Larynx

Case report: Leiomyosarcoma of the parapharyngeal space

July 5, 2012     Pradipta Kumar Parida, MBBS, MS; Jaimanti Bakshi, MBBS, MS; Sanjeev Bhagat, MBBS, MS; Ramandeep Singh Virk, MBBS, MS
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Abstract

Leiomyosarcoma is usually found in the female genital tract, the retroperitoneum, the wall of the gastrointestinal tract, and subcutaneous tissues. An appearance of this malignant tumor in the parapharyngeal space is extremely rare and may be difficult to diagnose. Because of its rarity, little information exists on management and prognosis. We report the case of a 50-year-old man with a parapharyngeal space leiomyosarcoma who was treated with total excision of the tumor and postoperative radiotherapy. At follow-up 6 months postoperatively, he was well and free of disease. To the best of our knowledge, this is only the third case of a leiomyosarcoma in the parapharyngeal area to be reported in the literature. We discuss the diagnosis and treatment of leiomyosarcoma in this aspect.

Acute candidal pharyngolaryngitis

July 5, 2012     Andrew Mallon, DO; Rima A. DeFatta, MD; Robert T. Sataloff, MD, DMA, FACS
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Use of inhaled steroids has been identified as a risk factor for the development of laryngeal candidiasis. Therefore, if dysphonia, cough, and general laryngeal irritation occur in a patient using inhaled steroids, the possibility of laryngeal candidiasis should be considered.

Primary NK/T-cell lymphoma of the larynx

April 30, 2012     Nechama Uri, MD; Yaakov Schindler, MD; Miriam Quitt, MD; Olga Valkovsky, MD; Geva Barzilai, MD
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Abstract

Laryngeal extranodal non-Hodgkin lymphoma is uncommon, accounting for less than 1% of all laryngeal neoplasms; the B-cell phenotype is predominant. Lymphomas outside the nasal cavity are rare and highly aggressive. We present a case of primary natural killer T-cell (NK/T-cell) lymphoma of the larynx that arose in a 45-year-old man. Because only a limited amount of data is available on laryngeal NK/T-cell lymphoma, the mainstay of treatment remains unclear, although some data suggest that radiotherapy alone is the best option. Our patient was treated with chemotherapy and radiotherapy, and he remained in remission 2 years later.

Laryngeal schwannoma excised under direct laryngoscopy: Case report

April 30, 2012     Iosif Vital, MD; Dan M. Fliss, MD; Jacob T. Cohen, MD
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Abstract

Laryngeal schwannomas (neurilemmomas) are extremely rare, and they present the otorhinolaryngologist with diagnostic and management challenges. These lesions usually present as a submucosal mass, and they are always a potential threat to the airway. We describe the case of a 75-year-old woman with a laryngeal schwannoma that arose from the left postcricoid area and covered the piriform sinus and arytenoid cartilage on that side. The tumor was completely excised under direct laryngoscopy with the use of a CO2 laser, and preservation of the mucosal lining of the larynx was achieved.

Laryngeal papilloma

April 30, 2012     Rima A. DeFatta, MD; Johnathan B. Sataloff; Grace E. Klaris; Robert T. Sataloff, MD, DMA, FACS
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Microbial colonization of Blom-Singer indwelling voice prostheses in laryngectomized patients: An Indian perspective

March 31, 2012     Suhail I. Sayed, MS, Rehan Kazi, MS, PhD, Shubhra Sengupta, MD, Abhay Chowdhari, MD, DM, and Mohan Jagade, MS, MCh
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Abstract

We analyzed a series of adults with an implanted voice prosthesis that had malfunctioned and required removal as a result of the attachment and growth of microorganisms. Our goal was to determine the characteristics of these colonizing microbes. We swabbed the esophageal side of each prosthesis to obtain microbial flora for analysis with standard culture media. In all, we studied 22 prostheses in 18 patients (3 patients had received multiple prostheses). We found mixed contamination (both yeast and bacteria) in 19 of the 22 cultures (86.4%); the other 3 cultures yielded bacteria only, and there was no instance of yeast only. The most common yeast isolated was Candida albicans (68.2% of cultures), and the most common bacterium was Pseudomonas aeruginosa (63.6%). The average lifetime of the prostheses was 201 days (∼6 mo, 3 wk). This study, which was the first of its kind in India, revealed that the microbial picture here was different from that found in previously reported studies of European populations. We presume the differences are attributable to different lifestyles and dietary habits.

Third branchial anomaly: Endoscopic management revisited

March 31, 2012     Mala Tanna, MD, Monica R. Sharma, DDS, and Bijal Patel, MD
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Third and fourth branchial apparatus anomalies may be misidentified as a recurrent deep neck abscess that does not respond to appropriate medical or surgical therapy or as recurrent acute suppurative thyroiditis, respiratory distress, or retropharyngeal abscess.

Topical measles-mumps-rubella vaccine in the treatment of recurrent respiratory papillomatosis: Results of a preliminary randomized, controlled trial

March 31, 2012     Jin Lei, MD, Wang Yu, MD, Lin Yuexin, MD, Chen Qi, MD, Sun Xiumin, MD, and Zhang Tianyu, PhD
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Abstract

We conducted a study to test the hypothesis that the measles-mumps-rubella (MMR) vaccine can either prevent further recurrences of recurrent respiratory papillomatosis (RRP) or prolong its remission. Our study population was made up of 26 children with RRP. All patients underwent surgical excision of their lesions. After the lesions were removed, half of these patients were prospectively randomized to receive a topical coating of the MMR vaccine on the site of their excised lesion (intervention group); the other half were treated with excision alone (control group). The patients in the intervention group experienced a longer period of recurrence-free remission than did those in the control group (median: 160 and 133 days, respectively), but the difference was not statistically significant. Therefore, it appears that topical MMR vaccine as an adjunct to routine surgical management may not be beneficial in preventing or slowing the return of RRP. However, we believe that further studies with larger patient populations are warranted.

Ventricular cyst of the larynx

March 1, 2012     Johnathan B. Sataloff, Rima A. DeFatta, MD, Mary J. Hawkshaw, BSN, RN, CORLN, and Robert T. Sataloff, MD, DMA FACS
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Surgery for supraglottic cysts may not be necessary in patients in whom the cysts do not grow or interfere with phonation, if these patients will comply with follow-up for close observation. If the mass enlarges or causes severe enough symptoms to warrant the risks of surgery, excision is usually safe and effective.

The association between Helicobacter pylori and laryngopharyngeal reflux in laryngeal pathologies

March 1, 2012     Engin Çekin, MD, Mustafa Ozyurt, PhD, Evren Erkul, MD, Koray Ergunay, MD, Hakan Cincik, MD, Burak Kapucu, MD, and Atila Gungor, MD
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Abstract

We conducted a study to determine the presence or absence of Helicobacter pylori and laryngopharyngeal reflux (LPR) in 43 previously untreated patients who had presented with a laryngeal lesion. Our aim was to determine if there was any association among H pylori, LPR, and laryngeal lesions. H pylori status was determined by real-time polymerase chain reaction (PCR) assays of biopsy tissue obtained during direct laryngoscopy. The presence or absence of LPR was determined on the basis of patients' reflux symptom index (RSI) and reflux finding score (RFS), which were based on their questionnaire responses and findings on endoscopic examination of the larynx, respectively. Patients with an RSI of 14 or more and/or an RFS of 8 or more were considered to have LPR. H pylori was present in 24 patients (55.8%) and absent in 19 (44.2%)-not a statistically significant difference. The prevalence of LPR was higher than the prevalence of H pylori; it was present in 30 patients (69.8%) and absent in 13 (30.2%). The difference was statistically significant (p = 0.01). We found no association between H pylori status and LPR status. Additionally, we analyzed two subgroups based on whether their lesions were benign or malignant/premalignant and found a significant relationship between LPR positivity and the presence of malignant/premalignant laryngeal lesions (p = 0.03). We found no association between H pylori status and either of the two subgroup categories.

Endolaryngeal lipoma: Case report and literature review

February 18, 2012     Saki Nader, MD, Soheila Nikakhlagh, MD, Fakher Rahim, PhD, and Payam Fatehizade, MD
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Abstract

Lipomas are the most common benign tumors affecting the soft tissues. They can occur at any age, but they typically appear in patients older than 40 years. They are found equally in men and women. Lipomas are uncommon in the head and neck, but when they do appear there, they can arise in any location, including the palate, tongue, tonsil, larynx, and parotid gland. We report the case of a 63-year-old man who presented to the emergency department with a large spindle-cell lipoma of the endolarynx. The patient was followed for 6 months, and he exhibited no snoring or breathing difficulties.

Suprahyoid pharyngotomy for excision of laryngeal venous malformation

January 25, 2012     Unnikrishnan K. Menon, MS(ENT), DNB(ENT), N.V. Deepthi, MBBS, and Indudharan R. Menon, MS(ENT), DLO, DNB(ENT)
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Abstract

We report an uncommon case of symptomatic venous malformation of the larynx in a 22-year-old man, and the successful surgical management thereof. A detailed radiologic investigation of the lesion was done, followed by surgical excision via a suprahyoid pharyngotomy using cold instruments. Long-term follow-up was maintained, and the patient had subjective and objective resolution of his symptoms and signs at 3 years postoperatively. We conclude that radiology can reveal hitherto unsuspected extensions of vascular malformations in the neck and that surgical excision is a viable mode of treatment in upper aerodigestive venous malformations.

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