A 12-year-old male with a family history of inflammatory bowel disease presented with sleep-disordered breathing and was found to have chronic, granulomatous swelling of the supraglottic larynx. His airway was managed with tracheostomy, regular interval laryngeal steroid injections, supraglottoplasty, and “pepper pot” CO2 laser resurfacing leading to eventual decannulation. Due to the non-necrotic nature of the granulomatous inflammation, as well as the patient’s family history of inflammatory bowel disease, the leading diagnosis was Crohn disease, but isolated laryngeal sarcoidosis could not be ruled out. There are only 13 reported cases of laryngeal manifestations of Crohn disease in the literature, with only 2 cases occurring in pediatric patients. This case report adds to this body of literature and discusses strategies for managing granulomatous supraglottic edema when definitive diagnosis is not fully clear.
Objective
The aim of this study was to evaluate our institutional experience with the combined transoral plus lateral pharyngotomy (TO+LP) approach in a subset of patients with advanced or recurrent oral and oropharyngeal malignancy.
Study Design
A retrospective study of procedures utilizing TO+LP for cancer resection between January 2007 and July 2019.
Setting
Tertiary academic medical center.
Methods
Thirty‐one patients underwent a TO+LP approach for the resection of oral and oropharyngeal tumors. Functional and oncologic outcomes were analyzed.
Results
Eighteen (58.1%) patients were treated with TO+LP for recurrent disease. Twenty‐nine required free tissue transfer and 2 (6.5%) had positive margins. The median time to decannulation was 22 days (range 6‐100 days). Thirteen (41.9%) patients still required enteral feeding at their most recent follow‐up. Patients without a history of prior radiation were decannulated sooner (
p
= .009) and were less likely to require enteral feeding at the first postoperative follow‐up (
p
= .034) than those who had prior head and neck radiotherapy.
Conclusion
A TO+LP approach can be used to achieve good functional and oncologic results for selected patients with advanced or recurrent oral and oropharyngeal cancer when minimally invasive options such as transoral robotic surgery, transoral laser microsurgery, or radiotherapy are not possible.
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