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Clinically based comments on the proposal for revision of the European Laryngological Society (ELS) classification of endoscopic cordectomies.
No full textNo abstract available
Conclusions
...In our opinion, there are no reasons to change the original
ClassiWcation of cordectomies from type I to IV. On the
other hand, the extension to the contralateral vocal fold (or arytenoid, ventricle, subglotts) should be stated in full.
Considering the above-mentioned examples, we should
classify them as type I cordectomy extended to contralateral
vocal fold, and type IV cordectomy extended to contralateral
vocal fold, respectively. Another reasonable subclassification
modality could be to associate a letter with
each cordectomy type (from I to IV) for anatomically identifying
the extension of surgical excision (sub-type a for
contralateral vocal fold extension, b for arytenoid extension,
c for ventricular extension, and d for subglottic extension).
Considering again our examples, we could classify
them as type Ia and IVa type cordectomies, respectively.
The extension to more than one laryngeal sub-sites could be
codified with two or more letters (Fig. 5). Following this
classification logic, a type VI cordectomy could be codified
as type V. From our viewpoint, the practical advantage of
our proposal of change of original ELS Classification is the
capability to express the eVective “weight” of surgical excision.
This information could be extremely useful in
patients’ follow-up and immediate understanding of functional
and oncological results..
Clinically-based comments to revised version of ELS classification of endoscopic cordectomies.
No full textnot availabl
Adult laryngeal hemangioma CO2 laser excision. A single institution 3-year experience (Vittorio Veneto 2001-2003).
No full textCONCLUSIONS:
Adult supraglottic hemangiomas can be treated successfully with CO2 laser excision with limited morbidity. Extended laryngeal cavernous hemangiomas involving hypopharynx should be approached with staged CO2 laser surgical procedures.
OBJECTIVES:
Hemangioma of the adult larynx is an uncommon, benign lesion characterized by thin, friable mucosa overlying the vascular stroma. The optimal surgical approach to these lesions is still controversial because only anecdotal case reports or very limited series are available. We report a 3-year, retrospective, single institution study of the results of CO2 laser treatment of supraglottic hemangiomas in adults.
PATIENTS AND METHODS:
Six consecutive cases of adult laryngeal hemangioma were treated by the first author with CO2 laser microsurgery alone.
RESULTS:
In five of six cases, no recurrences have been diagnosed (median follow-up period: 29 months). One case presented limited persistence of disease in the retro-cricoid and arytenoids at 20-month follow-up control
GLOTTIC LASER SURGERY: OUTCOMES ACCORDING TO 2007 ELS CLASSIFICATION.
No full textThe aim of the present investigation was to analyze the oncological results of a series of early stage glottic carcinomas treated with CO(2) laser-assisted endoscopic surgery. We focused on prognosis factors with significant impact on local control and disease-free survival (DFS). This retrospective study was conducted on a series of 177 consecutive patients with pT1-T2 glottic carcinomas treated with CO(2) laser-assisted endoscopic surgery in the period 2000-2007. All considered patients had at least a 24-month follow-up period (mean follow-up 49.1 ± 23.0 months). The overall survival and the disease-specific survival rates were respectively 90.8 and 98.8%. The rates of local control with primary laser surgery, ultimate local control with laser alone, and laryngeal preservation were 86.3, 94.3, and 97.7%, respectively. Arytenoids (p = 0.006) and limited subglottic involvements (p = 0.0002) have a significant impact on DFS. Endoscopic laser surgery is the gold standard in the treatment of early glottic carcinoma because of high local control rates with laser alone, day surgery modality, very low morbility, good post-operative voice quality in most of the cases, and low costs
Bene e coscienziosamente: Achille Bertini Calosso, Soprintendente ai Monumenti e alle Gallerie dell’Umbria. Tutela e valorizzazione del patrimonio culturale umbro
No full textCO(2) laser treatment of laryngeal stenoses after reconstructive laryngectomies with cricohyoidopexy, cricohyoidoepiglottopexy or tracheohyoidoepiglottopexy.
No full textSupracricoid 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
Nodal marginal zone lymphoma: current knowledge and future directions of an heterogeneous disease
No full textOrgan-preservation surgery following failed radiotherapy for laryngeal cancer. Evaluation, patient selection, functional outcome and survival.
Full text linkPURPOSE OF THE REVIEW:
Although radiotherapy is a well codified treatment for laryngeal carcinomas, the management of local recurrence after failed radiotherapy remains controversial. Total laryngectomy is the classical salvage surgical approach. Recent evidence showed that selected laryngeal recurrences may be successfully treated with partial laryngectomies with comparable survival rates, acceptable morbidity, tracheostomy closure, effective swallowing, and satisfactory voice intelligibility.
RECENT FINDINGS:
Recurrent laryngeal carcinoma after radiotherapy failure requires a comprehensive clinical, radiological and pathological restaging. Strict selection criteria are mandatory for the identification of radiotherapy failure cases amenable to conservative laryngeal surgery. Although larger series confirmation is necessary, conservative salvage surgery seems definitely promising. Salvage endolaryngeal laser surgery after irradiation failure allows in selected cases a mean local control rate of 65%. Selectively, supracricoid laryngectomy can be a flexible alternative to salvage total laryngectomy being conservative of laryngeal functions (mean local control rate of 85%). Selected laryngeal recurrences can be correctly treated also with vertical or horizontal supraglottic laryngectomies. In partial laryngectomies, intraoperative frozen sections are mandatory: postoperatively permanent sections have to confirm all margins.
SUMMARY:
When proper selection criteria for conservative salvage laryngeal surgery are used, laryngeal function can be preserved with oncological efficacy also after radiotherapy failure
Paediatric laryngeal malignant nerve sheath tumour.
No full textMalignant nerve sheath tumours (MNSTs) are more frequently diagnosed in the extremities, the chest wall and the abdominal wall. Laryngeal MNST is an extremely rare occurrence, particularly in children. We treated a laryngeal recurrence of MNST in a 13-year-old boy with chemotherapy followed by horizontal supraglottic laryngectomy extended to left arytenoid and ipsilateral vocal fold and bilateral neck dissection. Four years later, hemithyroidectomy was performed for thyroid MNST recurrence. At present, 6 years after last intervention, the patient shows no evidence of recurrent disease
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