Endoscopic Airway Management of Laryngeal Sarcoidosis

Butler, Colin R.; Nouraei, S.A.R.; Mace, Alasdair; Khalil, S. Abi; Sandhu, Shona K.; Sandhu, Guri

doi:10.1001/archoto.2010.16

Cited by 35 publications

(54 citation statements)

References 21 publications

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“…A study similar to ours has recently been published showing a favourable effect of a combination of intralesional steroid injections and mucosa-sparing laser reduction based on the same principle as our method [19]. The positive effect of the current treatment can be demonstrated by comparing this and our study to a study from 1982 from the Mayo Clinic at a time when laser surgery was not practised.…”

Section: Discussionsupporting

confidence: 70%

“…However, as our patients only had symptoms and radiological findings located to the larynx, a bronchoscopic procedure was not performed. Several articles describe isolated laryngeal sarcoidosis without discussing the terms of this diagnosis [5,9,19]. We have used the diagnosis of clinically isolated laryngeal sarcoidosis based on the clinical findings.…”

Section: Discussionmentioning

confidence: 99%

“…None of our six patients were treated with tracheostomy. Of the ten patients treated with intralesional steroid and laser reduction, emergency tracheotomy was performed on two prior to the operation, but in both cases the tracheostoma could be closed [19].…”

Section: Discussionmentioning

confidence: 99%

“…For mild single-organ disease of the upper respiratory tract, a recent article suggests topical/local treatment, either medical or surgical or a combination of both [18]. Intralesional steroid injection in combination with mucosa-sparing laser surgery has recently been described with good results [19]. Steroid can be administered either by inhalation [20] or intralesionally [5,15,21].…”

Section: Introductionmentioning

confidence: 99%

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Clinically isolated laryngeal sarcoidosis

Plaschke¹,

Owen²,

Rasmussen³

2010

Eur Arch Otorhinolaryngol

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Laryngeal sarcoidosis is rare (0.5% of patients with sarcoidosis), the pathogenesis is unknown and the optimal treatment remains a matter of debate. We undertook this study to elucidate possible pathogenic factors in clinically isolated laryngeal sarcoidosis and to describe results of supraglottoplastic surgery. From 1995 to 2009, we identified six patients with histologically proven sarcoidosis of the larynx treated at Rigshospitalet. All patients were subjected to a panel of blood tests and MR scan of the head and neck. All patients had dyspnoea at admission, and five were subjected to a combination of CO(2)-laser excision of supraglottic tissue and closure of the incision with sutures. All serological tests were negative or normal, including angiotensin 1 converting enzyme. The clinical expression was uniform with pale, smooth swellings of the supraglottic structures. Surgery proved successful to maintain normal breathing. None of the many parameters examined--some previously having been found to be abnormal in sarcoidosis--were abnormal in the present cohort. We are therefore unable to elucidate the pathogenesis. The combined surgical approach re-established normal airway function for all five patients and complete remission without further swellings was seen in two patients.

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinically isolated laryngeal sarcoidosis

Plaschke¹,

Owen²,

Rasmussen³

2010

Eur Arch Otorhinolaryngol

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“…[33]. Combining two previously supported therapies, intralesional steroids and surgical debulking, showed some promise.…”

Section: Treatmentmentioning

confidence: 99%

Sarcoidosis of the Head and Neck

Badhey

Kadakia

Carrau

et al. 2014

Head and Neck Pathol

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Sarcoidosis is a complex disorder that often times involves the head and neck. Despite the presence of strong clinical evidence, tissue diagnosis and imaging is needed for confirmation of the disease. Although typically managed medically, when found in the sinonasal tract or intracranially, it may necessitate the intervention of a rhinologist-skull base surgeon. This article seeks to provide a comprehensive review of head and neck sarcoidosis, as this fascinating disorder often poses a diagnostic and therapeutic challenge. A brief discussion of surgical treatment for pituitary lesions is also provided. Articles from 1997 to 2013 were selected and reviewed by three researchers utilizing the most recent literature regarding sarcoidosis in the head and neck. PubMed searches were conducted using search terms such as "sarcoidosis", "neurosarcoid", and "extra-pulmonary sarcoid", among many others. A large collection of articles was generated and reviewed by the team of authors, and appropriate information was extracted to compose a thorough and expansive review of the subject. 10-15 % of patients with sarcoidosis have head and neck manifestations. Sinonasal and pituitary sarcoidosis presents a diagnostic challenge owing to its non-specific symptoms. Although systemic steroid therapy is often the first time treatment, endoscopic surgery is commonly used to treat advanced pituitary sarcoidosis refractory to medical management. As tissue diagnosis and imaging is key, a multi-disciplinary team approach is advantageous. Our study collates the available literature on head and neck sarcoidosis to provide a comprehensive review of the subject. This provides helpful information to guide all practitioners involved in the care of these challenging patients, namely pathologists, radiologists, otolaryngologists, and skull base surgeons, in the workup and management of head and neck sarcoidosis.

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Progressive Upper Airway Obstruction and Dysphagia in a Child With Supraglottic Edema

Hong

2020

JAMA Otolaryngol Head Neck Surg

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A 9-year-old, vaccinated boy with glucose-6-phosphate dehydrogenase deficiency and β-thalassemia trait presented with 1 month of progressive dyspnea, snoring, dysphagia, and weight loss. Both parents had a history of latent tuberculosis infection treated after immigrating to the US from Syria shortly after the patient's birth. The patient's pediatrician diagnosed him with reactive airway disease and adenotonsillar hypertrophy. He was referred to the otolaryngology clinic, where flexible laryngoscopy revealed diffuse upper airway lymphoid hyperplasia and supraglottic edema. He was sent to the emergency department, where he was stridulous and afebrile with a normal white blood cell count and an elevated erythrocyte sedimentation rate. A computed tomography scan of the neck revealed diffuse edema and contrast enhancement of the nasopharynx, oropharynx, hypopharynx, and supraglottis. A chest radiograph was normal.The patient was taken urgently to the operating room for direct microlaryngoscopy (Figure 1A and B) and intubated. Results of biopsies and cultures of the tonsils, adenoids, and supraglottis revealed diffuse non-necrotizing granulomas (Figure 1C) and oropharyngeal flora with negative acid-fast bacilli and Grocott methenamine silver stains. He remained intubated, and treatment with systemic corticosteroids and antibiotics was initiated. During this time, he had a normal angiotensin-converting enzyme (ACE) level and normal titers for antinuclear antibody (ANA), cytoplasmic antineutrophilic cytoplasmic antibody, perinuclear antineutrophilic cytoplasmic antibody, antimyeloperoxidase antibody, antiproteinase 3 antibody,anti-double-strandedDNAantibody,Smithantibody,Sjogrenantibodies,andhistoplasma antibodies. He also had normal results on tuberculin purified protein derivative and interferon-γ release assay (QuantiFERON; Qiagen).

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Endoscopic Airway Management of Laryngeal Sarcoidosis

Cited by 35 publications

References 21 publications

Clinically isolated laryngeal sarcoidosis

Clinically isolated laryngeal sarcoidosis

Sarcoidosis of the Head and Neck

Progressive Upper Airway Obstruction and Dysphagia in a Child With Supraglottic Edema

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