Search

Objective: This case report describes a rare presentation of a cartilaginous choristoma of the oral cavity within the tonsillar fossa, emphasizing the importance of recognizing and differentiating this uncommon entity from more frequently encountered oral lesions. Methods: A comprehensive clinical and histopathological examination was conducted on a 30‐year‐old male patient who presented with a painless mass in the nasopharynx. An excisional biopsy was carried out, and a histopathological analysis was conducted to establish a definitive diagnosis. Results: Histopathological examination demonstrated a cartilaginous choristoma, characterized by the presence of mature hyaline cartilage surrounded by the connective tissue. The patient underwent surgical excision of the lesion, and follow‐up assessments indicated a favorable postoperative outcome without recurrence. Conclusion: Cartilaginous choristomas in the oral cavity are exceedingly rare. Awareness of this entity is crucial for accurate diagnosis and appropriate management, as it can mimic other more common oral lesions. This case report contributes to the limited literature on oral cartilaginous choristomas and underscores the significance of considering this entity in the differential diagnosis of oral mucosal masses. [ABSTRACT FROM AUTHOR]

Purpose: Vocal fold scar is one the most challenging benign laryngeal pathologies. The purpose of this paper is to propose a classification that will allow for a common description of this entity between laryngologists, prevent discrepancies in interpretation, allow for comparison of related studies, and offer a training tool for young laryngologists. Methods/Results: Based on the depth and laterality of scarring, we propose 4 types: type I, characterized by atrophy of lamina propria with/without affected epithelium; type II, where the epithelium, lamina propria, and muscle are affected; type III, where the scar is located on the anterior commissure; type IV, which includes extended scar formation in both anteroposterior and rostro-caudal axis with significant loss of vocal fold mass. Conclusion: We believe that our proposal is comprehensive and encompasses all existing iatrogenic and non-iatrogenic etiologies in a simple and concise manner. It also serves its purpose as a descriptive, comparative, and training tool. [ABSTRACT FROM AUTHOR]

In July 1999, the European Laryngological Society (ELS) has accepted a proposal for the classification of different laryngeal endoscopic cordectomies. This is actually a common classification system used as a tool for surgical training, documentation and comparison of results. The same harmonization work is deemed necessary for the treatment of supraglottic lesions. The ELS is proposing a classification of the different laryngeal endoscopic supraglottic partial laryngectomies. This classification comprises four types of supraglottic laryngectomies: Type I, limited excision of small size superficial lesions of the free edge of the epiglottis, the ary-epiglottic fold, the arytenoid, or the ventricular fold or any other part of the supraglottis; Type II, medial supraglottic laryngectomy without resection of the pre-epiglottic space, suitable for T1 lesions of either the suprahyoid or the infrahyoid laryngeal surface of the epiglottis (Type IIa, superior hemi-epiglottectomy or Type IIb, total epiglottectomy, respectively); Type III, medial supraglottic laryngectomy with resection of the pre-epiglottic space, suitable for T1–T2 tumors of the infrahyoid endolaryngeal epiglottis without (Type IIIa) or with (Type IIIb) extension to the ventricular fold, necessitating its excision; finally, Type IV, lateral supraglottic laryngectomy, suitable for tumors of the threefolds’ region, which may include the ventricular fold (Type IVa) or the arytenoid (Type IVb), when involved. As in the cases of endoscopic cordectomies, these operations are similarly classified according to the surgical approach used and the degree of resection completed in order to facilitate their use in daily clinical practice. [ABSTRACT FROM AUTHOR]

There has been an ongoing confusion among pathologists in their attempt to accurately identify lesions of Reinke’s space. Nodules, polyps and Reinke’s edema fall in the same basket and differentiation between them relies largely on the clinical description of the pathologic specimen by the operating surgeon than on their distinct pathologic features. By revising the pertinent literature, the need for an establishment of the aforementioned term still remains and is further stressed out, as confusion among the various pathologic descriptions of these lesions still exists. This is further verified by a study conducted in the Department of Otorhinolaryngology–Head and Neck Surgery of the University Hospital of Louvain at Mont-Godinne, Belgium, involving 323 operative specimens obtained from 200 patients with macroscopic picture. Statistical analysis showed lack of agreement between surgical and histopathologic diagnosis in almost a third of the cases (Cohen’s kappa coefficient of 0.683 ± 0.037, P < 0.001). We, therefore, propose the term “exudative lesions of Reinke’s space” to include Reinke’s edema, polyps and nodules. These lesions share common histologic features, which are located in the Reinke’s space and whose macroscopic appearance is largely dependent upon the presence and duration of certain causative factors. [ABSTRACT FROM AUTHOR]

Our objective was to introduce a new technique for cricoid cartilage reconstruction. A 74-year-old male patient with a history of a 6-month progressively worsening dyspnea was found to have an extensive mass of the left cricoid cartilage. Although the extent of his disease would necessitate total laryngectomy, the patient underwent an open extended left hemicricoidectomy with reconstruction of the defect by a pedicled osseomuscular flap composed of the body of the hyoid bone and the contralateral sternohyoid muscle. Both frozen section and subsequent histopathological evaluation gave the diagnosis of a chondrosarcoma. A Montgomery T-tube was left in place for 3 months and was subsequently replaced by a tracheostomy tube to be removed 1 month later. Six months postoperatively, the patient remains in an excellent respiratory condition. The reconstructed site is patent without any signs of restenosis as up to date. We conclude that our technique appears to be a reliable alternative to total laryngectomy in cases of extended chondrosarcomas, as well as in cases where reconstruction of the cricoid cartilage is mandated. Further follow-up and additional cases are warranted. [ABSTRACT FROM AUTHOR]

Pyriform sinus carcinoma is a highly malignant carcinoma of the head and neck region as a result of its location and its potential for metastatic spread. Decisions regarding the operative procedure remain very difficult. In this paper, we present a modified partial laryngo-pharyngectomy in which, following extended vertical laryngectomy, the cancerous mass is removed from the involved pyriform sinus and the remaining hypopharynx is reconstructed by using the preserved outer perichondrium of the resected thyroid cartilage. This technique has been applied with adequate success during the last five years in five cases in our department. It is indicated when a pyriform sinus carcinoma does not extend to the pyriform apex and does not involve the anterior and posterior laryngeal commissures, paraglottic space, retrocricoid region and posterior pharyngeal wall beyond the midline. All patients treated were male and middle-aged. Our technique appears to be a reliable alternative for the operative treatment of pyriform sinus carcinoma. [ABSTRACT FROM AUTHOR]

Objectives: To present the value of office-based laryngological procedures as an effective alternative method to the treatment of benign and malignant laryngeal pathologies. Methods: We have reviewed the technological advancements of fiber-guided laser systems, fiberoptic endoscopes, and high-definition imaging systems that have enabled office-based laryngological procedures. We describe the importance of case and patient selection, the available laser systems, and the technique applied. Results: Several benign and malignant pathologies can be now treated in the office under local anesthesia with angiolytic or thermocoagulative lasers and with success rate comparable to that of general anesthesia. Safety guidelines and laser precautions must be implemented invariably to protect the patient and caregivers from the untoward effects of laser. Although there is considerable reduction of cost with office procedures, there are risks of undertreatment, increased repeatability, as well as tissue edema from the burning effect. Conclusions: The low learning curve, high patient satisfaction rate, and excellent results indicate that in-office laser procedures have become an effective weapon in our armamentarium. [ABSTRACT FROM AUTHOR]

The article present a series of 17 cases (16 patients) of chronic ear disease where a cochlear implant was successfully implanted after fat graft obliteration of the mastoid cavity and blind pit closure of the external auditory meatus (EAM). Fat graft obliteration of the mastoid cavity and blind pit closure of the EAM is a reliable technique. Fat is superior to other obliterating materials because of low metabolic rate, easy accessibility, easy removal at implantation and resistance to necrosis. All patients with working implants remain disease-free at present and enjoy life as hearing human beings.

Acronyms and abbreviations are frequently used in otorhinolaryngology and other medical specialties. CO laser-assisted transoral surgery of the pharynx, the larynx and the upper airway is a family of commonly performed surgical procedures termed transoral laser microsurgery (TLM). The abbreviation TLM can be confusing because of alternative modes of delivery. Classification and definition of the different types of procedures, performed transorally or transnasally, are proposed by the Working Committee for Nomenclature of the European Laryngological Society, emphasizing the type of laser used and the way this laser is transmitted. What is usually called TLM, would more clearly be defined as CO laser transoral microsurgery or CO TOLMS or CO laser transoral surgery only (with a handpiece) would be defined as CO TOLS. KTP transnasal flexible laser surgery would be KTP TNFLS. Transoral use of the flexible CO wave-guide with a handpiece would be a CO TOFLS. One can argue that these clarifications are not necessary and that the abbreviation TLM for transoral laser microsurgery is more than sufficient. But this is not the case. Laser surgery, office-based laser surgery and microsurgery are frequently and erroneously interchanged for one another. These classifications allow for a clear understanding of what was performed and what the results meant. [ABSTRACT FROM AUTHOR]

The terms used to describe vocal fold motion impairment are confusing and not standardized. This results in a failure to communicate accurately and to major limitations of interpreting research studies involving vocal fold impairment. We propose standard nomenclature for reporting vocal fold impairment. Overarching terms of vocal fold immobility and hypomobility are rigorously defined. This includes assessment techniques and inclusion and exclusion criteria for determining vocal fold immobility and hypomobility. In addition, criteria for use of the following terms have been outlined in detail: vocal fold paralysis, vocal fold paresis, vocal fold immobility/hypomobility associated with mechanical impairment of the crico-arytenoid joint and vocal fold immobility/hypomobility related to laryngeal malignant disease. This represents the first rigorously defined vocal fold motion impairment nomenclature system. This provides detailed definitions to the terms vocal fold paralysis and vocal fold paresis. [ABSTRACT FROM AUTHOR]

We present herein the proposal of the European Laryngological Society working committee on nomenclature for a systematic classification of open partial horizontal laryngectomies (OPHL). This is based on the cranio-caudal extent of laryngeal structures resected, instead of a number of different and heterogeneous variables present in existing nomenclatures, usually referring to eponyms, types of pexy, or inferior limit of resection. According to the proposed classification system, we have defined three types of OPHLs: Type I (formerly defined horizontal supraglottic laryngectomy), Type II (previously called supracricoid laryngectomy), and Type III (also named supratracheal laryngectomy). Use of suffixes 'a' and 'b' in Type II and III OPHLs reflects sparing or not of the suprahyoid epiglottis. Various extensions to one arytenoid, base of tongue, piriform sinus, and crico-arytenoid unit are indicated by abbreviations (ARY, BOT, PIR, and CAU, respectively). Our proposal is not intended to give a comprehensive algorithm of application of different OPHLs to specific clinical situations, but to serve as the basis for obtaining a common language among the head and neck surgical community. We therefore intend to present this classification system as a simple and intuitive teaching instrument, and a tool to be able to compare surgical series with each other and with non-surgical data. [ABSTRACT FROM AUTHOR]

Both epistaxis and hypertension are frequent problems in the adult population. The relationship between the level of arterial pressure and incidence of epistaxis in a patient with hypertension is a question that appears frequently in the clinical practice. A systematic review of the literature regarding the relation of arterial hypertension with epistaxis was performed through MEDLINE and EMBASE. All studies, whether examining the correlation of arterial pressure at presentation of a patient with nasal bleeding or the repercussion of episodes of epistaxis in hypertensive patients, were included in this review. Studies were evaluated independently by two reviewers according to a standard evaluation form. Overall, nine studies fulfilled our inclusion criteria. Five of them were single-group (patient) studies, while the remaining four included a control group. In eight studies, the patient group included patients with epistaxis, while one focused on hypertensive patients. Six out of nine studies agree that arterial pressure is higher at the time of epistaxis, as compared to the control group or to the general population. Seven out of nine studies conclude that there is cross-correlation between arterial pressure and the actual incident of epistaxis. The presence of high arterial blood pressure during the actual episode of nasal bleeding cannot establish a causative relationship with epistaxis, because of confounding stress and possible white coat phenomenon, but may lead to initial diagnosis of an already installed arterial hypertension. [ABSTRACT FROM AUTHOR]

Scarring of the vocal folds leads to a deterioration of the highly complex micro-structure with consecutively impaired vibratory pattern and glottic insufficiency. The resulting dysphonia is predominantly characterized by a reduced vocal capacity. Despite the considerable progress in understanding of the underlying pathophysiology, the treatment of scarred vocal folds is still an unresolved chapter in laryngology and phonosurgery. Essential for a successful treatment is an individual, multi-dimensional concept that comprises the whole armamentarium of surgical and non-surgical (i.p. voice therapy) modalities. An ideal approach would be to soften the scar, because the reduced pliability and consequently the increased vibratory rigidity impede the easiness of vibration. The chosen phonosurgical method is determined by the main clinical feature: Medialization techniques for the treatment of glottic gap, or epithelium freeing techniques for improvement of vibration characteristics often combined with injection augmentation or implantation. In severe cases, buccal mucosa grafting can be an option. New developments, include treatment with anxiolytic lasers, laser technology with ultrafine excision/ablation properties avoiding coagulation (Picosecond infrared laser, PIRL), or techniques of tissue engineering. However, despite the promising results by in vitro experiments, animal studies and first clinical trials, the step into clinical routine application has yet to be taken. [ABSTRACT FROM AUTHOR]

Intralesional use of cidofovir (Vistide) has been one of the mainstays of adjuvant therapy in patients with recurrent respiratory papillomatosis (RRP) since 1998. In 2011, a communication provided by the producer of cidofovir addressed very serious side effects concerning its off-label use. As this was a general warning, it was inconclusive whether this would account for its use in RRP. The aim of this study is to determine whether nephrotoxic, neutropenic, or oncogenic side effects have occurred after intralesional use of cidofovir in patients with RRP. Update of recent developments in RRP, a multicentre questionnaire and a multicentre retrospective chart review. Sixteen hospitals from eleven countries worldwide submitted records of 635 RRP patients, of whom 275 were treated with cidofovir. RRP patients received a median of three intralesional injections (interquartile range 2-6). There were no statistical differences in occurrence of neutropenia or renal dysfunction before and after cidofovir. There was no statistical difference in occurrence of upper airway and tracheal malignancies between the cidofovir and the non-cidofovir group. In this retrospective patient chart review, no clinical evidence was found for more long-term nephrotoxicity, neutropenia or laryngeal malignancies after the administration of intralesional cidofovir in RRP patients. [ABSTRACT FROM AUTHOR]

The article ‘Laser-assisted surgery of the upper aero-digestive tract: a clarification of nomenclature. A consensus statement of the European Laryngological Society,’ written by Marc Remacle, Christoph Arens, Mostafa Badr Eldin, Guillermo Campos, Carlos Chiesa Estomba, Pavel Dulguerov, Ivana Fiz, Anastasios Hantzakos, Jerôme Keghian, Francesco Mora, Nayla Matar, Giorgio Peretti, Cesare Piazza, Gregory N. Postma, Vyas Prasad, Elisabeth Sjogren, Frederik G. Dikkers, was originally published Online First without open access. After publication in volume 274 issue 10, page 3723–3727 the authors decided to opt for Open Choice and to make the article an open access publication. Therefore, the copyright of the article has been changed to © The Author(s) 2018 and the article is forthwith distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, duplication, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. [ABSTRACT FROM AUTHOR]

The article presents the authors' views on studies related to treatment of recurrent respiratory papillomatosis (RRP) and adverse reactions. The author comments on outcome of the studies which focuses on nephrotoxic, neutropenic, or oncogenic side effects of intralesional cidofovir in patients with RRP.