RESUMO
Se realizó un estudio prospectivo y descriptivo, incluyendo 103 pacientes que fueron tratados por cáncer de laringe en etapa inicial (T1-T2) con cirugía transoral. De ellos, 55 se diagnosticaron en estadio T1, 16 en estadio T1-b y 32 en estadio T2. El control local inicial (CLI) en pacientes con tumores malignos de laringe estadificados T1 fue 91%, el control local con rescate (CLR) 96%, la preservación de la función de la laringe (PFL) 93% y la sobrevida específica 96%. En T1-b, el CLI fue 81%, el CLR 94%, la PFL 94% y la sobrevida específica 94%. En T2, el CLI fue 63%, el CLR 94%, la PFL 72% y la sobrevida específica 78%. La cirugía transoral en cáncer de laringe con T inicial tiene resultados oncológicos similares a otros tratamientos (cirugía externa o radioterapia), pero consideramos que es la mejor opción por su baja morbilidad, menor duración del tratamiento, y porque deja abiertas todas las posibilidades para tratar posibles recurrencias. (AU)
A prospective and descriptive study was conducted, including 103 patients who were treated for early stage laryngeal cancer (T1-T2) with transoral surgery. Of these, 55 were diagnosed in stage T1, 16 in stage T1-b and 32 in stage T2. The initial local control (CLI) in patients with malignant T1 laryngeal tumors was: 91%, local control with rescue (CLR) 96%, preservation of larynx function (PFL) 93% and specific survival 96%. In T1-b the CLI was 81%, the CLR 94%, the PFL 94% and the specific survival 94%. In T2 the CLI was 63%, the CLR 94%, the PFL 72% and the specific survival 78%. Transoral surgery in laryngeal cancer with initial T has oncological results similar to other treatments (external surgery or radiotherapy), but we consider that it is the best option because of its low morbidity, shorter duration of treatment, and because it leaves open all the possibilities to treat possible recurrences. (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Neoplasias Laríngeas/cirurgia , Recidiva Local de Neoplasia/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Operatórios/métodos , Prega Vocal/patologia , Qualidade da Voz , Traqueostomia/estatística & dados numéricos , Neoplasias Laríngeas/classificação , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/fisiopatologia , Neoplasias Laríngeas/mortalidade , Neoplasias Laríngeas/radioterapia , Estudos Prospectivos , Epiglote/patologia , Duração da Terapia , Intubação Gastrointestinal/estatística & dados numéricosRESUMO
Congenital epiglottic cyst is a rare embryonic disease. As a congenital laryngeal mucocele, its clinical manifestations include repeated sudden dyspneic respiration and even suffocation accompanied by laryngeal stridor after birth. During food intake, bucking and vomiting is a key feature. Delay in diagnosis and treatment of the disease affects growth and the development of neonatorum leading to suffocation and death. This study was designed to investigate the safety of anesthesia in infants with congenital epiglottic cyst during operation to reduce the occurrence of its complications. The treatment of operations on 12 infants with congenital epiglottic cysts were retrospectively analyzed. Twelve cases of infants with epiglottic cysts received emergency enucleation. Owing to adequate preanesthetic preparation, cystectomies were successfully performed with microwave cauterization under suspension laryngoscopy. None of the 12 patients showed apparent suffocation during anesthesia, the surgical results were good, and after 6 months to 1 year of follow-up, the disease had not recurred. Because of the acute onset of the disease and its severe symptoms and complications, attention should be paid to improve preoperative preparation. Careful selection of proper anesthesia is the key to achieving a successful operation.
Assuntos
Anestesia/métodos , Atropina/efeitos adversos , Cistos/cirurgia , Epiglote/patologia , Doenças da Laringe/congênito , Anestesia/efeitos adversos , Atropina/administração & dosagem , Cistos/congênito , Feminino , Humanos , Lactente , Recém-Nascido , Doenças da Laringe/cirurgia , Laringoscopia , Masculino , Estudos Retrospectivos , Resultado do TratamentoRESUMO
The aim of the present study was to evaluate the dimensions of the pharyngeal airway space (PAS) in awake, upright children with different anteroposterior skeletal patterns using cone beam computed tomography (CBCT). The volume, area, minimum axial area and seven linear measurements of PAS were obtained from the CBCT images of 50 children (mean age 9.16 years). The patients were divided in two groups according to the ANB angle (group I 2° ≤ ANB ≤ 5°; group II ANB > 5°). Means and standard deviations of each variable were compared and correlated using independent t-test and Pearson's correlation test. There were statistically significant differences in the following parameters: angle formed by the intersection between NA and NB lines (p<0.001), angle formed by the intersection between SN and NB lines (p<0.05), Minimal pharyngeal airway space between the uvula and the posterior pharyngeal wall (p<0.05), airway volume (p<0.01), airway area (p<0.01) and minimum axial area (p<0.05). The anteroposterior cephalometric variable SNB had positive correlation with the variables PAS-UP (p<0.01), Minimal pharyngeal airway space between the uvula tip and the posterior pharyngeal wall (p<0.05), Pharyngeal airway space on mandibular line (p<0.05), Minimal pharyngeal airway space between the back of the tongue and the posterior pharyngeal wall (p<0.05), volume airway (p<0.05), airway area (p<0.05) and minimum axial area (p<0.05). The vertical cephalometric variables angle formed by the intersection between SN and GoGn lines (p<0.05) and angle formed by the intersection between FH and mandible plane (p<0.05) showed negative correlation with PAS-UT. These results showed that PAS was statistically larger in group I than group II, indicating that the dimensions of the PAS are affected by different anteroposterior skeletal patterns.
Assuntos
Má Oclusão/classificação , Faringe/patologia , Pontos de Referência Anatômicos/patologia , Cefalometria/métodos , Criança , Tomografia Computadorizada de Feixe Cônico/métodos , Epiglote/patologia , Feminino , Humanos , Imageamento Tridimensional/métodos , Masculino , Má Oclusão/diagnóstico por imagem , Má Oclusão/patologia , Mandíbula/patologia , Maxila/patologia , Nariz/patologia , Palato Duro/patologia , Faringe/diagnóstico por imagem , Sela Túrcica/patologia , Língua/patologia , Úvula/patologiaRESUMO
UNLABELLED: The involvement of pre-epiglottis space can change the indication for partial laryngeal resection. AIM: The aim of this study was to evaluate inter-observer and intra-observer agreement by means of computed tomography analysis regarding the involvement of the pre-epiglottis space (PES) from carcinoma of the upper aerodigestive tract and its relation with therapeutic planning. MATERIALS AND METHODS: Retrospective study of ninety-five computed tomography exams of patients with squamous cell carcinoma, from 1990 to 2004, were selected and evaluated; 87 were males and eight females, with ages ranging from 32 to 73 years. Imaging results were analyzed twice by three radiologists, individually, without any previous knowledge of the clinical stage. No patient had received any previous treatment up to the moment of imaging examination, such as surgery, chemotherapy or radiotherapy. All the cases were confirmed by biopsy. Information was obtained from the medical charts. RESULTS: Kappa Index was calculated by assessing agreement between the three observers. We obtained substantial to almost perfect levels of agreement. CONCLUSIONS: After a general Kappa Index of 0.72, the results suggest a substantial agreement in the involvement of the PES by means of computed tomography analysis.
Assuntos
Carcinoma de Células Escamosas/patologia , Epiglote/patologia , Neoplasias Hipofaríngeas/patologia , Neoplasias Laríngeas/patologia , Adulto , Idoso , Carcinoma de Células Escamosas/diagnóstico por imagem , Epiglote/diagnóstico por imagem , Feminino , Humanos , Neoplasias Hipofaríngeas/diagnóstico por imagem , Neoplasias Laríngeas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Estudos Retrospectivos , Tomografia Computadorizada por Raios XRESUMO
O comprometimento do espaço pré-epiglótico pode alterar a indicação de cirurgias parciais da laringe. OBJETIVO: Avaliar a concordância inter e intra-observadores da análise da tomografia computadorizada do envolvimento do espaço pré-epiglótico (EPE) por carcinoma epidermóide do trato aerodigestivo superior e sua repercussão no planejamento terapêutico. MATERIAL DE MÉTODO: Foram analisadas retrospectivamente as tomografias computadorizadas, do período de 1990 a 2004, de 95 pacientes com carcinoma epidermóide, sendo 87 do sexo masculino e apenas 8 eram do sexo feminino, com idade variando de 32 a 73 anos. Os exames foram avaliados duas vezes por três radiologistas, separadamente, sem o conhecimento prévio do estadiamento clínico. Todos os pacientes não haviam recebido qualquer tratamento até o momento do exame de imagem, como cirurgia, quimioterapia ou radioterapia. Todos os casos tiveram o diagnóstico confirmado por biópsia. As informações foram obtidas baseadas na revisão de prontuários médicos. RESULTADOS: O índice Kappa foi calculado para estimar a concordância entre os três observadores. A força de concordância variou de boa a excelente. CONCLUSÃO: Após um Kappa geral de 0,72, o resultado sugere uma concordância geral boa na avaliação do envolvimento do espaço EPE através de tomografia computadorizada.
The involvement of pre-epiglottis space can change the indication for partial laryngeal resection. AIM: The aim of this study was to evaluate inter-observer and intra-observer agreement by means of computed tomography analysis regarding the involvement of the pre-epiglottis space (PES) from carcinoma of the upper aerodigestive tract and its relation with therapeutic planning. MATERIALS AND METHODS: Retrospective study of ninety-five computed tomography exams of patients with squamous cell carcinoma, from 1990 to 2004, were selected and evaluated; 87 were males and eight females, with ages ranging from 32 to 73 years. Imaging results were analyzed twice by three radiologists, individually, without any previous knowledge of the clinical stage. No patient had received any previous treatment up to the moment of imaging examination, such as surgery, chemotherapy or radiotherapy. All the cases were confirmed by biopsy. Information was obtained from the medical charts. RESULTS: Kappa Index was calculated by assessing agreement between the three observers. We obtained substantial to almost perfect levels of agreement. CONCLUSIONS: After a general Kappa Index of 0.72, the results suggest a substantial agreement in the involvement of the PES by means of computed tomography analysis.
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Carcinoma de Células Escamosas/patologia , Epiglote/patologia , Neoplasias Hipofaríngeas/patologia , Neoplasias Laríngeas/patologia , Carcinoma de Células Escamosas , Epiglote , Neoplasias Hipofaríngeas , Neoplasias Laríngeas , Invasividade Neoplásica , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Estudos Retrospectivos , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: To report on the results of using a lateral thyrotomy approach on the paraglottic space to gain greater access for laryngocele resection under direct vision. STUDY DESIGN: A 26-year prospective and retrospective study. The study was conducted on 10 adult patients (5 men and 5 women) who had laryngocele of varying size on the paraglottic space. Six of the patients had internal laryngocele and four had exteriorized laryngocele. Five laryngoceles were left-sided, three were right-sided, and two were bilateral. METHODS: A V-shaped, full-thickness thyroid lamina resection with the triangle base at the superior border and the apex at a point midway of the thyroid lamina vertical extent was performed. RESULTS: A V-shaped lateral thyrotomy made exposure to the paraglottic space possible for direct submucosal laryngocele dissection. This approach has presented no complications to date. Postoperative minor edema or hematoma was found in the aryepiglottic and ventricular folds, but this disappeared within a few days. There was no recurrence; the minimum follow-up was 1 year. CONCLUSION: The triangular lateral thyrotomy approach provided access to the paraglottic space and superb visibility for resection of laryngocele of any size under direct vision, thus avoiding recurrence, morbidity, and complications.
Assuntos
Glote/cirurgia , Laringe/anormalidades , Cartilagem Tireóidea/cirurgia , Adolescente , Adulto , Idoso , Dissecação/efeitos adversos , Epiglote/patologia , Feminino , Seguimentos , Hematoma/etiologia , Humanos , Doenças da Laringe/etiologia , Edema Laríngeo/etiologia , Laringe/patologia , Laringe/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recidiva , Estudos RetrospectivosRESUMO
OBJECTIVE: To evaluate transcutaneous fine needle aspiration biopsy of the preepiglottic space for staging supraglottic squamous cell carcinoma. STUDY DESIGN: We studied 28 patients who underwent total or horizontal supraglottic laryngectomy as their main therapy modality due to supraglottic squamous cell carcinoma, followed in some cases by adjuvant radiation therapy. All the patients underwent transcutaneous fine needle aspiration. RESULTS: The cytopathologic examination of the material obtained by aspiration was compared to the histopathologic analysis of the laryngectomy specimens; the efficiency was 96.4%. The method did not cause any morbidity. CONCLUSION: Transcutaneous fine needle aspiration biopsy of the preepiglottic space is useful for preepiglottic space evaluation, with a high correlation with histopathologic results and no morbidity.
Assuntos
Biópsia por Agulha/métodos , Carcinoma de Células Escamosas/patologia , Epiglote/patologia , Neoplasias Laríngeas/patologia , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/cirurgia , Epiglote/cirurgia , Feminino , Humanos , Neoplasias Laríngeas/cirurgia , Laringectomia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/diagnóstico , Estudos Prospectivos , Sensibilidade e EspecificidadeAssuntos
Humanos , Masculino , Feminino , Neoplasias Laríngeas/etiologia , Neoplasias Laríngeas/terapia , Neoplasias Laríngeas/cirurgia , Neoplasias Laríngeas/radioterapia , Laringe/anatomia & histologia , Terapia a Laser/métodos , Microcirurgia/métodos , Laringectomia , Epiglote/patologia , DrenagemRESUMO
The histological findings in laryngeal biopsies and local clinical findings in thirty cases of leprosy have been reported in detail. It is emphasised that in areas where there is significant incidence of leprosy, laryngeal involvement may be expected even in the absence of local clinical manifestations and be got confirmed by histological examination and demonstration of acid-fast bacilli. Further, histological appearance may not be very characteristic at the outset. The observations made by previous authors have been reviewed and discussed.