CT-Scan vs MRI in Diagnosing Laryngeal Carcinoma

Background: MRI imaging offers more sensitivity than CT to cartilage invasion but results in a high rate of false-positive studies which decreases their overall accuracy. The objective is to compare accuracy of CT scan vs MRI in the laryngeal carcinoma. Subjects and Methods: All patients have been diagnosed, with and without contrast, including neck MRI and CT. In order to prevent invalidation, before laryngeal biopsy, MRI and CT scanning have been done such that the images are not altered by peri tumorous inflammation. Results: The MRI classification was right for 20 out of 25 patients (80 percent) and 5 outsized cases: three cT1b lesions were pT1a and two cT1a lesions were squamous cell papilloma’s during pathological examination. CT was accurately identified in 17 out of 25 patients (68%), with 8 understated cases: 3 cT1a lesions by CT were pT1b, 3 cT1a lesions were pT3, and 2 tumours had not been found in the CT scan. Conclusion: Our research showed that MRI in preoperative stage early glottic cancer is more sensitive than CT to accurately select eligible patients for conservatory larynx surgery like super cricoid laryngectomy and cordectomy.

Incidence of anesthetic and surgical complications in laryngeal laser surgeries

Introduction: Carbon dioxide (CO2) laser is an available technological tool for laryngeal surgeons. Given the importance of laser outcomesand complications, this research was conducted to identify the complications associated with laser surgery in the patients referring to the5th Azar Medical-Educational Center in Gorgan, Iran, from 2013 to 2017. Methods: This descriptive cross-sectional study was conducted on 85 patients with laryngeal lesions who underwent microscopic surgerywith CO2 laser at the 5th Azar Medical Educational Center in Gorgan, Iran, from 2013 to 2017. The patients were examined for the associated short-term complications 1, 7, and 21 days after the operation. They were also examined after 3 months to determine the long-term complications and patient satisfaction with sound quality. The data were analyzed in SPSS software (version 16). A p-value less than 0.05 was considered statistically signifificant. Results: Out of the 85 patients undergoing laser surgery, 60 (70.6%) cases were male. None of the patients experienced short-term complications. In terms of long-term complications, 2 (2.35%) cases, who had failed to perform the follow-up, had recurrent lesions after 3 months of surgery. In addition, 18 (21.8%) subjects had recurrent hoarseness, 18.8% (n=16) and 2.35% (n=2) of whom were detected with laryngeal carcinoma and recurrence, respectively. However, a total of 67 (78.91%) cases did not suffer from long-term complications. In this study, out of 85 patients undergoing larynx surgery, 69 (81.2%) cases had benign pathology, while the rest (n=16, 18.8%) had malignant pathology. Conclusions: It seems that a CO2 lasersurgery that follows scientific principles can produce good outcomes.

Usage of piezoelectric instruments in larynx surgery

Objective: The aim of the study was to estimate usability of the piezoelectric knife in larynx surgery. Prove that the piezoelectric staff can be used to do any different shape incision within the larynx cartilages. Material and methods: 35 patients hospitalized in our Department in 2014–2016 were enrolled in our study. 24 patients went vertical partial laryngectomy and 1 patient went horizontal partial laryngectomy because of larynx cancer. 5 patients went partial laryngectomy because of low stage of piriformis recess cancer. Piezoelectric staff was used to do thyroidectomy and resection of thyroid cartilage suspected of carcinomatosis infiltration. The rest 4 patients had done widening of larynx lumen due to larynx stenosis or slenderness. The piezoelectric tool was used to do different incision or resection within the larynx cartilages in case of widening lumen of the larynx. Results: The larynx cartilages, especially thyroid cartilage could be cut in different shapes using piezoelectric tools. The usage of this equipment causes the minimal loss and small destruction of local healthy tissues. Conclusions: The Piezoelectric instrument is useful instrument suit to operate within larynx cartilages. Exchangeable tip available in different shapes enables different resections of cartilages. Using the piezoelectric staff we can remove pathological tissue with minimal local destruction. Our observation shows that larynx operation with a usage of the piezoelectric knife is safe and effective. Current English literature does not describe usage piezoelectric tools in larynx surgery. It is essential to do more observation about that type of operations.

Angled telescopic surgery, an approach for laryngeal diagnosis and surgery without suspension

CONTEXT: Many methods have been used successfully for the diagnosis and treatment of laryngeal diseases. Microscopic and, recently, telescopic surgery represent the state of the art in endoscopic laryngeal surgery but drawbacks are possible during their application. To keep the suspension apparatus adequately positioned, excessive force is sometimes placed on the upper teeth and tongue with the laryngoscope tube causing damage. Complications in relation to the pharynx, larynx and cardiovascular system have also been reported. OBJECTIVE: In order to reduce complications resulting from the manipulation or stimulation of the upper aerodigestive tract and from torque forces on the upper teeth. We present a method of larynx surgery in which laryngeal suspension is not required. DESIGN: Technical report. TECHNIQUES: We have devised a fiber-optic telescope with its 40mm distal portion deviated 60 degrees from the direction of the proximal portion. This angle was taken by measuring patients immediately before standard microlaryngeal surgery was performed. The surgical instruments have the same angle as the telescope, in order to work on the larynx. This technique provides an image that is not limited by the distal aperture of the laryngoscope and has an advantage in that magnification and illumination may be provided by changing the distance of the lesion from the tip of the instrument. we have operated on four patients with laryngeal diseases and have had no complications as a result of this approach. We feel that this technique gives us the freedom to view the lesions better and helps to minimize the drawbacks caused by laryngeal suspension.

Influence of Age on Laryngeal Carcinoma

The constant increase in human life expectancy has led to a higher proportion of oncologic patients of advanced age. The clinical characteristics of 272 patients with laryngeal carcinoma diagnosed when they were 70 or older are compared with those of a group of younger patients with the same kind of tumor. The advanced age group showed a higher proportion of women, less tobacco and alcohol use, a predominance of glottic location, and a higher previous morbidity. The T category was similar in both groups, but the advanced age group had a higher proportion of N0 tumors. The planning of treatment was similar in the two groups of patients, except for less use of both chemotherapy and partial larynx surgery in the advanced age group. Results in terms of local and regional control, distant metastasis, and 5-year adjusted survival were similar in both groups of patients. The results suggest that advanced age is not a determining factor when considering radical treatment in a patient with laryngeal carcinoma.