Özgürsoy, Ozan Bağış

Laryngeal cysts are rare in adults; therefore, the majority of previous reports deal primarily with laryngeal cysts in infants and children. Ductal cysts of the larynx arise from the submucous glands when the ducts of these glands are occluded. They are most commonly located in the vallecula. In this report, we present a rare cause of life-threatening stridor in adults, a large ductal cyst of the larynx that was removed via endoscopic CO 2 laser resection. On the basis of clinical observations during the postoperative period, we conclude that endoscopic CO 2 laser resection is a reliable and safe method for removing cysts of the larynx. It is also a cost-effective procedure that minimizes hospitalization time and the need for tracheotomy.

ObjectiveTo investigate the manofluorographic and functional outcomes after endoscopic laser cricopharyngeal myotomy (ELCPM) for cricopharyngeal (CP) bar.Study DesignCase series with chart review.SettingAcademic medical center.Subjects and MethodsReview of patients undergoing ELCPM between 2001 and 2007 was undertaken to determine the demographic, clinical, and manofluorographic findings before and six months after surgery. Two groups were established according to pharyngeal driving pressures: normal pressure group (> 55 mm Hg) and low pressure group (< 55 mm Hg).ResultsFourteen patients underwent ELCPM for CP bar without a concomitant head and neck or Zenker's procedure. There were no major surgical complications. All 14 patients improved at least one stage on the Functional Outcome Swallowing Scale (FOSS) after surgery. There was a statistically significant decrease in the FOSS stages after surgery. Videofluoroscopy demonstrated a significant postoperative increase in the mean cross‐sectional CP opening (CP‐area) from 32.75 to 123.52 mm2. Manofluorographic pressure recordings showed a significant postoperative decrease in the intrabolus pressure gradient across the cricopharyngeal region (IB‐Gra) from 25.44 to 13.22 mm Hg. Despite significant overall results, the change in the IB‐Gra showed no difference between the patient groups.ConclusionSubjective (FOSS) and objective manofluorographic (CP‐area, IB‐Gra) improvement in CP bar patients occurred after ELCPM. We suggest IB‐Gra as a reliable objective indicator for patients who might benefit from ELCPM and as an appropriate parameter for follow‐up after surgery. However, continued research on a larger patient population is required to enhance our understanding of CP bar and predictors of outcome after treatment of CP bar dysphagia.

ObjectiveTo identify major arteries in relationship to large pharyngeal tumors during transoral laser microsurgery.Study DesignCase series with planned data collection.SettingMayo Clinic, Jacksonville, Florida.Subjects and MethodsWe developed a new technique that combines three‐dimensional CT angiography and enhanced soft‐tissue neck CT for evaluation of pharyngeal tumors before transoral laser microsurgery. Data from CT angiography were used to create three‐dimensional images of the tumor and adjacent arterial branches to better orient the surgeon to the spatial relationships of major arteries and pharyngeal tumors. Included were selected patients who had large tumors involving the pharynx and who underwent transoral laser microsurgery.ResultsEighteen patients were studied from June 2008 through January 2009. Tumor enhancement was absent or modest in four of 18 patients. Three of these four patients had superficial squamous cell carcinomas and one had adenoid cystic carcinoma. The remaining 14 patients had good tumor enhancement. The tumor involved the lingual artery in three and displaced the lingual or facial artery in two of these 14 patients. One anomalous right inferior thyroid artery was identified. Compared with routine enhanced soft‐tissue neck CT, three‐dimensional CT angiography greatly enhanced the anatomical relationships of the major arteries. In one patient, the surgeon's approach was changed after three‐dimensional CT angiography demonstrated an encased lingual artery.ConclusionThree‐dimensional CT angiography was useful in identifying the anatomical orientation of major arteries and the planning of transoral laser microsurgery to treat tumors involving the pharynx.