September 30, 2010 Yoav Hahn, MD, Richard Isaacs, MD, and Peter C. Belafsky, MD, PhD
July 31, 2010 Jacqui Allen, MBChB, FRACS and Peter C. Belafsky, MD, PhD
July 31, 2010 Nir Hirshoren, MD, Jeffrey M. Weinberger, MD, FRCSC, Tzahi Neuman, MD, Ophir Ilan, MD, PhD, and Avraham Ben-Yaakov, MD
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Abstract
Laryngeal vascular leiomyomas are uncommon benign tumors that seldom recur following complete excision. The choice of excision procedure-via direct laryngoscopy or an open approach-is dictated by tumor size, the expected amount of blood loss, and any comorbidities the patient may have. We report an unusual case of a recurrent laryngeal vascular leiomyoma in a 64-year-old woman who also had a concurrent parathyroid adenoma and a history of breast carcinoma. A surgical resection via an external approach along with laser resection of a small glottic component was needed.
June 30, 2010 Itzhak Brook MD, MSc
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I was shaken to my core 4 years ago when I was diagnosed with throat cancer. Even though my cancer was removed and I received local radiation, it recurred 20 months later. Unfortunately, my surgeons were unable to completely remove the tumor using laser, and I was left with no choice except to undergo laryngectomy. I faced the daunting realization that I could no longer continue to lecture and speak in public.
June 30, 2010 Robert E. Stephens, PhD, Austin Bancroft, DO, Alan G. Glaros, PhD, and Lisa H. Lowe, MD
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Abstract
We conducted a retrospective study to measure laryngeal descent in human infants and to determine if there is any correlation between the associated anatomic changes and the timing of the peak incidence of sudden infant death syndrome (SIDS), which is 2 to 4 months of age. We performed a computerized search of hospital records at our institution to identify magnetic resonance imaging (MRI) scans of the head and neck and plain radiographs of the lateral neck in patients younger than 1 year of age (range: 1 to 357 days). After unusable images were excluded, 79 head and neck MRI scans and 111 lateral neck x-rays were suitable for study. Two measurements were taken from each image: one from the tip of the epiglottis to the uvula and one from the tip of the epiglottis to the center of the sella turcica. These measurements were then graphed against the subject's age. SPSS statistical software was used to determine growth curves of the various measurements. The first derivative of these curves was calculated to determine the rate of laryngeal descent at a given age. We found that most subjects did not have an overlapping epiglottis and uvula during the first few months of life. The rate of laryngeal descent, based on measurements of the distance between the epiglottis and uvula, gradually increased in a near-linear fashion from as low as 0.005726 mm/day at day 1 of life to as high as 0.028366 mm/day at 300 days of age. We found no sharp increase in the rate of descent at 2 to 4 months of age, and thus no support for our hypothesis that there might be a correlation between anatomic changes and the peak incidence of SIDS.
May 31, 2010 James R. Tate, MD and Peter C. Belafsky, MD, PhD
March 31, 2010 Philip B. Zald, MD, Stephen M. Weber, MD, PhD, and Joshua Schindler, MD
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Abstract
Laryngeal adenoid cystic carcinoma (ACC) is a rare clinical entity that poses a number of diagnostic and therapeutic challenges. We present a case of ACC of the subglottic larynx, and we review its diagnosis and management. We also discuss the workup of submucosal masses of the subglottic larynx, with an emphasis on clinical and radiologic diagnosis, surgical treatment, radiotherapy, and emerging therapies. The presence of a submucosal mass in the subglottic larynx should raise suspicion for the presence of ACC.
March 31, 2010 Amy L. Rutt, DO, Mary J. Hawkshaw, BSN, RN, CORLN, and Robert T. Sataloff, MD, DMA, FACS
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Abstract
Laryngeal cancer in patients younger than 30 years is uncommon. We present data on this population obtained from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program. We identified 99 patients in this age group from the SEER 17 registry, which includes data submitted from 1973 through 2003. This population was made up of 52 females and 47 males; most were white, and most were aged 25 to 29 years. Malignancies of the glottis were the most common cancers, followed by supraglottic lesions. The 5-year relative survival rate was lowest among those aged 15 to 19 years-60.1%; 5-year relative survival among those aged 20 to 24 and 25 to 29 years was 87.7 and 87.4%, respectively. The etiology of squamous cell carcinoma (SCC) in children and adolescents remains uncertain, but in the adult population, a history of smoking, drinking, and poor oral hygiene cannot be ignored. Carcinoma of the larynx in young people has been related to malignant degeneration of papillomas and to complications of radiotherapy for papillomas. Infection with the human immunodeficiency virus possibly accelerates the development of SCC in patients with significant risk factors, presumably by impairing normal immune surveillance mechanisms.
March 31, 2010 Sardar U. Khan, DLO, FCPS, FRCS(Ire), Cyril Kenefick, FRCS, FRCS(Edin), Gerard O'Leary, FRCS(Edin), FRCS(Ire), and James J. Lucey, FRCPath
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Abstract
We describe the case of a 57-year-old man who was referred to us with persistent sore throat, dysphagia, and enlarged tonsils. He had not responded to earlier treatment with antibiotic therapy and other routine measures. In view of the persistent nature of the patient's symptoms and the tonsillar hypertrophy, we decided to perform a tonsillectomy and to send the excised specimens for pathologic analysis. Histologic evaluation identified non-Hodgkin lymphoma in both tonsils. The patient was treated with postoperative chemo- and radiotherapy, and he was free of symptoms during 18 months of follow-up. To the best of our knowledge, only 4 cases of bilateral non-Hodgkin lymphoma of the tonsils have been reported in the English-language literature. We also discuss the importance of histologic analysis of excised tonsil tissue in selected cases.
February 1, 2010 Ninef E. Zaya, MD and Gayle Woodson, MD
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Abstract
We report an unusual case of hypocalcemia and respiratory distress related to acid-suppressive therapy. The patient was a 50-year-old woman with bilateral laryngeal paralysis and hypoparythyroidism resulting from a thyroidectomy performed more than 30 years previously. She required large doses of calcium supplementation to maintain a normal calcium level. Her airway had been marginally adequate. A few weeks prior to presentation, she began to experience increasing dyspnea. Examination was suggestive of laryngopharyngeal reflux, and she was started on a therapeutic trial of esomeprazole 40 mg twice daily. Three days later, she presented to the emergency room with airway distress. Laboratory studies indicated that the patient had hypocalcemia. The esomeprazole was discontinued, and she was treated with intravenous calcium; her symptoms resolved. We attribute the airway distress to tetany in synkinetically reinnervated laryngeal adductor muscles. We recommend that acid-suppressive therapy should be used with caution in patients with hypoparathyroidism or hypocalcemia.
February 1, 2010 Swapna K. Chandran, MD and Robert T. Sataloff, MD, DMA, FACS
January 1, 2010 Garima Agarwal, MD and Soham Roy, MD, FACS, FAAP
