Cases reported "Carcinoma, Squamous Cell"

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11/23. Secondary placement of a voice prosthesis after total pharyngolaryngectomy with colon interposition: voice restoration in colon interposition.

    We present a patient treated by a total pharyngolaryngoesophagectomy and postoperative radiotherapy for a hypopharyngeal T4N2bM0 squamous cell carcinoma. The upper digestive tract was reconstructed with a pedicled left colon interposition through the posterior mediastinum. A voice prosthesis was placed 9 months after the initial treatment, following measurement of the tracheo-neopharyngeal wall thickness by sonography. Fifteen months after the total pharyngolaryngectomy, the patient remains free of recurrent disease and has successfully resumed speaking with the voice prosthesis.
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12/23. Pulmonary thromboembolism following total laryngectomy and neck dissection: a case report.

    A fifty-five-year-old male patient underwent total laryngectomy, bilateral modified radical neck dissection, and primary voice restoration for squamous cell carcinoma of the supraglottic larynx. During surgery the left internal jugular vein was found to be thrombosed and, therefore, ligated and resected. In the early postoperative period, pulmonary thromboembolism was suspected and confirmed by lung perfusion scintigraphy which showed bilateral segmental and subsegmental perfusion defects. The patient was successfully treated by anticoagulant therapy. It may be advisable to consider thromboprophylaxis in head and neck surgery in patients with clinically suspected pulmonary thromboembolism, if no contraindication exists.
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13/23. Vascularized hemitracheal autograft for laryngotracheal reconstruction: a new surgical technique based on the thyroid gland as a vascular carrier.

    BACKGROUND: The management of extensive laryngotracheal stenosis has been a challenge confronting head and neck surgeons for over a century. The key to the successful restoration of a stable airway is providing a cartilaginous infrastructure to provide support to withstand both the negative and positive lumenal pressures produced during normal respiration and deglutition. We introduce a novel technique for restoration of such defects. methods: The blood supply to the thyroid gland by way of the inferior thyroid artery and the superior thyroid artery and vein are mobilized for transfer. One half to two thirds of the circumference of the adjacent tracheal rings are mobilized on the basis of the requirements of the stenotic segment. This mucochondrial composite tracheal flap is advanced superiorly to the ipsilateral "laryngeal" region where insetting of the cartilage and the mucosa is performed. Primary reconstruction or, more likely, a staged repair of the secondary tracheal defect is performed. RESULTS: Three case reports are presented. The patients were successfully decannulated postoperatively, continue to have an adequate voice, and are tolerating a diet (3-27 months postreconstruction). CONCLUSION: A new surgical technique for reconstruction of benign laryngotracheal stenoses is introduced to restore phonatory capability and a stable airway. The composite thyroid-tracheal graft based on the inferior and superior thyroid arterial pedicles allows a single-staged, primary reconstruction of the hemilarynx with a well-vascularized composite thyrotracheal flap that allows resurfacing as well as replacement of the infrastructure of the glottis and subglottis. This technique would be an excellent method to restore the cricoid ring following partial resection for primary cartilaginous tumors.
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14/23. Unusual complication of surgical voice restoration.

    A case of oesophageal obstruction following the removal of a tracheoesophageal valve by division is presented. The obstruction was caused by impaction of a portion of the valve at a previously undiscovered benign oesophageal stricture. The obstruction was resolved by interventional radiology with no long-term sequelae. To the best of our knowledge this complication has not been described previously.
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15/23. A possible case of werner syndrome presenting with multiple cancers.

    The treatment of a man with six metachronous primary cancers is described. The primary lesions were in the soft palate, both edges of the tongue, the hard palate, the esophagus, and the right ureter. Pathologically, all of the first five tumors in the head and neck and esophagus were proven to be squamous cell carcinoma with various grades of differentiation, and the last one was transitional cell carcinoma. The cancers were found in the early clinical stage, and were completely controlled one by one except for the ureteral tumor under treatment. His characteristic medical history and physical findings, i.e. bilateral cataracts, short stature, baldness, diabetes mellitus, high-pitched voice, and multiple malignancies, met the clinical criteria for possible werner syndrome, a genetic premature aging disorder, though the possibility of phenocopy of this syndrome has not been ruled out. We have followed him carefully because he might be vulnerable to malignant tumor formation.
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16/23. A patient with primary squamous cell carcinoma of the thyroid intermingled with follicular thyroid carcinoma that remains alive more than 8 years after diagnosis.

    Primary squamous cell carcinoma of the thyroid is an extremely rare tumor with a highly aggressive clinical course. We report here on a patient with primary squamous cell carcinoma of the thyroid who remains alive more than 8 years after diagnosis. A 56-year-old man presented with a hoarse voice and a rapidly progressing mass on the right side of the thyroid gland. The patient underwent a total thyroidectomy without neck lymph node dissection. Histopathologic findings revealed primary squamous cell carcinoma combined with follicular carcinoma of the thyroid. The tumors metastasized to the cervical lymph nodes, thoracic spine and lung. He underwent 5000 rads of adjuvant radiotherapy to the neck. TSH suppressive therapy with L-thyroxine was administered alone rather than radioactive iodine therapy or chemotherapy. The patient's clinical course has been remarkable over the first 7 years; he has remained stable except for a transient paraplegia due to nerve compression. The patient underwent colectomy for the diagnosis of a colon cancer. Recent evaluation has revealed a new lesion in the lung; this was diagnosed as metastatic follicular carcinoma originating from the thyroid. High dose radioactive iodine therapy was administered, and he remains alive in stable condition.
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17/23. Bilateral vocal cord paralysis with respiratory failure. A presenting manifestation of bronchogenic carcinoma.

    A patient with lung cancer presented with upper airway obstruction and hypercapnic respiratory failure resulting from bilateral vocal cord paralysis. Computed tomography demonstrated tumor extension into the superior mediastinum, with probable disruption of both recurrent laryngeal nerves. Unlike the more common unilateral cord paralysis, bilateral cord dysfunction is often associated with preservation of voice and varying degrees of stridor that may lead to potentially life-threatening delays in diagnosis and treatment. Proper management requires urgent translaryngeal intubation if airway obstruction is high grade, with subsequent consideration of laryngeal surgical procedures for long-term care.
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18/23. pneumothorax as a complication of tracheoesophageal voice prosthesis use.

    A previously unreported association of pneumothorax and the use of a tracheoesophageal voice prosthesis is presented. A review of 44 cases revealed that two patients developed a pneumothorax requiring chest tube placement. Pulmonary barotrauma is believed to be the cause of the injury. In those patients in whom the tracheoesophageal voice prosthesis has been effective, it has produced excellent results. However, certain pulmonary conditions may be considered a relative contraindication to the use of the tracheoesophageal voice prosthesis in patients who must generate significant force to produce voice. patients using a voice prosthesis who present with symptoms of chest pain or dyspnea must be evaluated carefully for pulmonary rupture.
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19/23. Squamous cell carcinoma of the larynx.

    A patient with a moderately advanced squamous cell carcinoma of the larynx (T2, glottic) is presented. The consultants discuss their preferred diagnostic and treatment options. All consultants agree that the chances for cure (5-yr survival) are 80-85%, but they differ as to the preferred treatment approach to preserve phonation. Drs. Biller and Pearson predict that 80-90% of patients would be alive and have usable voice, with surgical treatment, whereas Dr. Bryce believes the chances of voice preservation are 65% after radiotherapy only. In his opinion an additional 10% would be helped by conservation partial laryngeal surgery.
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20/23. Vocal rehabilitation by tracheogastric shunt method after pharyngolaryngoesophagectomy for malignancy.

    After pharyngolaryngoesophagectomy had been performed to remove a malignant tumor, a shunt was created between the elevated gastric tube and the trachea for vocal rehabilitation in two patients. By covering the tracheostoma, the patients were able to produce a substituted voice without any reflux. However, strange vibrations of the gastric tube slightly disturbed the intelligibility of the shunt voice.
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