The pathology and management of subglottic cancer

Ferlito, Alfio; Rinaldo, Alessandra

doi:10.1007/s004050050217

Cited by 46 publications

(21 citation statements)

References 23 publications

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“…The jugular chain of lymph nodes should be considered as a secondary site of lymphatic spread for subglottic cancers [48]. The incidence of supraclavicular (level V), middle (level III) and lower jugular (level IV) node metastases, which are only present after the involvement of the paratracheal nodes, is low [24]. Glottic, supraglottic, transglottic and subglottic cancers may metastasize to precricoid or prelaryngeal lymph node or Delphian node and to sub-Delphian nodes in the anterior tracheal compartment of level VI [23,[49][50][51][52][53][54][55].…”

Section: Choice Of Surgical Procedures For Elective Treatment Of the Neckmentioning

confidence: 99%

“…This is a generic term used for any type of neck dissection, such as conventional radical neck dissection, modified radical neck dissection, selective neck dissection (3 node levels resected), or limited neck dissection (no more than 2 node levels resected) [14]. Elective (prophylactic) neck dissection has been recommended for the N0 neck in patients with T2-T4 supraglottic cancers [15][16][17], T3-T4 glottic cancers [17][18][19][20][21][22], T3-T4 subglottic cancers [17,[22][23][24] and in patients with recurrent supraglottic and advanced glottic cancers treated by radiotherapy and salvaged by laryngectomy [25].…”

Section: Elective Neck Dissectionmentioning

confidence: 99%

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Surgical Treatment of the Neck in Cancer of the Larynx

Ferlito¹,

Silver²,

Rinaldo³

et al. 2000

ORL

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Current concepts in management of the clinically negative and clinically positive neck in laryngeal cancer are reviewed. Occult disease in the neck not detected by physical and radiographic examination may also be difficult to identify on routine histologic examination. Immunohistochemistry or molecular analysis may detect metastatic involvement not apparent by light microscopy. The surgeon should be aware of the relatively high incidence of micrometastases in patients with laryngeal cancer to establish optimal treatment approaches. Elective treatment of the neck is recommended for supraglottic tumors staged T2 or higher, and glottic or subglottic tumors staged T3 or higher.The neck may be treated electively by either surgery or irradiation, but irradiation is best reserved for cases where that modality is employed for the primary tumor. Elective neck dissection provides important information for prognostic purposes and therapeutic decisions, by establishing the presence, number, location and nature of occult lymph node metastases. The selective lateral neck dissection (levels II, III and IV), unilateral or bilateral, is the procedure of choice for elective treatment. Paratracheal nodes (level VI) should be dissected in cases of advanced glottic and subglottic cancer. Complete radical or functional neck dissections are excessive in extent, as levels I and V are almost never involved. Sentinel lymph node biopsy may fail to detect tumor on frozen section examination or may not reveal ‘skip’ metastases.The clinically involved neck is usually treated by complete radical or functional neck dissection of levels I through V. Selective neck dissection has been employed successfully in selected cases, particularly for N1 or occasionally N2 nodal involvement. The selective neck dissection can be extended to include structures at risk. More advanced disease has been treated in this manner often in association with adjuvant chemotherapy and/or irradiation. While the benefit of adjuvant treatment is difficult to assess, it appears most useful in cases with extranodal spread of disease, a factor associated with the worst prognosis.

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Section: Choice Of Surgical Procedures For Elective Treatment Of the Neckmentioning

confidence: 99%

Section: Elective Neck Dissectionmentioning

confidence: 99%

Surgical Treatment of the Neck in Cancer of the Larynx

Ferlito¹,

Silver²,

Rinaldo³

et al. 2000

ORL

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“…Clinical symptoms and signs of the disease such as dyspnea, stridor, hoarseness or dysphagia may indicate the localization and size of the tumor, and may indicate the potential difficulties in airway management 5,8 . The diagnosis of subglottic tumor is based on physical examination, imaging such as CT, and magnetic resonance imaging (MRI) 4 . In our case, difficult breathing with inspiratory stridor was noted during physical examination suggesting difficult intubation/ventilation.…”

Section: Discussionmentioning

confidence: 99%

“…The tumor most frequently occurs in the seventh decade, predominantly in male patients (male to female ratio 4:1). Slow growing and low tendency for metastatic spread is typical for this tumor 2,4 . Symptoms depend on the size and location, and may include hoarseness, stridor and dyspnea 5 .…”

Section: Introductionmentioning

confidence: 99%

Laryngeal Chondrosarcoma: Successful Use of Video Laryngoscope in Anticipated Difficult Airway Management

2016

ACC

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SUMMARY -Laryngeal chondrosarcoma is a rare mesenchymal tumor, most frequently affecting cricoid cartilage. The objective of this report is to present successful video laryngoscope usage in a patient with anticipated difficult airway who refused awake fiberoptic endotracheal intubation (AFOI). A 59-year-old male patient was admitted in our hospital due to difficulty breathing and swallowing. On clinical examination performed by ENT surgeon, preoperative endoscopic airway examination (PEAE) could not be performed properly due to the patient's uncooperativeness. Computed tomography revealed a spherical tumor that obstructed the subglottic area almost entirely. Due to the narrowed airway, the first choice for the anticipated difficult airway management was AFOI, which the patient refused. Consequently, we decided to perform endotracheal intubation with indirect laryngoscope using a C-MAC video laryngoscope (Karl Storz, Tuttlingen, Germany). Reinforced endotracheal tube (6.0 mm internal diameter) was placed gently between the tumor mass and the posterior wall of the trachea in the first attempt. Confirmation of endotracheal intubation was done by capnography. In a patient with subglottic area chondrosarcoma refusing PEAE and AFOI, video laryngoscope is a particularly helpful device for difficult airway management when difficult airway is anticipated.

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“…This problem concerns the inferior boundary of the supraglottis and the upper limit of the subglottic region, giving rise to a good deal of confusion in classifying laryngeal neoplasms (16,21,22).…”

Section: Areas Where Standardizatio N Is Neededmentioning

confidence: 99%

The Future of Laryngology

Ferlito

Buckley²,

Ossoff³

et al. 2001

Acta Oto-Laryngologica

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Ferlito A, Buckley JG, Ossoff RH, Rinaldo A, Weir N. The future of laryngology. Acta Otolaryngol 2001; 121: 859 -867.Otorhinolaryngolog y has only been recognized as a single and distinct specialty since about 1920 (1). The specialty of otolayrngolog y is a product of the 20th century; otology and laryngology have quite different origins. The early otologists were surgeons used to the scalpel and trephine whilst the early laryngologists were physicians who combined their knowledge of the larynx with that of the chest. The link between the two, namely rhinology, was embraced by the laryngologists. The two separate disciplines had their own practitioners, departments and journals and only came together, with a few exceptions, in the middle of the rst half of the 20th century (2).This technological era is fast-moving and rapidly changing. Medicine must be updated and go where the ''world goes''. In the beginning otolaryngology was a specialty created from a fusion of the disciplines of otology and laryngology (2) and concerned the study and treatment of otological, rhinological, laryngological and pediatric otolaryngological diseases. However, the increasing knowledge and complexity of the subject lead this specialty to subdivide again over the last few decades. Within 5 years of completion of residency training, it is no longer possible in most cases to consider a general otolaryngologist to be a well-prepared and updated specialist in all elds of the specialty. We have seen increasing subspecialization in otolaryngology over the last few years. This has principally been into otology neurotology, rhinology, laryngology, head and neck surgery and pediatric otolaryngology . Within these areas some practitioners have developed further special expertise in the elds of otological and oncological skull base surgery, hearing and balance, facial plastic and reconstructive surgery and voice disorders. There is also a trend towards subspecialization in some aspects of otology (3).There still remains a need for the general otolaryngologist but there is also a place for suf cient subspecialists to serve a wider population's needs (2). Subspecialization is a natural progression of the accumulation of increasing knowledge that improves the technology and surgical techniques, as well as focusing on a clinical practice that is of bene t to both the specialty and the patient (4). The American Board of Otolaryngolog y (ABOto) has suggested that they would consider subspecialty certi cation in those situations in which there is already a well-established subspecialty (4). A certi cate that recognizes subspecialty training provides an obvious recognition of the additional training and expertise (4). The approval of a Certi cate of Added Quali cation (CAQ) in a subspecialty was granted by the ABOto in otology neurotology and pediatric otolaryngology . Approval has also been given for subspecialization in facial plastic surgery in conjunction with the American Board of Plastic Surgery (4). Specialization increases in the clinic as in th...

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The pathology and management of subglottic cancer

Cited by 46 publications

References 23 publications

Surgical Treatment of the Neck in Cancer of the Larynx

Surgical Treatment of the Neck in Cancer of the Larynx

Laryngeal Chondrosarcoma: Successful Use of Video Laryngoscope in Anticipated Difficult Airway Management

The Future of Laryngology

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