By Tim Price, Paul Montgomery, Martin Birchall, Patrick Gullane
Contemporary advances in versatile endoscopy have ledto the advance of the Trans-Nasal FlexibleLaryngo-Esophagoscope (TNLE) which makes visualisation,identification, biopsy and therapy of stipulations of theupper aero-digestive tract more straightforward and attainable underlocal anaesthesia in an outpatient setting.A targeted and important source for oncologists, otolaryngologists,gastroenterologists, respiration physicians, and ENT surgeons,Diagnostic Atlas of Tumors of the higher Aero-Digestive Tractbrings the reader up to date with the right kind identificationand analysis for malignant illness of the larynx, phary Read more...
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Extra resources for A diagnostic atlas of tumors of the upper aero-digestive tract: a transnasal video endoscopic approach
In selected patients concurrent chemoradiation therapy has been used to preserve laryngeal function. Early glottic lesions rarely metastasize to cervical nodes and should raise the possibility of understaging. In treating the neck, levels II, III, IV, and V should be considered. 7 Postcontrast axial CT scan just below level of true cords. Subglottic extension of tumour (thin arrows). Note sclerotic left thyroid lamina (thick arrows). Arrows = subglottic extension. The overall 5-year survival for early glottic tumors is between 85% and 90%.
PRESENTATION The most common symptoms for supraglottic tumors include hoarseness, dysphagia, odynophagia, and a neck swelling. Presentation is usually late and as nodal disease is more common, patients are more likely to present with a neck mass. Other symptoms include hemoptysis, dyspnea with stridor, chronic cough, and referred otalgia. Supraglottic cancers tend not to cause noticeable symptoms early in the disease course. Spread of supraglottic tumors often involves structures outside the larynx such as the tongue base, vallecula, piriform fossa and postcricoid region.
The cricoid cartilage is involved early, as there is no intervening muscular layer to protect the cricoid. Partial or complete fixation of one or both vocal folds is common due to submucosal spread, superiorly, through the conus elasticus and can make differentiation between a true subglottic tumor and spread from a glottic tumor difficult. The hypopharynx and esophagus may be involved by posterior spread beneath the cricoid cartilage. Early stage T1 and T2 tumors are not common, around 20% of cases, but if found, usually do not have nodal disease.
A diagnostic atlas of tumors of the upper aero-digestive tract: a transnasal video endoscopic approach by Tim Price, Paul Montgomery, Martin Birchall, Patrick Gullane