Oropharyngeal dysphagia in head and neck cancer: how to reduce aspiration pneumonia.

OBJECTIVE: Oropharyngeal dysphagia is caused by difficulty in bolus preparation and transport from the mouth to the oesophagus; this may result in malnutrition and aspiration pneumonia. It has a high prevalence in head and neck cancer patients. The objective of this study is to reduce these complications using a new protocol of diagnosis and evaluation of oropharyngeal dysphagia. METHOD: This is a prospective study developed in a secondary hospital. All patients diagnosed with head and neck cancer in 2021 and 2022 are subjected to this protocol: an oropharyngeal dysphagia screening test, a swallowing-related quality of life questionnaire and a flexible endoscopic evaluation of swallow. RESULTS: A total of 72 evaluations are reported using this protocol, before and after cancer treatment, and only 1 presents with aspiration pneumonia. CONCLUSION: Using this protocol, the incidence of aspiration pneumonia can be reduced, and diet recommendations can be given earlier in order to maintain a patient's nutritional requirements.

[Predictive biochemical indicators of a postlaryngectomy pharyngocutaneous fistula: a clinical study]. / Indicadores bioquímicos predictivos de fístula faringocutánea postlaringuectomía: un estudio clínico.

UNLABELLED: The aim of this clinical study was to determinate biochemical predictor indicators of postlaryngectomy pharyngocutaneous fistula. PATIENTS AND METHODS: We have studied 100 patients with T2- 4 a laryngeal and piryform sinus carcinoma who underwent a laryngectomy. All patients were ASA 2-3. We studied serum albumin, protein serum level, cholesterol and lymphocites in each patient. These variables underwent statistical analysis (p < 0.05). RESULTS: 19% of the patients developed a postlaryngectomy pharyngocutaneous fistula, with a long-stay of 25 days vs. 10 days of stay in patients without postlaryngectomy pharyngocutaneous fistula. 7 postlaryngectomy pharyngocutaneous fistula needed surgical repair. Low serum albumin (< 3.5 g/dL) and a low level of serum proteins (< 6.5 g/dL) were predictive indicators of postlaryngectomy pharyngocutaneous fistula (p < 0.05). CONCLUSIONS: Our results suggest that a low-level of serum proteins and albumin are predictive clinical parameters of postlaryngeal pharyngocutaneous fistula.

[Neurilemmoma of the larynx: a case report]. / Neurinoma laríngeo: a propósito de un caso.

Neuromas or Schwannomas are extremely rare among tumors of the larynx. They are Schwann cell tumors that can be difficult to distinguish from neurofibromas. They present usually as supraglottic masses, since they may arise from the internal branch of the superior laryngeal nerve. Nuclear magnetic resonance imaging is the best diagnostic technique, conferring a high degree of suspicion. We present an exceptional case of a laryngeal neuroma, with a very long evolution, a large tumor volume, dyspnea and vocal cord fixation, with complete resolution through an external approach following surgical removal. The difficulties encountered with its pathological and clinical diagnosis are discussed as well as a review of the literature.

[Spread channels of anterior commissure cancer: clinico-pathological study and surgical implications]. / Vías de diseminación del cáncer de comisura anterior: estudio clínico-patológico e implicaciones quirúrgicas.

UNLABELLED: The aim of the present study is to describe the spread channels of the anterior commisure cancer, its clinical significance and its surgical implications. PATIENTS AND METHODS: A prospective study was performed at the ENT Department of the Complutense University in about 31 patients with anterior commisure carcinoma wo underwent surgery between 1994/97. Specimens were processes with Whole-Organ Serial Sections. RESULTS: Patients were differenciated into two groups: 1) Patients with glottic tumors, with a good cord mobility and no invasive tumor in commisure region (18 patients); In these patients, conservative surgery was possible; 2) Another group (13 patients) with aggressive lesions (80% with cartilage involvement), vocal cord fixation and transglottic lesions. In these group, conservative surgery was contraindicated. CONCLUSIONS: This report emphasizes the importance of laryngoscopy in surgical technique of anterior commisure cancer.

[Early glottic carcinoma: a clinico-pathological study]. / Cáncer glótico precoz: estudio clínico-patológico.

UNLABELLED: The aim of the present study is to evaluate histopathological features of malignization of laryngeal dysplasia and recurrence of early glottic carcinoma. PATIENTS AND METHODS: A prospective study was perform in a cohort of 134 patients who underwent surgery between 1992/99 at the ENT department of the Complutense University of Madrid. Tumor localization, malignization rate and recurrence rate were studied in 68 cases of laryngeal dysplasia, 11 of in situ-carcinoma and 55 of microinvasive carcinoma. RESULTS: Nine laryngeal dysplasias experienced invasive carcinoma (13%) and six patients with invasive glottic carcinoma had laryngeal recurrence (11%), all of them with anterior commisure involvement. Eight patients underwent total laryngectomy for recurrence (6%) and three patients died of laryngeal cancer. CONCLUSIONS: Anterior commisure involvement was the most important risk factor in early glottic carcinoma.

[Extracapsular spread in advanced laryngeal cancer]. / Rotura capsular en el cáncer avanzado de laringe.

UNLABELLED: The aim of the present study is to evaluate histopathological features of extracapsular spread detected in patients with laryngeal cancer. PATIENTS AND METHODS: Specimens of 47 patients with laryngeal cancer were processed as Whole-Organ Serial Sections at the ENT Department of the Complutense University of Madrid between 1994/97. RESULTS: Extracapsular metastases were found in 21 patients. The risk for extracapsular spread was higher in those patients with: supraglottic or piriform sinus cancer, more than 2-3 neck metastatic nodes, tumor diameter of more than 2 cm and N2 stage.

[Elective dissection in cancer of the larynx]. / Vaciamiento electivo en cáncer de laringe.

OBJECTIVE: 1) To determine if elective neck dissection (END) is more effective than surgery without END in patients with cancer and a clinically negative neck (N0). 2) To determine if selective posterolateral neck dissection is effective in these patients. PATIENTS AND METHODS: The study included 74 patients with laryngeal cancer and no palpable nodes who were treated surgically at the ENT Department of the Universidad Complutense de Madrid between 1994 and 1997. Thirty-seven patients underwent surgery alone (Group A) and 37 patients underwent laryngeal surgery and elective neck dissection (Group B). No patient underwent irradiation. Minimum follow-up was 24 months. RESULTS: Cervical recurrence was observed in 4 (11%) patients who underwent laryngeal surgery alone and in 2 (5%) patients who underwent laryngeal surgery and elective neck dissection. CONCLUSIONS: Laryngeal surgery with elective neck dissection was more effective than laryngeal surgery without END in patients with laryngeal cancer and a clinically negative neck. Selective lateral neck dissection was effective for the elective treatment of these patients.

[Clinical and histological indicators predictive of cervical metastases in laryngeal cancer]. / Indicadores predictivos (IP) clinicopatológicos de metástasis cervicales en cáncer de laringe.

INTRODUCTION: A study was made of possible clinical and pathological indicators associated with cervical lymph node involvement in laryngeal cancer. PATIENTS AND METHODS: Between 1994 and 1997, 85 patients with laryngeal cancer underwent surgery in the ENT department of the Complutense University of Madrid (Spain). A statistical analysis was made to identify clinical and pathological indicators of lymph node metastases. RESULTS: Predictive indicators (PI) of cervical metastatic disease in our study were: 1) tumor location; 2) low degree of differentiation; 3) invasion > 5 mm deep; 4) perineural invasion; and 5) invasion of the pre-epiglottic space.

[Stomal recurrence after laryngectomy. An inevitable late complication]. / Recidiva estomal tras laringuectomía. Una complicación tardía inevitable?

Postlaryngectomy tumoral recurrence on the stoma is a terrible late complication that has a fatal outcome. In spite of advances in laryngeal surgery and modern reconstructive techniques, it is still a major cause of death in patients with laryngeal cancer. In a review of 500 patients who underwent surgery for laryngeal cancer in 1981-86 and 1995-97, we found no changes in the frequency of stomal recurrence between periods (4% in both periods). Stomal recurrence was associated in our study with subglottic extension and with transglottic lesions. Previous tracheotomy was not a decisive factor in the appearance of stomal recurrence in our patients.

[Retrospective study of cancer in the tonsillar area]. / Estudio retrospectivo del cáncer de región amigdalina.

Between 1975 and 1991, 64 patients with locoregional tonsilar carcinoma were treated by surgery and postoperative radiotherapy. Follow-up was continued for a minimum of 5 years. Patients were classified according to the UICC 1987/AJCC 1988 criteria. The histological stage was stage I in 5 patients, stage II in 7 patients, stage III in 17 patients, and stage IV in 27 patients. The 5 year overall survival was 33%. The prognosis was significantly worse in stage III or IV than in stage I or II (26% vs 67% respectively, p < 0.02).