancers "limités" de l'étage glottique du larynx et chimiothérapie exclusive--15 ans d'expérience.

A retrospective analysis of the files of 25 patients with an early glottic well-differentiated untreated invasive squamous cell carcinoma, staged as T1-T2-NO with a complete response after cisplatin-fluorouracil neo-adjuvant chemotherapy, managed with exclusive chemotherapy is presented. Five-year actuarial (Kaplan-Meier method) survival and local control estimate was 83.8% and 33.6%, respectively. Patients with local recurrence after exclusive chemotherapy were always salvaged with partial laryngeal surgery or radiation therapy resulting in an overall 100% local control and laryngeal preservation rate. Five-year actuarial nodal recurrence distant metastasis, and metachronous second primary estimate was 0%, 0% and 20.2%, respectively.

Tracheal resection with end-to-end anastomosis for isolated postintubation cervical trachea stenosis: long-term results.

A 20-year experience with end-to-end tracheal resection and anastomosis for isolated postintubation stenosis of the cervical trachea, in a consecutive series of 32 adult patients, has been reviewed. Surgical death was never encountered. The overall incidences for superficial wound infection, pneumonia, and inferior left laryngeal nerve paralysis were 6.2%, 3.1%, and 3.1%, respectively. One-, 3- and 5-year actuarial anastomosis success rates were 96.7%, 93.3%, and 93.3%, respectively. Successful revision tracheal end-to-end anastomosis was performed once, resulting in an overall 96.9% success rate in our series. None of the following variables-sex, age, cause for intubation, intubation type (laryngotracheal and/or tracheotomy) and duration, delay from initial injury, presence of an open stoma, number of tracheal rings resected, and type of sutures used-were statistically related to the anastomosis success rate or the incidence of complications.

Cisplatin-fluorouracil exclusive chemotherapy for T1-T3N0 glottic squamous cell carcinoma complete clinical responders: five-year results.

PURPOSE: To evaluate cisplatin-fluorouracil exclusive chemotherapy (EC) for T1-T3N0 glottic squamous cell carcinoma complete clinical responders (CCR) after cisplatin-fluorouracil induction chemotherapy (IC). PATIENTS AND METHODS: A retrospective analysis was performed of 58 patients with T1-T3N0 glottic squamous cell carcinoma CCR after IC consecutively managed at our department between 1985 and 1992. Twenty-one CCR were managed with EC. Thirty-seven CCR were managed with IC and a conventional laryngeal-preservation modality. Analyses of survival, local control, nodal recurrence, distant metastasis, and metachronous second primary tumor were performed using the Kaplan-Meier actuarial life-table method. In CCR managed with EC, the independent factors of age, tumor classification, exact tumor location, true vocal cord motion, arytenoid cartilage motion, total dosage of drugs delivered, and number of courses received were tested for potential correlation with survival, local recurrence, nodal recurence, and distant metastasis. RESULTS: The 5-year survival, local control, nodal recurrence, distant metastasis, and metachronous second primary tumor rates in CCR managed with EC were 95.2%, 70.7%, 0%, 0%, and 14.3%, respectively. The 5-year rates of survival, local control, nodal recurrence, distant metastasis, and metachronous second primary tumor in CCR managed with IC and a conventional laryngeal-preservation modality were 86.1%, 97%, 2.7%, 6%, and 14.5%, respectively. Local recurrence was statistically more likely in CCR managed with EC (P = .002). Local recurrence in CCR managed with EC was always salvaged with partial laryngectomy or radiation therapy, which resulted in an overall 100% local control and laryngeal-preservation rate within this group. In CCR managed with EC, none of the variables analyzed was statistically related to survival, local recurrence, nodal recurrence, or distant metastasis. CONCLUSION: The present retrospective studies demonstrated that within T1-T3N0 glottic squamous cell carcinoma CCR, there is clearly a significant subset of patients with chemocurable tumors who achieved both perfect preservation of structure-supporting voice and long-term survival after EC. Careful monthly follow-up evaluation allowed for timely successful salvage of local recurrence after EC without the need for total laryngectomy. Such management did not appear to increase the risk for subsequent nodal failure, subsequent distant metastasis, or reduced survival.

Supracricoid partial laryngectomy after failed laryngeal radiation therapy.

Twelve patients managed with supracricoid partial laryngectomies (SCPLs) after failed laryngeal radiation therapy (RT) were evaluated. None of the recurrent tumors were amenable to vertical or horizontal partial laryngectomy. Results were analyzed for tracheostomy decannulation, oral alimentation, morbidity, local control, and survival. Major complications included perichondritis (2 patients), laryngeal stenosis (2 patients), and pneumonia from aspiration (1 patient). Mucocutaneous fistula and cricoarytenoid joint ankylosis were not encountered. Margins of resection were uninvolved in all cases. The Kaplan-Meier 3-year actuarial survival and local control estimate was 83.3%. Salvage total laryngectomy allowed for an overall 100% local control rate and a 75% laryngeal preservation rate. This preliminary report suggests that, in patients with failed laryngeal RT not amenable to vertical or horizontal partial laryngectomy, the SCPL procedures should be discussed before advocating salvage total laryngectomy. Further series analyzing the role and limitations of the various SCPL procedures after failed laryngeal RT are warranted.

Glottic carcinoma with a fixed true vocal cord: outcomes after neoadjuvant chemotherapy and supracricoid partial laryngectomy with cricohyoidoepiglottopexy.

Twenty patients with glottic squamous cell carcinoma and a fixed true vocal cord underwent neoadjuvant chemotherapy followed by supracricoid partial laryngectomy with cricohyoidoepiglottopexy. Phonation, respiration, and deglutition were preserved. Local control was better than has been previously reported for either extended vertical partial laryngectomy or radiation therapy. All patients were monitored for at least 3 years or until death. The Kaplan-Meier 3-year survival, local recurrence, nodal recurrence, distant metastasis, and second primary rates were 75%, 10.8%, 5%, 10.8%, and 10.8%, respectively. Overall local control was achieved in all cases, and laryngeal preservation in 90%. Our experience suggested that neoadjuvant chemotherapy with supracricoid partial laryngectomy with cricohyoidoepiglottopexy deserves further consideration in the treatment of glottic tumors with a fixed true vocal cord.

[Supra-cricoid partial laryngectomy extended to the anterior arch of the cricoid with tracheo-crico-hyoido-epiglottopexy. Oncologic and functional results]. / Laryngectomie partielle supracricoidienne étendue à l'arc antérieur du cricoïde avec trachéocricohyoidoépiglottopexie. Résultats carcinologiques et fonctionnels.

21 patients with glottic carcinoma presenting anterior infraglottic extent of tumor, classified T2-T4, were offered and extended supracricoid partial laryngectomy with tracheocricohyoidoepiglottopexy (TCHEP) between 1979 and 1994 at our department. The technique for the procedure, the duration of tracheotomy tube, naso-gastric feeding tube, and hospital stay are presented. Postoperative complications and management were described. The 5-year actuarial survival, local control, nodal recurrence, distant metastasis, and metachroneous second primary tumor estimate was 74.7%, 88.9%, 11.1%, 22.4% and 15%, respectively. Overall a 95.2% (20/21) local control rate was achieved with a 90.5% (19/21) laryngeal preservation rate.

[Long-term results of total conservative parotidectomy for pleomorphic adenoma]. / Résultats à long terme de la parotidectomie totale conservatrice pour adénome pléomorphe.

OBJECTIVES: Evaluation of the long-term results (10 and 15 years) achieved with total conservative parotidectomy for pleomorphic adenoma. METHODS: A retrospective analysis of the files of 127 patients with pleomorphic adenoma of the parotid gland consecutively treated with a total conservative parotidectomy at our department from 1970 to 1985. Actuarial analysis (Kaplan Meier method) of survival and local recurrence, as well as overall estimation of immediate and definite postoperative facial paresis and paralysis was performed. RESULTS: Ten- and fifteen-year survival and local control estimations were 90.8% and 99.1%, respectively. Immediate and permanent facial paresis and paralysis overall estimates were 64.6% and 6.3% and 2.1% and 0%, respectively. CONCLUSION: Total conservative parotidectomy for pleomorphic adenoma results in a very high long term local control associated with a very low rate of facial dysfunction.

Acoustic parameters and speech analysis after supracricoid hemilaryngopharyngectomy.

Selected characteristics of speech and voice were compared in 10 patients who had undergone supracricoid hemilaryngopharyngectomy (SCHLP) and 20 normal adult laryngeal (NAL) speakers. Durational features of tape-recorded speech samples were measured using a stopwatch. Frequency features were analyzed with the Computerized Speech Lab and the multidimensional voice program. SCHLP speech proved comparable to NAL speech in average fundamental frequency, speech rate, and group phrasing. SCHLP speech and voice were statistically less efficient than NAL speech in fundamental frequency range, jitter, shimmer, noise-to-harmonic ratio, and maximum phonation time. Age, associated cricopharyngeal myotomy, postoperative radiation therapy, and time elapsed from SCHLP completion were not statistically related to the speech and voice parameters of SCHLP speakers.

[Exclusive chemotherapy in T1-T3N0 cancers of the vocal cord with complete clinical response after neoadjuvant treatment with a cisplatin-fluorouracil combination]. / Chimiothérapie exclusive dans les cancers de la corde vocale T1-T3N0 en réponse clinique complète après traitement néo-adjuvant cisplatine-fluorouracile.

OBJECTIVES: Evaluation of cisplatin-fluorouracil exclusive chemotherapy for invasive squamous cell carcinoma of the glottis staged as T1-T3N0 with a complete response after cisplatin-fluorouracil neo-adjuvant chemotherapy. METHODS: A retrospective analysis of the files of 69 patients with a well-differentiated untreated invasive squamous cell carcinoma, staged as T1-T3N0 with a complete response after cisplatin-fluorouracil neo-adjuvant chemotherapy is presented. Actuarial analysis (Kaplan Meier method) of survival and local failure is presented among the group of 25 patients treated with exclusive chemotherapy and the group of 44 patients in whom the local treatment (partial laryngeal surgery or radiation therapy) initially planned was maintained. RESULTS: Three-year survival and local control estimate was 91.8% and 69.3%, respectively after exclusive chemotherapy and 92.5% and 97.2% if the local treatment was performed as initially planned. Patients with local recurrence after exclusive chemotherapy were always salvaged with partial laryngeal surgery or radiation therapy resulting in an overall 100% local control and laryngeal preservation rate. CONCLUSION: Exclusive chemotherapy for T1-T3N0 glottic carcinomas with a complete response after cisplatin-fluorouracil neo-adjuvant chemotherapy should be considered especially in patients in whom preservation of voice is of utmost importance.

CO2 laser posterior transverse cordotomy for isolated type IV posterior glottic stenosis.

One case of isolated type IV posterior glottic stenosis successfully treated with CO2 laser posterior transverse cordotomy is presented. This report emphasized the value of the CO2 laser posterior transverse cordotomy in this situation. A review of the various therapeutic options advocated in the medical literature to treat isolated posterior glottic stenosis is also presented.

Duration and frequency characteristics of speech and voice following supracricoid partial laryngectomy.

Selected characteristics were compared in the speech and voice of 28 treated with a supracricoid partial laryngectomy (SCPL) and of 14 normal adult laryngeal (NAL) speakers. Tape-recorded speech samples were measured for durational features with a stopwatch. Frequency features were analyzed with the Computerized Speech Lab and a multidimensional voice program. The SCPL speech proved comparable to NAL speech in average fundamental frequency. The SCPL speech and voice were statistically less efficient than NAL speech in fundamental frequency range, jitter, shimmer, noise to harmonics ratio, maximum phonation time, speech rate, and phrase grouping. The completion of an arytenoid cartilage resection did not statistically modify the duration and frequency features of SCPL speakers. Among SCPL speakers 1) the average fundamental frequency was statistically higher (p = .02) in patients who underwent a cricohyoidoepiglottopexy when compared to patients who underwent a cricohyoidopexy, 2) the maximum phonation time was statistically related to the patient's age (p = .002), and 3) the jitter and shimmer values were statistically related (p = .01 and p = .005) to the time elapsed since SCPL completion. Explanations and implications of these findings are discussed.

[Inoperable tracheal and cricoid-tracheal stenoses. Results of laser therapy and prolonged calibration]. / Les sténoses trachéales et cricotrachéales inopérables. Résultats du traitement par le laser et le calibrage prolongé.

Palliative desobstruction was performed with laser and a Montgomery T tube in 11 patients with tracheal or cricotracheal stenosis. Surgery was theoretically indicated for these long thick stenotic areas with underlying diseased cartilage but could not be performed due to the poor clinical status of the patients or recurrence after anastomosis. Calibration with the Montgomery T tube was maintained for a mean of 5 years. The T tube was removed in 3 patients and was well tolerated in 4. Two patients died during the course of the study and two others required a definitive tracheotomy. Palliative treatment with Laser desobstruction and long-term calibration can be a useful alternative to conventional surgery.