Onco-epidemiological features of head and neck tumors within the competence of the otorhinolaryngological service across the regions of the Republic of Belarus

Objective. To analyze the onco-epidemiological features of head and neck tumors within the competence of the otorhinolaryngological service across the regions of the Republic of Belarus.Materials and methods. The material for the study was data on 21,533 cases of malignant neoplasms of the head and neck (including laryngeal tumors) registered in the Belarusian Cancer Registry from 2009 to 2018.Results. Significant changes have occurred in the structure of the incidence of head and neck malignant neoplasms over the past decade. The leading positions are occupied by such tumors of visual localization as cancer of the oropharynx (14.9 %), the floor of the oral cavity (12.4 %), tonsils (11.4 %) and tongue (excluding the root of the tongue) (11.4 %), which are available for diagnosis during routine clinical examination.Conclusion. The analysis of newly diagnosed cases of malignant neoplasms depending on the localization has showed that regardless of the availability of otorhinolaryngologists and staffing levels, patients with primary manifestations of the tumor process are not timely referred to the health experts for morphological verification, which requires further organizational decisions on patient referral at different levels of health care and defining the role and scope of responsibility of subject-matter primary care specialists.

Epstein-Barr Virus-Associated Carcinoma of the Larynx: A Systematic Review with Meta-Analysis

Over the past few decades, several publications have investigated the role of Epstein-Barr virus (EBV) in head and neck squamous cell carcinomas, and an increasing number of them have shown its presence in laryngeal tumors. The purpose of this meta-analysis was to evaluate the association of EBV with laryngeal carcinoma. The search was carried out in two databases, Scopus and PubMed, using the following terms: “Epstein-Barr virus” and “laryngeal carcinoma”. A total of 187 records were found, of which 31 were selected for meeting the inclusion and exclusion criteria. The meta-analysis yielded an overall pooled prevalence of 43.72% (95% confidence interval (CI): 34.35–53.08). Studies carried out in Europe and Eurasia had slightly higher pooled prevalence than other subgroups, while the prevalence of studies performed in developed countries was higher than in developing countries (46.37% vs. 34.02%). Furthermore, laryngeal carcinoma occurred almost three times as often among EBV-infected individuals compared to those without EBV infection (odds ratio = 2.86 (95% CI: 1.18–6.90); Begg’s test, p = 0.843 and Egger’s test, p = 0.866). Our findings support the idea that EBV is related to laryngeal carcinoma. However, further studies are needed before recognizing a definitive etiological role of EBV in the development and/or progression of laryngeal carcinomas.

Radiation-Related Hypopharynx-Stenosis with Spared Larynx Treated by a Novel-Shaped Silicone Stent

Background: Radiation-related hypopharyngeal stenoses are considered as complications after larynx sparing therapy of hypopharyngeal or laryngeal tumors. Methods: The reported patient suffered from chondronecrosis of the cricoid after radiation of a larynx carcinoma and was treated by removing the necrotic cartilage. To prevent emerging stenosis of the hypopharynx, a customized hypopharyngeal stent was constructed on the basis of CT scan data. The Y-shaped stent was placed dorsal to the larynx, caudal to the arytenoid cartilages and remained in place without dislocation or irritation of the larynx for 8 weeks. During that time, the hypopharynx was stented, and the mucosa grew around the stent covering the complete circumference of the hypopharynx again. 18 weeks after removal of the stent, the hypopharynx did not reveal any re-stenosis. Conclusion: This customized hypopharyngeal stent is the first reported approach applied with spared larynx, which has been tolerated for a long period of time.

Schwannoma of False Vocal Cord - A Rare Entity

Laryngeal Schwannoma is rare comprising 0.1 – 1.5% of all benign laryngeal tumors. The most common site in larynx is aryepiglottic fold followed by arytenoids, ventricular folds, and vocal cord. Patients present with the symptoms of hoarseness, dysphagia or globus sensation. We present a 33-year-old male with supraglottic schwannoma who experienced hoarseness of voice for three months. The patient underwent micro laryngeal surgery and submucosal solid tumor of false vocal cord was removed. Postoperative recovery was uneventful and after one month of follow up the patient was improving with no hoarseness of voice.

Expression of Programmed Death Receptor 1 (PD-1) Gene and Its Ligand (PD-L1) in Patients with Laryngeal Cancer

(1) Background: The interaction of the programmed death receptor (PD-1) with its ligand 1 (PD-L1) allows cancer cells to escape from the control of the immune system. Research evaluating the expression of immune checkpoint genes in the tissues of laryngeal tumors may contribute to the introduction of new effective immunotherapeutic methods in this group of neoplasms. The aim of this study was to evaluate the expression of the gene for the programmed death receptor (PD-1) and its ligand (PD-L1) in laryngeal tumors (T1, T2, T3) in patients without lymph node involvement and distant metastases. (2) Methods: The study included 73 patients: 39 of them were diagnosed with carcinoma planoepiteliale keratodes (study group) and 34 with nasal septal deviation undergoing septoplasty (control group). Biological material for molecular tests (Real time PCR) was collected during surgical procedures. Furthermore, all study participants completed a questionnaire regarding, among others, smoking and body weight. (3) Results: Gene expression for programmed death receptor 1 (PD-1) and its ligand 1 (PD-L1) was, statistically, significantly higher (p < 0.0001) in tumor tissue than in unchanged mucosa. Moreover, it was found that the greater the tumor size, the higher the expression level of the tested molecules. (4) Conclusions: Although further research on the role of the PD-1/PD-L1 pathway in laryngeal tumors is necessary, the presented reports are promising and may constitute a contribution to considerations on the introduction of targeted immunotherapy with anti-PD1 and anti-PD-L1 monoclonal antibodies in the treatment of these tumors.

Modular Approach to Open Partial Horizontal Laryngectomy: Step-by-Step Anatomic Dissection

Open partial laryngectomies still play an important role in contemporary conservative management of laryngeal cancer. A comprehensive and systematic classification of open partial horizontal laryngectomies (OPHLs) was presented by the European Laryngological Society working committee in 2014. The aim of this video is to show the main surgical steps in OPHL using a cadaveric dissection and to explain the modular approach for removal of laryngeal tumors.

High-flow nasal oxygen for laryngeal tumor debulking: case report and current challenges

<p class="abstract">High-flow nasal oxygen (HFNO) has brought new opportunities in shared airway surgery. Contemporary challenges with its use in severely obstructive conditions such as laryngeal tumors still need to be addressed as there is discrepancy in its use and access among centres. We reported a case in which the use of HFNO allowed laryngeal tumor debulking while avoiding tracheotomy in a stridulous patient. The patient described was a 70 year old patient with stridor at rest secondary to a laryngeal tumor diagnosed five days before surgery. Tumor debulking could be safely initiated under general anaesthesia, which would not have been possible without HFNO. This report served as an example of an alternative to awake tracheotomy in the management of severely obstructive laryngeal pathology We wish to discuss through this case management of severely obstructive laryngeal pathology in the era of HFNO, while encouraging discussion on its potential benefits and limits.</p>