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Alqaryan S, Alrabiah A, Alhussinan K, Alyousef M, Alosamey F, Aljathlany Y, Aljasser A, Bukhari M, Almohizea M, Khan A, Alqahtani K, Alammar A. Measurement of the lengths of different sections of the upper airway and their predictive factors. Surg Radiol Anat 2024; 46:1063-1071. [PMID: 38735016 DOI: 10.1007/s00276-024-03345-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/08/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND No studies have been conducted to define the lengths of the upper airway's different segments in normal healthy adults. AIMS/OBJECTIVES This study aimed to determine the length of the subglottis and extrathoracic trachea and the factors affecting it. MATERIAL AND METHODS This was an observational retrospective review study. Included 102 adult patients who underwent CT scan during the quiet inspiration phase of the upper airway. RESULTS The results revealed significant positive linear relationships between height and both anterior and posterior subglottic measurements (p < 0.001). Additionally, a statistically significant, moderately strong negative correlation between age and extrathoracic tracheal measurements (p > 0.001) was observed. Men exhibited longer anterior (p < 0.001) and posterior (p > 0.001) subglottic measurements. In both sexes, the average length of the anterior subglottis was 14.16 (standard deviation [SD]: 2.72) mm, posterior subglottis was 14.51 (SD: 2.85) mm and extrathoracic trachea was 66.37 (SD: 13.71) mm. CONCLUSION AND SIGNIFICANCE We concluded that a normal healthy adult's anterior subglottis length is 6.3-19.3 mm (mean: 14.16 [SD: 2.72] mm), posterior subglottis length is 6.1-20.0 mm (mean: 14.51 [SD: 2.85] mm) and extrathoracic trachea length is 25.2-98.5 mm (mean: 66.37 [SD: 13.71] mm). Age, height and sex affected the upper airway length.
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Affiliation(s)
- Saleh Alqaryan
- Department of Otolaryngology - Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, 11411, Riyadh, Saudi Arabia
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Abdulaziz Alrabiah
- Department of Otolaryngology - Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, 11411, Riyadh, Saudi Arabia
- Department of Otolaryngology - Head & Neck Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Khaled Alhussinan
- Department of Otolaryngology - Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, 11411, Riyadh, Saudi Arabia.
| | - Mohammed Alyousef
- Department of Otolaryngology - Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, 11411, Riyadh, Saudi Arabia
| | - Faisal Alosamey
- Department of Otolaryngology - Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, 11411, Riyadh, Saudi Arabia
| | - Yousef Aljathlany
- Department of Otolaryngology - Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, 11411, Riyadh, Saudi Arabia
| | - Abdullah Aljasser
- Department of Otolaryngology - Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, 11411, Riyadh, Saudi Arabia
- Otorhinolaryngology - Head and Neck Surgery, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Manal Bukhari
- Department of Otolaryngology - Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, 11411, Riyadh, Saudi Arabia
| | - Mohammed Almohizea
- Department of Otolaryngology - Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, 11411, Riyadh, Saudi Arabia
| | - Adeena Khan
- Department of Radiology, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Khalid Alqahtani
- Department of Otolaryngology - Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, 11411, Riyadh, Saudi Arabia
| | - Ahmed Alammar
- Department of Otolaryngology - Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, 11411, Riyadh, Saudi Arabia
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2
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Schuering JHC, Halperin IJY, Ninaber MK, Willems LNA, van Benthem PPG, Sjögren EV, Langeveld APM. The diagnostic accuracy of spirometry as screening tool for adult patients with a benign subglottic stenosis. BMC Pulm Med 2023; 23:314. [PMID: 37641058 PMCID: PMC10464043 DOI: 10.1186/s12890-023-02592-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 08/02/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND There is a considerable diagnostic delay in the diagnosis 'benign acquired subglottic stenosis in adults' (SGS, diagnosed by the reference standard, i.e. laryngo- or bronchoscopy). Patients are frequently misdiagnosed since symptoms of this rare disease may mimic symptoms of 'asthma.' The 'Expiratory Disproportion Index' (EDI) obtained by spirometry, may be a simple instrument to detect an SGS-patient. The aim of this study was to evaluate the diagnostic accuracy of the EDI in differentiating SGS patients from asthma patients. METHODS We calculated the EDI from spirometry results of all SGS-patients in the Leiden University Medical Center (LUMC), who had not received treatment 2 years before their spirometry examination. We compared these EDI results with the EDI results of all true asthma patients between 2011 and 2019, who underwent a bronchoscopy (exclusion of SGS by laryngo- or bronchoscopy). RESULTS Fifty patients with SGS and 32 true asthma patients were included. Median and IQR ranges of the EDI for SGS and asthma patients were 67.10 (54.33-79.18) and 37.94 (32.41-44.63), respectively. Area under the curve (ROC) of the accuracy of the EDI at discriminating SGS and asthma patients was 0.92 (95% CI = 0.86-0.98). The best cut-off point for the EDI was > 48 (i.e. possible upper airway obstruction), with a sensitivity of 88.0%% (95%CI = 77.2-95.0%%) and specificity of 84.4% (95%CI = 69.4-94.1%). CONCLUSIONS The EDI has a good diagnostic accuracy discriminating subglottic stenosis patients from asthma patients, when compared to the reference standard. This measurement from spirometry may potentially shorten the diagnostic delay of SGS patients. Further studies are needed to evaluate clinical reproducibility.
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Affiliation(s)
- Juliëtta H C Schuering
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center Leiden, Zuid-Holland, The Netherlands.
| | - Ilan J Y Halperin
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center Leiden, Zuid-Holland, The Netherlands
| | - Maarten K Ninaber
- Department of lung medicine, Leiden University Medical Center Leiden, Zuid-Holland, The Netherlands
| | - Luuk N A Willems
- Department of lung medicine, Leiden University Medical Center Leiden, Zuid-Holland, The Netherlands
| | - Peter Paul G van Benthem
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center Leiden, Zuid-Holland, The Netherlands
| | - Elisabeth V Sjögren
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center Leiden, Zuid-Holland, The Netherlands
| | - Antonius P M Langeveld
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center Leiden, Zuid-Holland, The Netherlands
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Dewan K, Chhetri DK, Hoffman H. Reinke's edema management and voice outcomes. Laryngoscope Investig Otolaryngol 2022; 7:1042-1050. [PMID: 36000026 PMCID: PMC9392404 DOI: 10.1002/lio2.840] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/07/2022] [Indexed: 11/15/2022] Open
Abstract
Objectives Reinke's edema is a chronic disease of the respiratory tract that occurs in adults with a history of chronic smoke exposure. Also known as polypoid corditis, polypoid laryngitis, and polypoid degeneration of the vocal fold, it is strongly associated with smoking, frequently with vocal misuse/abuse, and occasionally with laryngopharyngeal reflux. Reinke's edema remains a cause of chronic dysphonia that is difficult to manage. This review provides perspectives on current and future management of Reinke's edema. Results Reinke's edema impacts <1% of the population. The excessive mass is seen in polypoid degeneration results in a loss of pitch control and a rough voice. Women are more likely to present for treatment as the characteristic lowering of vocal pitch is more noticeable in women than men. Multiple grading systems have been proposed within the literature. The current standard of care is surgical excision, after smoking cessation. The microflap technique remains the approach of choice for bulky lesions. Surgical management of Reinke's edema has evolved with the introduction of various lasers into otolaryngologic practice; some which can now be used in the office setting. While many management approaches have been described within the literature, there is a little direct comparison and no obvious superior method of Reinke's edema management. Conclusion To date, the biology of Reinke's edema is not well understood. Additional research is needed further elucidate the role of uncontrolled reflux in the development and recurrence of Reinke's edema.
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Affiliation(s)
- Karuna Dewan
- Department of Otolaryngology—Head and Neck SurgeryLouisiana State UniversityShreveportLouisianaUSA
| | - Dinesh K. Chhetri
- Department of Head and Neck SurgeryDavid Geffen School of Medicine at University of California Los AngelesLos AngelesCaliforniaUSA
| | - Henry Hoffman
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Iowa Hospitals and ClinicsIowa CityIowaUSA
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Marchioni A, Andrisani D, Tonelli R, Andreani A, Cappiello GF, Ori M, Gozzi F, Bruzzi G, Nani C, Feminò R, Manicardi L, Baroncini S, Mattioli F, Fermi M, Fantini R, Tabbì L, Castaniere I, Presutti L, Clini E. Stenting versus balloon dilatation in patients with tracheal benign stenosis: The
STROBE
trial. Laryngoscope Investig Otolaryngol 2022; 7:395-403. [PMID: 35434321 PMCID: PMC9008152 DOI: 10.1002/lio2.734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/31/2021] [Accepted: 12/28/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Alessandro Marchioni
- Respiratory Diseases Unit, Department of Surgical and Medical Sciences University Hospital of Modena Modena Italy
| | - Dario Andrisani
- Respiratory Diseases Unit, Department of Surgical and Medical Sciences University Hospital of Modena Modena Italy
- PhD Course Clinical and Experimental Medicine (CEM) University of Modena & Reggio Emilia Modena Italy
| | - Roberto Tonelli
- Respiratory Diseases Unit, Department of Surgical and Medical Sciences University Hospital of Modena Modena Italy
- PhD Course Clinical and Experimental Medicine (CEM) University of Modena & Reggio Emilia Modena Italy
| | - Alessandro Andreani
- Respiratory Diseases Unit, Department of Surgical and Medical Sciences University Hospital of Modena Modena Italy
| | - Gaia Francesca Cappiello
- Respiratory Diseases Unit, Department of Surgical and Medical Sciences University Hospital of Modena Modena Italy
| | - Margherita Ori
- Respiratory Unit and Cystic Fibrosis Adult Center Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
| | - Filippo Gozzi
- Respiratory Diseases Unit, Department of Surgical and Medical Sciences University Hospital of Modena Modena Italy
- PhD Course Clinical and Experimental Medicine (CEM) University of Modena & Reggio Emilia Modena Italy
| | - Giulia Bruzzi
- Respiratory Diseases Unit, Department of Surgical and Medical Sciences University Hospital of Modena Modena Italy
| | - Chiara Nani
- Respiratory Diseases Unit, Department of Surgical and Medical Sciences University Hospital of Modena Modena Italy
| | - Raimondo Feminò
- Anesthesiology Unit University Hospital of Modena Modena Italy
| | - Linda Manicardi
- Respiratory Diseases Unit, Department of Surgical and Medical Sciences University Hospital of Modena Modena Italy
| | - Serena Baroncini
- Respiratory Diseases Unit, Department of Surgical and Medical Sciences University Hospital of Modena Modena Italy
| | | | - Matteo Fermi
- Otolaryngology Unit University Hospital of Modena Modena Italy
| | - Riccardo Fantini
- Respiratory Diseases Unit, Department of Surgical and Medical Sciences University Hospital of Modena Modena Italy
| | - Luca Tabbì
- Respiratory Diseases Unit, Department of Surgical and Medical Sciences University Hospital of Modena Modena Italy
| | - Ivana Castaniere
- Respiratory Diseases Unit, Department of Surgical and Medical Sciences University Hospital of Modena Modena Italy
- PhD Course Clinical and Experimental Medicine (CEM) University of Modena & Reggio Emilia Modena Italy
| | - Livio Presutti
- Anesthesiology Unit University Hospital of Modena Modena Italy
| | - Enrico Clini
- Respiratory Diseases Unit, Department of Surgical and Medical Sciences University Hospital of Modena Modena Italy
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Powell J, Verdon B, Wilson JA, Simpson AJ, Pearson J, Ward C. Establishment of an immortalized human subglottic epithelial cell line. Laryngoscope 2019; 129:2640-2645. [PMID: 30623447 PMCID: PMC6849794 DOI: 10.1002/lary.27761] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2018] [Indexed: 02/06/2023]
Abstract
Objective Translational research into subglottic disease is restricted by the availability of primary human tissue originating from this subsite. Primary epithelial cells are also limited by their inability to survive beyond several divisions in culture outside of the body. Specific subglottic cell lines, useful for in vitro studies, have not yet been described. We therefore demonstrate what we believe to be the first immortalized subglottic epithelial cell line. Methods Subglottic tissue was derived from a single adult patient's neoplasia‐free human subglottic brushing specimen. Cells were immortalized using a lentiviral vector expressing simian virus 40 T antigen. Karyotyping was performed on the transformed cells using single nucleotide polymorphism array comparative genomic hybridization. Transformed cells were phenotypically characterized by light microscopy, immunohistochemistry, and electrophysiology studies. Results The immortalized subglottic cell line (SG01) was able to divide successfully beyond 20 passages. Karyotyping demonstrated no significant genomic imbalance after immortalization. The cells demonstrated normal epithelial morphology and cytokeratin expression throughout. SG01 cells were also successfully cultured at air–liquid interface (ALI). At ALI cells demonstrated cilia, mucus production, and relevant ion channel expression. Conclusion The novel SG01 subglottic epithelial cell line has been established. This cell line provides a unique resource for researchers to investigate subglottic diseases, such as subglottic stenosis. Level of Evidence NA. Laryngoscope, 129:2640–2645, 2019
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Affiliation(s)
- Jason Powell
- Department of Otolaryngology-Head and Neck Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.,Institute of Cellular Medicine, Newcastle upon Tyne, United Kingdom
| | - Bernard Verdon
- Institute for Cell and Molecular Biosciences, Newcastle upon Tyne, United Kingdom
| | - Janet A Wilson
- Department of Otolaryngology-Head and Neck Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.,Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - A John Simpson
- Institute of Cellular Medicine, Newcastle upon Tyne, United Kingdom
| | - Jeffery Pearson
- Institute for Cell and Molecular Biosciences, Newcastle upon Tyne, United Kingdom
| | - Chris Ward
- Institute of Cellular Medicine, Newcastle upon Tyne, United Kingdom
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Hînganu MV, Hînganu D, Cozma SR, Asimionoaiei-Simionescu C, Scutariu IA, Ionesi DS, Haba D. Morphofunctional evaluation of buccopharyngeal space using three-dimensional cone-beam computed tomography (3D-CBCT). Ann Anat 2018; 220:1-8. [PMID: 30048758 DOI: 10.1016/j.aanat.2018.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/13/2018] [Accepted: 06/21/2018] [Indexed: 10/28/2022]
Abstract
The present study aims to identify the anatomical functional changes of the buccopharyngeal space in case of singers with canto voice. The interest in this field is particularly important in view of the relation between the artistic performance level, phoniatry and functional anatomy, as the voice formation mechanism is not completely known yet. We conducted a morphometric study on three soprano voices that differ in type and training level. The anatomical soft structures from the superior vocal formant of each soprano were measured on images captured using the Cone-beam Computed Tomography (CBCT) technique. The results obtained, as well as the 3D reconstructions emphasize the particularities of the individual morphological features, especially in case of the experienced soprano soloist, which are found to be different for each anatomical soft structure, as well as for their integrity. The experimental results are encouraging and suggest further development of this study on soprano voices and also on other types of opera voices.
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Affiliation(s)
- Marius Valeriu Hînganu
- Department of MorphoFunctional Sciences I, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Delia Hînganu
- Department of MorphoFunctional Sciences I, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania.
| | - Sebastian Romică Cozma
- Department of Otorhinolaryngology, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Cristina Asimionoaiei-Simionescu
- 2nd Department of Wind Instruments, Percussion and Singing, Faculty of Performance, Composition and Music Theory Studies, "George Enescu" University of Arts, Iasi, Romania
| | | | - Dorin Savin Ionesi
- Department of Knitwear and Clothing Technology, Faculty of Textile, Leather and Industrial Management, "Gheorghe Asachi" Technical University of Iasi, Romania
| | - Danisia Haba
- Department of Oral & Maxillofacial Surgery, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
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Goodyer E, Müller F, Hess M, Kandan K, Farukh F. Biomechanical Flow Amplification Arising From the Variable Deformation of the Subglottic Mucosa. J Voice 2017; 31:669-674. [PMID: 28433346 DOI: 10.1016/j.jvoice.2017.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 03/18/2017] [Accepted: 03/22/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study mapped the variation in tissue elasticity of the subglottic mucosa, applied these data to provide initial models of the likely deformation of the mucosa during the myoelastic cycle, and hypothesized as to the impact on the process of phonation. STUDY DESIGN Six donor human larynges were dissected along the sagittal plane to expose the vocal folds and subglottic mucosa. A linear skin rheometer was used to apply a controlled shear force, and the resultant displacement was measured. These data provided a measure of the stress/strain characteristics of the tissue at each anatomic point. A series of measurements were taken at 2-mm interval inferior of the vocal folds, and the change in elasticity was determined. RESULTS It was found that the elasticity of the mucosa in the subglottic region increased linearly with distance from the vocal folds in all 12 samples. A simple deformation model indicated that under low pressure conditions the subglottic mucosa will deform to form a cone, which could result in a higher velocity, thus amplifying the low pressure effect resulting from the Venturi principle, and could assist in maintaining laminar flow. CONCLUSIONS This study indicated that the deformation of the subglottic mucosa could play a significant role in the delivery of a low pressure airflow over the vocal folds. A large scale study will now be undertaken to secure more data to evaluate this hypothesis, and using computational fluid dynamics based on actual three-dimensional structure obtained from computed tomography scans the aerodynamics of this region will be investigated.
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Affiliation(s)
- Eric Goodyer
- De Montfort University, Bio-Informatics Research Group, Leicester, UK.
| | | | - Markus Hess
- Universitat Klinic, Eppendorf, Hamburg, Germany
| | | | - Farukh Farukh
- De Montfort University, Bio-Informatics Research Group, Leicester, UK
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8
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Merlotti A, Alterio D, Vigna-Taglianti R, Muraglia A, Lastrucci L, Manzo R, Gambaro G, Caspiani O, Miccichè F, Deodato F, Pergolizzi S, Franco P, Corvò R, Russi EG, Sanguineti G. Technical guidelines for head and neck cancer IMRT on behalf of the Italian association of radiation oncology - head and neck working group. Radiat Oncol 2014; 9:264. [PMID: 25544268 PMCID: PMC4316652 DOI: 10.1186/s13014-014-0264-9] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 11/17/2014] [Indexed: 12/25/2022] Open
Abstract
Performing intensity-modulated radiotherapy (IMRT) on head and neck cancer patients (HNCPs) requires robust training and experience. Thus, in 2011, the Head and Neck Cancer Working Group (HNCWG) of the Italian Association of Radiation Oncology (AIRO) organized a study group with the aim to run a literature review to outline clinical practice recommendations, to suggest technical solutions and to advise target volumes and doses selection for head and neck cancer IMRT. The main purpose was therefore to standardize the technical approach of radiation oncologists in this context. The following paper describes the results of this working group. Volumes, techniques/strategies and dosage were summarized for each head-and-neck site and subsite according to international guidelines or after reaching a consensus in case of weak literature evidence.
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Affiliation(s)
- Anna Merlotti
- Radioterapia AO Ospedale di Circolo-Busto Arsizio (VA), Piazzale Professor G. Solaro, 3, 21052, Busto Arsizio, VA, Italy.
| | | | | | | | | | - Roberto Manzo
- Radioterapia Azienda Ospedaliera ASL Napoli 1-Napoli, Napoli, Italy.
| | | | - Orietta Caspiani
- Radioterapia Ospedale Fatebenefratelli, Isola Tiberina-Roma, Roma, Italy.
| | | | - Francesco Deodato
- Radioterapia Università Cattolica del S. Cuore -Campobasso, Roma, Italy.
| | - Stefano Pergolizzi
- Dipartimento SBIMOF Sezione di Scienze Radiologiche, Università di Messina, Piazza Pugliatti Salvatore, 1, 98122, Messina, ME, Italy.
| | - Pierfrancesco Franco
- Dipartimento di Oncologia, Radioterapia Oncologica, Università di Torino, Turin, Italy.
| | - Renzo Corvò
- Oncologia Radioterapica, IRCS S. Martino-IST- Istituto Nazionale per la Ricerca sul Cancro, Università Genova, Genova, Italy.
| | - Elvio G Russi
- Radioterapia Az. Ospedaliera S. Croce e Carle-Cuneo, via M. Coppino 26 12100, Cuneo, Italy.
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Klink T, Holle J, Laudien M, Henes FO, Moosig F, Platzek C, Adam G, Gross WL, Bley TA. Magnetic resonance imaging in patients with granulomatosis with polyangiitis (Wegener's) and subglottic stenosis. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2012; 26:281-90. [PMID: 23086288 DOI: 10.1007/s10334-012-0351-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 09/25/2012] [Accepted: 10/01/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the ability of MRI to detect subglottic stenosis and to differentiate between active and inactive subglottic inflammation in patients with granulomatosis with polyangiitis (GPA). MATERIALS AND METHODS MRI studies of the larynx of 18 GPA patients with suspected SGS were included. The MRI protocol included T1- and T2-weighted and STIR-sequences, dynamic contrast enhancement (DCE) and diffusion weighted imaging (DWI). Two independent observers reviewed the MR images. SGS were identified and quantified, inflammatory activity was assessed using edema imaging, DCE and DWI. Final MRI diagnoses were compared to the clinical, laryngoscopic and histopathologic results. RESULTS MRI confirmed SGS in all GPA patients with significant narrowing of the airway lumen and thickening of subglottic wall. Assessing the subglottic inflammatory activity, MRI showed a sensitivity of 87.5 % and a specificity of 60.0 %. Interrater agreement was κ = 0.769. Of the different MR technical approaches tested, edema imaging was most sensitive and specific. DWI led to significant differences in the apparent diffusion coefficient between active and inactive subglottic inflammation. No significant differences were found with DCE imaging. CONCLUSION MR imaging has shown the ability to detect and grade SGS in patients with GPA. It non-invasively assesses the status of inflammatory activity utilizing edema sensitive sequences and DWI.
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Affiliation(s)
- Thorsten Klink
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
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Virk J, Sandhu G. Where is the glottis? Clin Otolaryngol 2012; 37:253-4. [DOI: 10.1111/j.1749-4486.2012.02487.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ferlito A, Rinaldo A, Devaney KO. Authors' response to the comments by Eckel on the editorial "The future of the TNM staging system in laryngeal cancer: time for a debate?". Eur Arch Otorhinolaryngol 2008; 266:153-4. [PMID: 18807060 DOI: 10.1007/s00405-008-0811-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Accepted: 08/29/2008] [Indexed: 11/30/2022]
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Kutta H, Willer A, Steven P, Bräuer L, Tsokos M, Paulsen F. Distribution of mucins and antimicrobial substances lysozyme and lactoferrin in the laryngeal subglottic region. J Anat 2008; 213:473-81. [PMID: 18657260 DOI: 10.1111/j.1469-7580.2008.00960.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The subglottic region of the larynx is of high clinical relevance with regard to infections and malignancies. Little is known about the distribution of mucins and antimicrobial substances in this area. In this study, we have investigated the mucin distribution in the normal subglottis of the larynx. Moreover, we analysed the expression of lysozyme and lactoferrin in this area. Therefore, the subglottic region of 34 larynges was investigated immunohistochemically with different antibodies to mucins and antimicrobial substances. The epithelium reacted positive with antibodies to mucins MUC1 (34/34), 5AC (26/34), 5B (10/34), 7 (8/34), 8 (10/34) and 16 (19/34); submucosal glands were positive to mucins MUC1 (34/34), 5B (10/34), 7 (8/34), and 16 (19/34); high columnar epithelial cells and serous parts of subepithelial seromucous glands were also positive for lysozyme (34/34) and lactoferrin (34/34). The results show that human subglottic epithelium and subepithelial submucosal glands produce a broad spectrum of mucins that is almost comparable with that in other areas of the respiratory tract. We hypothesize that the mucin diversity of the subglottis has an impact on positive functional consequences during vocal production and antimicrobial defence. This antimicrobial defence is supported by synthesis and secretion of antimicrobial substances such as lysozyme and lactoferrin. Moreover, knowledge of the observed distribution pattern of mucins in the subglottis can be a useful tool for a classification of subglottic laryngeal carcinomas.
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Affiliation(s)
- Hannes Kutta
- Department of Anatomy, Christian Albrecht University of Kiel, Kiel, Germany.
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Damrose EJ. On the development of idiopathic subglottic stenosis. Med Hypotheses 2008; 71:122-5. [PMID: 18295979 DOI: 10.1016/j.mehy.2007.12.017] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2007] [Revised: 11/25/2007] [Accepted: 12/02/2007] [Indexed: 10/22/2022]
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Kutta H, Knipping S, Claassen H, Paulsen F. [Functional anatomy of the larynx from clinical points of view: part II: Laryngeal mucous membrane, blood supply, innervation, lymphatic drainage, age-related changes]. HNO 2007; 55:661-75; quiz 676. [PMID: 17431564 DOI: 10.1007/s00106-007-1557-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Diseases of the larynx are of concern not only for ear, nose, and throat physicians and phoniatricians but also for other clinicians who treat the larynx either conservatively or surgically, including speech therapists, pediatricians, anesthetists, oncologists, pulmonologists, radiologists, and general practitioners. Based on today's state of knowledge and taking into account our own research results of the last years as well as clinical points of view, the present contribution gives a short overview of the anatomy and physiology of the larynx. Part 2 discusses the functional anatomy of the laryngeal mucous membrane (glycoconjugates, mucins, trefoil factor family peptides, antimicrobial substances, larynx-associated lymphoid tissue), the vascular supply, innervation, and lymphatic drainage, as well as age-related laryngeal changes and their effects on swallowing, breathing, and phonation.
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Affiliation(s)
- H Kutta
- Klinik und Poliklinik für Hals-, Nasen-, und Ohrenheilkunde, Universitätskrankenhaus Hamburg-Eppendorf, Hamburg
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