Laryngeal Schwannoma: A Rare Entity.

Of all schwannomas, 24-45% arise from the head and neck area. Laryngeal schwannoma is an uncommon site. We report a case of a 34-year-old male who presented to the emergency department with worsening sudden onset inspiratory stridor. On direct laryngoscopy, he was noted to have a laryngeal mass, which caused a ball-and-valve effect on the laryngeal inlet, resulting in airway compromise. He was subsequently intubated and admitted to the intensive therapy unit. He underwent endoscopic removal of a bulky submucosal swelling in the supraglottic region using coblation. The post-operative histopathological assessment confirmed features of laryngeal schwannoma. A six-month post-operative follow-up showed no signs of recurrence. Due to the rarity of this condition, the evidence for the most efficient management of these cases is still not clear. Diagnosis is by histology assessment, although clinical evaluation should raise suspicion. Surgery remains the mainstay of treatment with a good overall prognosis. In current literature, the technique of surgical excision varies with different outcomes. We report a case that was managed with micro-laryngoscopy and coblation with good effect.

Spindle Cell Carcinoma of the Larynx with Tracheobronchial Aspergillosis: A Rare Coincidence.

We herein report a rare coincidence and a possible association between laryngotracheal fungal infection and spindle cell carcinoma of the larynx (SpCC). A 79-year-old gentleman presented to the Emergency Department with manifestations of airway obstruction. Flexible nasendoscopy showed pooling of saliva around the larynx and his neck palpation did not show cervical lymphadenopathy. Further imaging showed bilateral transglottic mass mainly in the subglottis along with right pulmonary nodularity. Percutaneous tracheostomy, panendoscopy and biopsy of the laryngeal mass confirmed a diagnosis of SpCC. A few days later, he was admitted and aspergillus fumigatus was found in a biopsy of his tracheal tissue. To the best of our knowledge, the possible correlation between laryngotracheal aspergillosis and such a rare type of cancer larynx (SpCC) has not been highlighted in the literature.

Sternocleidomastoid flap augmentation of the pharyngeal closure after total laryngectomy.

The objective of the study was to evaluate the effect of sternocleidomastoid (SCM) flap augmentation of the pharyngeal closure after total laryngectomy on the incidence of pharyngocutaneous fistula (PCF). Thirty patients with T4a laryngeal carcinoma and none of them receiving primary radiotherapy previously were divided into two equal groups. Group A patients had SCM flap augmentation of the pharyngeal closure after total laryngectomy. Group B patients had the standard pharyngeal closure without augmentation. Both groups were followed up for 30 days postoperatively for the development of PCF. The use of the SCM added about extra 15 min to the surgical procedure in all patients (p < 0.001). The shape of the suture line of the neopharynx was horizontal in 14 patients (7 in each group) while it was T-shaped in the remaining 16 (8 in each group). Neck dissection was done in all patients except only two patients who previously had the neck dissection done in combination with partial laryngectomy. Three patients in each group developed PCF either early (10 days or less postoperatively) or late (more than 10 days but less than 30 days postoperatively). There was no statistically significant difference in the length of hospital stay between the two groups. The use of SCM flap did not reduce the incidence of PCF after total laryngectomy.

Is the External Branch of the Superior Laryngeal Nerve Dispensable in Thyroid Surgery?

BACKGROUND: There is growing evidence that the external branch of the superior laryngeal nerve (eSLN) participates in thyroarytenoid (TA) contraction, but little data quantify its role in vocal cord adduction. Injury to the eSLN, such as in thyroid surgery, is difficult to diagnose and likely underappreciated. It is the authors' belief that eSLN injury contributes to aspiration by depriving its contribution to the laryngeal plexus. The goal of this study was to measure the glottic closing force (GCF) from eSLN stimulation in a porcine model. METHODS: The recurrent laryngeal nerve (RLN) and eSLN were identified bilaterally in four porcine necks. Bilateral RLNs and eSLNs were stimulated simultaneously to obtain a control GCF using a pressure transducer placed in the glottis. Subsequently, bilateral eSLNs were stimulated and the GCF measured to quantify its percent contribution to the control value. RESULTS: Stimulation of the RLNs and the eSLNs each led to TA muscle contraction and a measureable GCF in all four porcine necks. The control GCF was 1000.1 mmHg, while the eSLN mediated CGF was 800 mmHg. The percentage GCF attributable to the eSLN was thus 800/1000 = 80%. CONCLUSIONS: Reflex glottic closure is one of the most important mechanisms for the prevention of aspiration during deglutition. The biomechanical quantification of glottic closure can be shown as the GCF. This study has shown that the eSLN contributes in a significant way to the GCF in a porcine model, a finding that has not been quantified to the best of the authors' knowledge. Therefore, greater focus should be placed on preserving this nerve in thyroid surgery.

External Branch of the Superior Laryngeal Nerve Mediated Glottic Closing Force in the Porcine Model.

OBJECTIVES: Based on our laboratory's newly confirmed motor pathway for glottic closure, we measured the glottic closing force (GCF) during isolated stimulation of the external branch of the superior laryngeal nerve (eSLN) in the porcine model. Glottic closure is 1 of the primary mechanisms for prevention of aspiration during deglutition. METHODS: The recurrent laryngeal nerve (RLN) and eSLN were identified bilaterally in 4 porcine necks. Subsequently, GCF was measured with a pressure transducer as the distal ends of individual nerves were stimulated in 4 animals. The RLN mediated GCF was measured first, followed by isolated eSLN mediated GCF, followed by transection of the RLN and repeat measurement of the eSLN GCF. Ultimately, the cricothyroid (CT) muscle attachment was released and the GCF measured. RESULTS: The GCF during isolated eSLN stimulation before and after RLN transection is approximately 89% of the RLN mediated GCF in each animal. The GCF after CT release is approximately 84% of the RLN perceived GCF. Transection of the RLN did not alter the eSLN observed GCF. CONCLUSIONS: The GCF obtained during isolated eSLN stimulation is adequate for delivery of an appropriate laryngeal protective response and may be considered a target motor nerve for augmenting GCF in selected rehab settings.