1/1519. Radial forearm free-flap reconstruction following radiotherapy and total laryngectomy. The authors' experience with six patients who underwent radial forearm free-flap reconstruction following radiotherapy and total laryngectomy is presented. All patients had undergone previous irradiation of 57.8 Gy on average as primary treatment for laryngeal cancer. A patch graft of the radial forearm free flap was used for pharyngoesophageal wall reconstruction in three patients, a radial forearm free flap for cervical soft tissue in one patient, and a double-folded radial forearm free flap for simultaneous pharyngoesophageal wall and cervical soft tissue in two patients. The free-flap transfers were successful in all patients. There was one patient who developed a small pharyngocutaneous fistula, which closed spontaneously. The radial forearm free flap is demonstrated to be a versatile technique for reconstruction of a moderate-sized defect in the treatment of laryngeal cancer. ( info) |
| The acquired immunodeficiency syndrome has produced a growing population of patients who, because of their associated immune system compromise, are prone to opportunistic infections and neoplastic diseases. The larynx, with its relatively inaccessible yet critical anatomic location, is a site in which these processes can produce clinical dilemmas, with respect to diagnosis as well as to therapy. By presenting 4 cases involving unusual laryngeal problems in patients infected with the human immunodeficiency virus (hiv), we emphasize these inherent diagnostic and therapeutic problems. Otolaryngologists must be familiar with the many diagnostic possibilities and therapeutic alternatives when hiv-infected patients present with laryngeal complaints. ( info) |
| Two cases of extracardiac rhabdomyoma are reported in a 54-year-old man with unexplained difficulty in breathing and in a 39-year-old man with a prolonged history of hoarseness. attention is drawn to the necessity of doing hypopharyngo-and laryngoscopy in such cases. One tumour was found in the left vallecula in the hypopharynx and the other on the left vocal cord. The literature and the histological findings in 53 cases are reviewed. It appears that this rare tumour is most frequently found in muscles derived from the pharyngeal arches. A total of 40 cases have been diagnosed during the last decade, and this increase is likely to continue in the future. It may turn out that extra-cardiac rhabdomyoma is not so rare as was first presumed. ( info) |
4/1519. Primary anaplastic giant cell adenocarcinoma of the larynx. Anaplastic giant cell adenocarcinoma is an extremely rare tumour arising in the bronchial mucosa. This report describes an example--the first to be reported--of such a tumour evidenced in the subglottic region in a 64-year-old man. Histologically, the tumour resembles that arising in the lung and its morphological characteristics justify a distinction of anaplastic giant cell adenocarcinoma from other types of laryngeal malignant epithelial tumours. As to its histogenesis, the neoplasm is most probably of glandular origin and should be considered as a dedifferentiated adenocarcinoma. The patient, who had undergone total laryngectomy followed by X-ray treatment, is alive one year after surgery. ( info) |
5/1519. E.N.T. manifestations of Von Recklinghausen's disease. Von Recklinghausen's disease (VRD) is a neurocutaneous, systemic disease characterized by CNS tumors and disorders, cafe-au-lait spots, generalized cutaneous neurofibromata, skeletal deformities, and somatic and endocrine abnormalities. It is an autosomal dominant, hereditary disorder found in approximately 1:2500 to 3300 births. There are many manifestations of this disease in the head and neck region of interest to the otolaryngologist. case reports of three patients with multiple ENT involvements are detailed. A review of the literature is presented with a brief discussion of diagnosis and treatment. The most common intracranial tumor in the adult is the acoustic neuroma, usually bilateral, while in the child it is the astrocytoma. A defect in the sphenoid bone is common and may produce temporal lobe herniation into the orbit causing pulsatile exophthalmos. Involvement of the facial bones usually causes radiolucent defects secondary to neurofibromata within nerve pathways, and a variety of asymmetrical changes, especially within the mandible. "elephantiasis" of the face is a hypertrophy of the soft tissues overlying a neurofibroma, often quite extensive and disfiguring. Laryngeal and neck involvement may compromise the airway and early and repeated surgical intervention is required. The over-all malignancy rate approaches 30%, indicating that the patient with VRD may be predisposed to developing a malignancy. There appears to be an increased surgical risk in these patients, with some demonstrating abnormal responses to neuromuscular blockade. ( info) |
6/1519. A case of laryngeal neurinoma with neurofibromatosis 2. We present a case of a laryngeal neurinoma in a patient with neurofibromatosis 2. A 39-year-old man presented to our hospital with multiple complaints including progressive bilateral hearing loss, dizziness, dyspnea, dysphagia, and a 9-year history of right lower leg weakness. magnetic resonance imaging demonstrated multiple lesions including bilateral cerebellopontine angle tumors, a foremen magnum tumor, multiple tumors of the spinal cord, a laryngeal tumor, and several retrocervical tumors. Fiberoptic laryngoscopy revealed a large submucosal supraglottic tumor. The laryngeal tumor was visualized through microlaryngoscopy and excised with a KTP laser directed through a quartz fiber. ( info) |
7/1519. A pathologic and clinical study of adenosquamous carcinoma of the larynx. Report of four cases and review of the literature. Four cases of adenosquamous carcinoma are described. Emphasis is put on the rarity of this histological type of tumour which was first described in the larynx by Gerughty et al. (1968) who reported three cases. An exhaustive histological documentation of the neoplasm accompanies the discussion of its pathomorphological characteristics, histogenesis, differential diagnosis, prognosis and treatment. Stress is laid on the extreme aggressiveness of the neoplasm and on its high biologic malignancy. Elective treatment is radical surgery. The tumour in question is a distinct anatomo-clinical entity with its own connotations and therefore must be distinguished from the most common squamous cell carcinoma of the larynx. ( info) |
8/1519. Atypical chondroma of the cricoid cartilage: fine-needle aspiration cytologic and histopathologic findings. chondroma of the laryngeal skeleton is a rare, benign neoplasm manifested either as a neck mass or, if situated within the airway, as slowly progressive obstruction, hoarseness, or dyspnea. The most common site is the posterior plate of the cricoid cartilage. An atypical perichondrial chondroma arising from the anterior plate of the cricoid cartilage membrane as a neck mass in a young female is presented. The diagnosis was made on a fine-needle aspiration of the mass and subsequently confirmed by histologic examination of the excised mass. Although rare, cartilaginous tumors of the laryngeal skeleton can manifest as a neck mass, and the diagnosis can be made by fine-needle aspiration biopsy in combination with radiographic and clinical examinations. Therefore, the existence and inclusion of these tumors in the differential diagnosis of neck masses by aspiration biopsy should be considered by clinicians and pathologists, and especially cytopathologists, when cartilaginous components are encountered. ( info) |
| Fewer than 15% of lipomas occur in the head and neck. To date, fewer than 100 cases of laryngeal lipoma have been reported in the literature. Typical clinical manifestations include dysphagia, dyspnea and hoarseness, as well as the presence of a smooth or pedunculated mass seen endoscopically and a low attenuation mass on computed tomography scan. Pathologic sections commonly reveal a tumor consisting of mature adipocytes, which is often encapsulated. Treatment of laryngeal lipoma varies from conservative total endoscopic removal to external surgical approaches. The following is a report of a single case of laryngeal lipoma, including pathologic and radiologic findings, as well as a review of the literature. ( info) |
10/1519. Laryngeal liposarcoma: report of a case. Laryngeal and hypopharyngeal liposarcomas are fairly rare tumors, with only 30 convincing cases reported to date. These tumors usually arise in the supraglottic area, and only two cases have been reported to affect the true vocal cord. They behave in an indolent fashion with multiple local recurrences and only rarely cause the patient's death. Our case highlights the natural history of this entity. A 62-year-old man presented because of air-way obstruction. A CT scan discovered a large 5 cm polypoid mass in the right aryepiglottic fold. The patient had already undergone three previous operations for the same reason in another clinic, with histopathological diagnoses of fibrovascular polyps. In the last recurrence, only a careful search for lipoblasts in the surgical specimen allowed us to identify this lesion as a low-grade well-differentiated liposarcoma. Complete resection was impossible in this case, despite total laryngectomy. ( info) |