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Purpose It is not always possible to create linear access to the larynx using a rigid operating laryngoscope for microlaryngoscopy. In this study, we evaluate the usability of a novel curved surgical prototype with flexible instruments for the larynx (sMAC) in a simulation dummy and human body donor. Methods In a user study (n = 6), head and neck surgeons as well as medical students tested the system for visualization quality and accessibility of laryngeal landmarks on an intubation dummy and human cadaver. A biopsy of the epiglottis was taken from the body donor. Photographic and time documentation was carried out. Results The sMAC system demonstrated general feasibility for laryngeal surgery. Unlike conventional microlaryngoscopy, all landmarks could be visualized and manipulated in both setups. Biopsy removal was possible. Visibility of the surgical field remained largely unobstructed even with an endotracheal tube in place. Overall handling of the sMAC prototype was satisfactorily feasible at all times. Conclusion The sMAC system could offer an alternative for patients, where microlaryngoscopy is not applicable. A clinical trial has to clarify if the system benefits in clinical routine.

Drug-induced sleep endoscopy (DISE) is a diagnostic technique for 3D dynamic anatomical visualisation of upper airway obstruction during sedated sleep. There is a lack of standardised procedure and objective measurement associated with information capture, information management, evaluation of DISE findings, treatment planning, and treatment outcomes. The objective of this study is to present clinical feasibility results using a DISE DATA FUSION system for capturing, merging, displaying and storing anatomical data from an endoscopic imaging system and cardiorespiratory data from an anaesthesiological monitoring system simultaneously in real-time during DISE. This prospective cohort study included 20 patients presenting with symptoms of sleep related breathing disorders undergoing drug-induced sedation endoscopy and had volunteered for DISE DATA FUSION system to be used during their DISE assessment. The DISE DATA FUSION system was used to capture, merge, display, and store anatomical changes from an endoscopic imaging system and cardiorespiratory changes from an anaesthesiological monitoring system simultaneously in real time during drug-induced sedation endoscopy assessment. In all 20 patients, anatomical obstructions at different levels of the pharyngeal lumen (soft palate, velum, tonsils, oropharynx lateral wall, base of tongue, and epiglottis) with a different obstruction configuration and severity were captured simultaneously in real time with its associated cardiorespiratory parameters. Furthermore, a composite video consisting of an anatomical image, blood oxygen level, pulse rate, blood pressure, and timestamp was created for every obstructive event. Our system provides a useful and better way of capturing, merging, visualising, and storing anatomical data/physiological data simultaneously during DISE in real time. Furthermore, it enhances the understanding of the impact of the anatomical severity due to the simultaneous display of the cardiovascular parameters at that specific time of anatomical obstruction for optimising surgical decision based on DISE. Electronic supplementary material The online version of this article (doi:10.1007/s00405-017-4765-7) contains supplementary material, which is available to authorized users.

Drug-induced sleep endoscopy (DISE) is a reliable upper airway evaluation tool, widely used to improve surgical results in patients with obstructive sleep apnea (OSA). Several factors, including sleeping position and depth of sedation, affect DISE findings. This study aimed to evaluate the impact of physical stress on DISE findings. Eighty-five patients with OSA underwent two DISE examinations at the same level of sedation. The "first DISE" (control group) was performed after polysomnography, while the "second DISE" (test group) performed immediately after a treadmill stress test. The two groups were compared for changes in degree and configuration of airway obstruction at the levels of the velum, oropharynx, tongue base, and epiglottis. There were several differences in DISE findings between the control and test groups. DISE findings obtained after the stress test revealed significant narrowing of multiple airway structures; upper airway narrowing was observed at the velum (19/48; 39.6%), oropharynx (31/63; 49.2%), and tongue base (9/61; 14.8%). Changes in configuration of upper airway obstruction were observed only at the level of the velum (33/85; 38.8%). Stress exercise test induces changes in the degree and configuration of upper airways narrowing, which causes surgeons to over or underestimate the obstructive pattern, depending on the clinical circumstance. When counseling patients on the likely value of sleep surgery based on DISE findings, stressful physical activity should be included as a contributing factor in treatment planning.

Few data are available about the pattern of upper airway (UA) obstruction in children < 2 years with obstructive sleep apnea syndrome (OSAS). Also, the role of adenoidectomy versus adenotonsillectomy (AT) is poorly defined in this age group. We performed drug-induced sedation endoscopy (DISE) in young OSAS children to investigate the pattern of UA obstruction and the value of DISE in therapeutic decision making. Retrospective analysis of ae2-year-old children undergoing DISE-directed UA surgery. OSAS severity and the treatment outcomes were documented by polysomnography. Data are available for 28 patients, age 1.5 years (1.3-1.8), BMI-z score 0.5 (-0.7 to 1.3) with severe OSAS, obstructive apnea/hypopnea index (oAHI) 13.8/hr (7.5-28.3). All but 3 had (> 50%) obstruction at the level of the adenoids, and all but 5 had (> 50%) tonsillar obstruction. DISE-directed treatment consisted of adenoidectomy (n = 4), tonsillectomy (n = 1), and AT (n = 23). There was a significant improvement in respiratory parameters. Twenty children (71.4%) had a postoperative oAHI < 2/hr. None had palatal or tongue base obstruction. Five children had a circumferential UA narrowing (hypotonia), 2 of them had residual OSAS. DISE showed a collapse of the epiglottis in 6 and late-onset laryngomalacia in 4. These findings did not affect surgical outcome. Adenotonsillar hypertrophy is the major cause of UA obstruction, and DISE-directed UA surgery was curative in 71,4% of children ae2 years. We suggest that DISE may be helpful in surgical decision making. Circumferential UA narrowing may result in less favorable surgical outcomes.

Obstructive sleep apnea (OSA) is characterized by recurrent episodes of partial or complete collapse of the pharynx that result in a decrease in oxyhemoglobin saturation. Nasofibrolaryngoscopy under induced sleep is a promising alternative for identifying sites of upper airway obstruction in patients with OSA. This study aimed to compare the obstruction sites screened by drug-induced sleep endoscopy (DISE) using the Nose oropharynx hypopharynx and larynx (NOHL) and Velum oropharynx tongue base epiglottis (VOTE) classifications. We also determined the relationship between OSA severity and the number of obstruction sites and compared the minimum SaO2 levels between DISE and polysomnography (PSG). This was a prospective study in 45 patients with moderate and severe OSA using DISE with target-controlled infusion of propofol bispectral index (BIS) monitoring. The retropalatal region was the most frequent obstruction site, followed by the retrolingual region. Forty-two percent of patients had obstruction in the epiglottis. Concentrically shaped obstructions were more prevalent in both ratings. The relationship between OSA severity and number of obstruction sites was significant for the VOTE classification. Similar minimum SaO2 values were observed in DISE and PSG. The VOTE classification was more comprehensive in the analysis of the epiglottis and pharynx by DISE and the relationship between OSA severity and number of affected sites was also established by VOTE. The use of BIS associated with DISE is a reliable tool for the assessment of OSA patients.

Laryngomalacia is a dynamic airway condition characterised by inward collapse of flaccid supraglottic structures during inspiration. Although the most common cause of stridor in the paediatric population, adult-onset laryngomalacia remains a rare entity and its management, challenging. Two cases of adult-onset laryngomalacia are reported. A review of the English literature is performed and additional publications identified by hand-searching relevant papers; 13 case reports/series comprising 28 cases of adult-onset laryngomalacia were identified, divided into two main groups: idiopathic (6/28) and acquired (22/28). The aetiology of the acquired form includes neurological, traumatic and iatrogenic. Reported therapeutic measures used are laser supraglottoplasty, epiglottopexy, partial epiglottidectomy, defunctioning tracheostomy and intubation whilst correcting the underlying cause. The majority of patients only required one therapeutic procedure (follow-up of 2-24 months). A strong index of suspicion is required to diagnose adult-onset laryngomalacia aided by in-office laryngoscopy. The rarity of this condition prevents management-based randomised controlled trials.

The objective of this study was to analyze atypical neoglottis after supracricoid subtotal laryngectomy (SSL) from a morphological and functional point-of-view using retrospective case series reviewin a Tertiary university referral center setting. From May 2003 until January 2010, 106 patients underwent SSL (CHEP, CHP, THEP, THP) for laryngeal cancer, in the Otolaryngology Department of the University Hospital of Modena. We performed a retrospective analysis of recorded videos in our database of patients who underwent SSL. Patients with atypical neoglottis were included in the study. Six patients with atypical neoglottis were identified and morphologically evaluated. The functional outcomes were collected and analyzed. Atypical neoglottis may form after SSL, in particular in the case of CHEP. In most cases, these atypical conformations are due to anomalous positioning of the epiglottis, or involvement of the lateral pharyngeal wall in the sphincteric and vibratory function of the neoglottis. Atypical neoglottis formation seems to guarantee adequate functional outcomes in terms of vocal and swallowing performance. © 2011 Springer-Verlag.

Primary haematopoietic neoplasms of the larynx constitute less than 1% of all laryngeal tumours. Most of them are extramedullary plasmocytomas, diffuse large B-cell lymphomas, or MALT-type marginal zone B-cell lymphomas. T- or NK-cell lymphomas have rarely been reported in this location. The diagnosis of laryngeal lymphomas is a challenge, due to the absence of clinical and gross differential criteria. A pathological study is required in all cases. We present hereby a primary laryngeal T/NK-cell lymphoma, nasal-type. The patient, of Mexican origin, presented with involvement of the epiglottis, both aryepiglottic folds, and cervical lymphadenopathies. Polychemotherapy was administrated with initial partial response, but rapid local progression and exitus followed six months after the diagnosis. The extranodal T/NK-cell lymphoma, nasal-type is a very aggressive subtype of extranodal lymphoma, usually located in the nasal cavity or in nearby sites. Primary involvement of the larynx is extremely unusual. The prognosis of extranasal cases of this type of lymphoma is poor, even when they are diagnosed in localized stages.

Pemphigus is an uncommon chronic disease with dermatologic and mucosal manifestations. Primary laryngeal involvement without skin lesions is extremely rare. The present paper describes a 72-year old man who presented with a 2-month history of hoarseness, haemoptisis and dysphagia. Clinical examination revealed an erythematous oral mucosa without ulcerations. Indirect laryngoscopy revealed supraglottic ulcerations mainly in the laryngeal surface of the epiglottis and in the right arytenoid. The lesions had characteristic gray color membranes. The patient underwent microlaryngoscopy under general anesthesia and biopsies were taken for histology that revealed inflammatory and granular lesions with necrosis. The diagnosis of pemphigus was based on immunohistopathology and the clinical examination. The patient underwent intravenous treatment with high doses of corticosteroids (prezolon 75 mg/24 h) for 10 days and gradually the dose was reduced to 10 mg/24 h. The patient had a very good response to the treatment and after a week approximately 80% of the lesions disappeared. However, the dose of 10 mg prednisolone per day was sustained for 3 months because any attempt of prednisolone discontinuation was related with reappearance of the clinical symptoms. After 3 months, finally the treatment was discontinued without problems. Now, 15 months later, the patient is well and without symptoms. He is under long-term follow-up. ENT surgeons should be aware of pemphigus as primary laryngeal manifestation in order to investigate and manage patients accordingly.

Supracricoid laryngectomy with cricohyoidopexy (CHP) or cricohyoidoepiglottopexy (CHEP) is a conservative laryngeal surgery tailored to T1b-T2-T3 glottic-supraglottic carcinomas. Tracheohyoidopexy (THP) and tracheohyoidoepiglottopexy (THEP) allow a chance of conservative surgery also for selected transglottic carcinomas. These techniques are comprehensively named reconstructive laryngectomies (RLs). Post RL laryngeal stenosis not due to carcinoma persistence or recurrence is an unusual occurrence. The aim of the present study has been to analyse retrospectively and describe the treatment of the cases of laryngeal stenosis after RL, which occurred in Vittorio Veneto Otolaryngological Department in a 6 year period. In the period between 1999 and 2004, 225 patients underwent RL in our Department. In 18 of them (8%) a laryngeal stenosis after RL was diagnosed. The same evidence was shown in 2 patients who underwent RL in other Institutions. All patients underwent CO(2) laser surgical treatment of the laryngeal stenosis. The 14 patients who underwent RL-CHEP, the 5 patients who underwent THEP and the patient who underwent CHP were treated on average with CO(2) laser 1.2 (range 1-2), 4.2 (range 2-7), and 2 times, respectively. Decannulation was possible in all patients but one after CO(2) laser treatment of the stenosis in a mean period of 3.4 months. Laryngeal stenoses after RLs can be successfully treated with CO(2) laser excision with a very limited morbility. The only reasonable contra-indication to CO(2) laser excision could be a cranio-caudal length of the laryngeal stenotic tract longer than 1 cm: in this occurrence diagnosed after THP or THEP, an external surgical approach could be preferred.

Although laryngeal tuberculosis is not frequent, it still occurs with an increasing incidence of pulmonary tuberculosis. Clinical pattern and spread mechanism of this disease have also changed as well. This study was performed to examine the current propensity seen in laryngeal tuberculosis and the clinical characteristics of this disease in patients showing atypical clinical pattern. The medical and videostroboscopic records of 60 patients with laryngeal tuberculosis diagnosed from the year 1994 to 2004 at the department of otorhinolaryngology in Severance Hospital were analyzed. The age of the patients ranged from 25 to 78 years, with their average age being 49.7 years. The ratio between men and women was 1.9:1. The major symptom encountered was hoarseness (96.6%). Clinically, granulomatous (n=22) and ulcerative types (n=11) of laryngeal tuberculosis were still prevalent, however, the incidence of atypical types such as polypoid (n=16) and nonspecific (n=11) were on the rise. Among the 27 cases that showed polypoid or nonspecific types, unilateral lesion was seen in 20 cases (74%). The most frequently affected area by this disease was true vocal cord, followed by false vocal cord, epiglottis, arytenoids and posterior commissure. Active pulmonary tuberculosis was present in 28 (46.7%), inactive pulmonary tuberculosis in 20 (33.3%), normal lung status in 12 cases (20%). Primary laryngeal tuberculosis was present in 9 cases (15%). Single lesion, polypoid and nonspecific type were prevalent in patients with inactive tuberculosis or normal lungs status. Physicians should be aware of the changes in the clinical pattern of laryngeal tuberculosis, which poses serious complications and risk of spreading.

Different types of human papilloma virus are known to be closely associated with laryngeal papillomas. On the other hand, the proliferation of epithelial cells is associated with various abnormalities in the mechanisms of cellular regulation. In this study, we detected the expressions of p53, p21 and p27 proteins in adult-onset laryngeal papillomas by immunohistochemical techniques. The objective of this study is to evaluate the expression of these factors in adult-onset laryngeal papillomas and to determine whether such expression is correlated with the existence of dysplastic epithelium covering the papillomas. Eighteen patients with adult-onset papillomas who were surgically treated at the Department of Otolaryngology at the University of Istanbul between January 1994 and December 1999 were included in this study. Anti-p21, -p27 and -p53 antibodies were used to perform immunostaining. Positive nuclear staining for p21 was detected in 14 of the 18 (78%) cases, especially in the parabasal layer. Also, in 78% of the cases, weak to strong immunoreactivity was observed for p27. In all cases, negative immunoreactivity was observed for p53 throughout the epithelium except for the basal and parabasal cells. A negative correlation was observed between the existence of dysplastic epithelium and p21 expression (P=0.02). In conclusion, variable p21 and p27 expression was detected by immunohistochemistry in our series of 18 cases of adult-onset laryngeal papillomatosis, and a statistically significant inverse correlation was detected between p21 expression and the existence of dysplastic epithelium covering the papillomas. Further prospective studies are warranted to determine the prognostic values of these variables and to evaluate their role in the pathogenesis of adult-onset laryngeal papillomas.

Laryngomalacia is the most common cause of stridor in newborns and infants. Up until now, different surgical techniques for the treatment of this disease have been described. We report on a modified technique, the so called epiglottopexy, which is a laser-surgical treatment strategy in severe laryngomalacia. A total number of six children (ages: 6 weeks-10.4 years) were treated for life-threatening stridor, which was due to an isolated posterior displacement of the epiglottis during inspiration. In two patients, shortened aryepiglottic folds contributed to the stridor. In all of the children, a modified technique of epiglottopexy was performed transorally; in two cases, this was followed by laser surgical transection of the aryepiglottic folds. Epiglottopexy on the base of the tongue was performed using single suture stitches following laser-surgical vaporization of the corresponding mucosal areas of the epiglottis and the base of the tongue. No intra- or postoperative complications were observed. All six children demonstrated significant airway improvement without any further stridor. Deglutation was not impaired. The presented laser-surgical technique seems to be an appropriate therapy for treatment of severe forms of laryngomalacia characterized by an isolated posterior displacement of the epiglottis during inspiration.

From April 1998 to May 2000, 14 patients with supraglottic cancer underwent transoral laser surgery (T-stage T1–2: 11 patients, T3: 3 patients). In three patients, an epiglottectomy or hemi-epiglottectomy was performed. In 11 patients, further structures (false cords, the valleculae and the base of the tongue and/or parts of the arytenoid cartilage) had to be resected. Thirteen patients had to undergo neck dissection and post-operative irradiation. Tracheostomy was carried out prophylactically in two cases. Every patient received a nasogastric tube peri-operatively. One week after surgery, an evaluation of dysphagia was performed by video endoscopy (VEED). Aspiration was the main problem; in no case did dysphagia occur. The aspiration was graded according to videolaryngoscopical classification. Four patients had an occasional and ten patients a permanent aspiration after surgery. According to this assessment, an individual deglutition therapy management was established. Ten patients with permanent aspiration received a temporary percutaneous endoscopic gastrostomy (PEG) and were integrated in a rehabilitation programme (stimulation of the swallowing reflex, training of compensatory swallowing manoeuvres, dietary regime). Due to this training programme, the PEG could be removed in eight patients after 2–9 months. No patient needed a laryngectomy or a tracheostomy due to aspiration. There were no cases of aspiration-associated pneumonia. To obtain satisfying functional results after transoral laser surgery of supraglottic cancers with resection of the epiglottis, post-operative deglutition management, consisting of video endoscopy, a training programme and often a PEG, is necessary.

We present a follow-up study of 142 patients on whom we performed supraglottic laryngectomy (SL) with an anterior subperichondral approach using Marullo’s technique, which was described in 1975. Between January 1976 and December 1992, 142 patients (age range, 35–73 years) with squamous cell carcinoma of the supraglottic larynx were treated with SL or extended SL (ESL) and ipsilateral or bilateral neck dissections with or without postoperative radiotherapy. All cases were staged according to the 1997 UICC TNM classification. Survival was defined by the Kaplan-Meyer method and showed an overall survival of 77% and a local control rate of 78%. Regarding functional rehabilitation, the mean nasogastric tube-removal time was 16 days (range, 10–39 days) for SL and 23 days (range, 11–¶102 days) for ESL. Voice quality was very satisfactory after SL, while the voice was often harsh or breathy after ESL with postoperative radiotherapy. The overall oncologic and functional results obtained with Marullo’s SL were very similar to those obtained with the classic Alonso’s operation and demonstrated that this technique makes it possible to reach “en bloc” supraglottic sites and the hyothyroepiglottic space. We consider the operation to be safe and simple to perform, provided the sub-perichondral plane is correctly identified. This approach allows the surgeon easily to reach the correct transverse level above the anterior commissure of the vocal cords. Inferiorly, the resection cuts through the floor of the ventricle and is considered to be the safe oncologic plane for pure supraglottic lesions. This technique has also been used successfully in extended resections to treat tumors involving the base of the tongue, pyriform sinus and one arytenoid.

The laryngeal component of voice quality markers has been quantified in the present study, suggesting that the laryngeal vestibule and lower pharynx play an important role in voice quality. Findings also show that voice quality can be partly described in terms of laryngeal configurations and that a knowledge of these configurations may be useful to the laryngologist, speech pathologist and singer. Twenty-five voice qualities were videorecorded, using a nasal fiberscope. Still photographs were taken for each voice quality and distance measurements made on each one for 15 laryngeal parameters. The raw data were normalized, sorted from high to low, turned into scalar values and processed to establish which parameters exhibited similar functions, which photographs were essentially identical, and in what respect any two photographs were different. Each voice quality was seen to be associated with a different, describable and quantifiable laryngeal configuration.

It is widely accepted that tumoral invasion of the pre-epiglottic space (PES) has a significant prognostic importance in supraglottic laryngeal carcinomas. The lymphatics of the supraglottic larynx drain to cervical lymph nodes via the PES. Since the supraglottic larynx is an embryological unit that contains the PES, malignant lesions of this region must be resected with en bloc surgery, including the PES. Tumors with PES invasion are already considered to be T3 in TNM staging. The purpose of this study was to review the clinical experience we have had with these tumors at Ankara University. The study comprised 150 patients with squamous cell carcinomas of the supraglottic larynx treated with either partial or total laryngectomies. Findings suggested that PES invasion occurred at early stages of supraglottic tumor progression. Suprahyoid epiglottic lesions behaved less aggressively than tumors originating from other supraglottic subsites and did not invade the PES until advanced stages. PES invasion was not considered to be a significant prognostic factor because the majority of the supraglottic lesions studied demonstrated PES invasion regardless of cervical lymph node metastases. Analysis of oncological and functional results revealed that en bloc resection of the supraglottis with the PES was facilitated by preservation of the hyoid bone.

We have read a very interesting paper “CO2 laser treatment of laryngeal stenoses after reconstructive laryngectomies with cricohyoidopexy, cricohyoidoepiglottopexy or tracheohyoidoepiglottopexy”. Our experience with reconstructive laryngectomies dates back to 1990. We have performed 82 reconstructive laryngectomies with CHP and CHEP. We have not had any experience with THEP [1]. In our series post-operative stenosis occurred in ten patients (12%). In majority of stenoses the neo-laryngeal mucosal Xap was recognized in six cases, semi-circumferential stenosis in three cases and one patient had synechia between epiglottis and arytenoid. They were treated with 23 laser CO2 procedures (mean 2,3 procedures, range 1–4 procedures). All operations were performed under general anesthesia with typical Kleinsasser set, together with a surgical microscope Zeiss S 21 with a focal lens of 400 mm connected to a micromanipulator. The continuous mode of 5–12 W was used. All patients received dexamethasone sodium phosphate (Dexaven) 4 mg every 8 h over a period of 48 h. Oral antibiotic 1 g cefuroxime sodium was continued for 10 days. Also methyl prednisolone was administered locally [2]. Unfortunately we have not had experience with mitomycin C yet. The main problem in the case of reconstructive laryngectomy is the lack of the rigid structures and the possibility to collapse, especially during sleep. It causes more problems which are technically diYcult in external approach procedure. It is more diYcult in comparison to widening neolaryngeal lumen after vertical laryngectomies. That is why we would like to recommend CO2 procedure with silastic separator or Montgomery tube insertion postoperatively. Patient B.C., 45-year-old female, after RL with CHP was treated with CO2 laser due to neo-laryngeal mucosal Xap. As a result of the operation the progression of stenosis was observed. Trying to avoid the external approach procedure the CO2 laser technique was repeated with subsequent selfmade silastic separator insertion. It was inserted endoscopically and Wxed with vicryl 2.0 sutures with Lichtenberger endolaryngeal needle carrier and tied bilaterally at the neck [3] (Fig. 1).

Immunohistochemistry was used to investigate the distribution pattern of calcitonin gene-related peptide (CGRP) nerve fibers in the laryngeal mucosa, glands and intrinsic muscles of the dog. CGRP immunoreactive nerve fibers were found more frequently than substance P immunoreactive nerve fibers in every region of the larynx. In the epithelia, CGRP nerve fibers were mainly found in the epiglottis, arytenoid region and subglottis. Many taste buds were observed in the arytenoid region and were densely innervated by the CGRP nerve fibers. In the lamina propria, the plexus of CGRP nerve fibers was present, with some of these fibers associated with blood vessels. Laryngeal glands were also innervated by a few CGRP nerve fibers. In the intrinsic laryngeal muscles, abundant immunoreactivity was observed and many motor end-plate-like structures were found with CGRP immunoreactivity. These findings strongly suggest that CGRP plays an important role in all of the sensory, motor and autonomic nervous systems of the larynx.

Extramedullary plasmacytoma (EMP) arises outside the bone marrow, particularly in the head and neck region (nasopharynx, nose cavity, sinuses, and tonsils), and can be associated with multiple myeloma (MM). Three cases of EMP in the head and neck region are described: a first case describes an EMP of the subglottis 3 years after treatment of MM, a second case of an EMP solitary in the middle ear presenting as a jugular foramen syndrome, and a third case of an EMP localised at the epiglottis, recurring at the floor of the nose cavity. Treatment of each EMP was surgical. We reviewed literature about aetiology, clinical course, diagnostics, treatment and prognosis. Important presenting symptoms vary from epistaxis, rhinorrhoea, a sore throat, dysphonia to haemoptoea. Association with MM must be confirmed or excluded. Histopathological examination, with immunological staining or flow cytometry confirms the diagnosis. CT and MRI are useful in staging EMP. The treatment of EMP is surgery and/or radiotherapy. The prognosis depends on tumour size (>5 cm) and nodal involvement. The 10-year survival rate is 50-80%.