NON VIBRATING SEGMENT PREDICTING GLOTTIS CARCINOMA

Submitted by drvulevu on Fri, 05/01/2020 - 13:08

 

Abstract

Endovideolaryngostroboscopy is the obliged evaluation tool in our everyday practice. Standardized protocol in management of broad spectrum of vocal pathology is useful in clinical, scientific and educational evaluation of patient from the first interview till the end of the treatment. Using of contemporary computerised multidimensional analysis of stroboscopic image we are approaching to optimum evaluation of any kind of interpersonal communication disorder. There were 66 patients in prospective clinical study of correlation between suspect endovideolaryngostroboscopic findings and histopathology verification of glottis carcinoma. Asymmetric and irregular vibrations with absent mucosal wave or absent vibrations of one part or of the whole vocal fold was improved as carcinoma in 85% of patients. The most frequent diagnosis was Ca planocellularae invasivum G2 NG 2, with subsequent open chordectomy. In every case of hoarseness longer more than 14 days, endovideolaryngostroboscopy is the golden standard for evaluating the need for microlaryngoscopy and biopsy.

Keywords :Standardized protocol, multidimensional analysis

 

NOTE – The Power Point adjusted version of this work was presented as Free Paper Presentation in 6. Balcan Congress of Otorinolaryngology Head and Neck Surger, in
Thessaloniki, Greece, in October 2nd – 5th,2008

 

 

Introduction

 

Contemporary, there are about ten different terms for endovideolaryngostroboscopy (EVLS), the widespread method in everyday ENT practice. Tarneaud in 1933, Oertel in 1878., Wendler in 1973. and Kittel  in 1978 were the keystones in establishing this visualization of vocal fold vibrations, that had an amazing correlation with Hirano (1974., 1981.) revolutionary describing of multilayered structure.

 

Any pathologic propagation through the basal membrane makes stiffening of superficial or intermediate layer of vocal fold that leads to change of regularity of vibration cycle.   

The most important part of our daily practice is using of endovideolaryngostroboscopy in early detection of vocal fold infiltration by recognizing the main sign- so called  adynamic or no vibrating part of the vocal fold, that is an absolute indication for microlaryngoscopy and histopathology verification.

Absent mucosal wave is also a very suspect sign that you can mark as absolute indication for microlaryngoscopy, too .

In literature overview we can find that Yumoto has described this theme in 2004.  (26)

In 2005. Rosen (17) and Zeitels (27) emphasized the role of EVLS in phonosurgical practice.

Finally, we must think about the limitations of this method, too, as Doellinger and ass.  have mentioned (4).

 

Method

 

There is standardised protocol in multidisciplinary team work in our Communication Disorders Care Centre (23).

The History, Clinical Examination and Endovidelaryngostroboscopy is in routine work in Phoniatric Dpt. We use Karl Storz- rigid 90 degree -Endoskope 20140020 with Telecam- C20212934 PAL CE. We are pointed on obligate four steps:

  1. History
  2. Indirect laryngoscopy
  3. Rigid endoscopy
  4. Endovideolaryngostroboscopy

Third and fourth step is detected synchronously with PC connection (TIGER DR SPEECH 2004/ SCOPE VIEW) and stored in database, ready for further analysis, including multidimensional computer analysis of speech and voice. We are pointed on possibility of team repeated analysis (including the surgeon), as well as educational and forensic options too.

Microlaryngoscopy and biopsy is performed in Endoscopy Dpt by well trained team. We use Microscope with Camera too (5).

As mentioned above, laryngologists are surgery members of our team, and after the treatment, patient is referred to Phoniatric Dpt. to continue with voice and speech rehabilitation that had begun in the first interview.

 

Results  and Discussion

 

Evaluation of correlation of suspect endovideolaryngostroboscopic finding

Image removed.

 

Figure 1- Carcinoma of the right vocal cord  + Sulcus on the left  

 

and positive histological analysis was carried on in prospective clinical study during two years (april 2006.- april 2008. )

There were 59 men and 7 women, 9 of 10 were heavy smokers, the most frequent age was between 51 and 60 years.

. The most frequent occupation was physical worker and manager (Table 1).

The history was typical; the main symptom was hoarseness, with rare additional symptoms. In 60% of all of them was satisfactory quick sending from primary and secondary health system level (less than 2 months), but unfortunately every tenth patient came to tertiary level after 6 months lasting of symptoms .

In the group of patients with absent mucosal wave there were 7 positive and 1 negative correlations (Table 2).

In the group of patients with absent vibrations there were 49 positive and 9 negative (Table 3).

In two patients there were false negative results. Owing to clear EVLS findings of absent vibrations on asymmetric side we insisted on repeated biopsy. In both cases the first result was Atypical Hyperplasia, and Carcinoma planocellularae  invasivum G2 NG 2 after repeated biopsy. One of them was a woman, non smoker, with fulminate progression after second biopsy, that led to front lateral partial laryngectomy with subsequent radiotherapy

Image removed.

Figure 2-Repeated biopsy of right vocal fold

 

The most frequent therapy in 57 patients with positive correlation, was open chordectomy (Table 4). Unfortunately, you can see that there were two total laryngectomies in cases of pre epiglottis space spreading.

EVLS is useful tool in post therapy controlling, too, as shown in

Image removed.

Figure 3- Status post radiotherapy in left vocal fold carcinoma

 

Conclusion

 

The fact that there were positive correlation between EVLS findings and hystologic analysis results in 85% of our patients, encourages in pronouncing EVLS as the gold standard in evaluation of patient with hoarseness longer than 2 weeks. This fact leads to earlier diagnosis, less aggressive treatment and better oncology and functional results.

Multidisciplinary team work  is the essential in establishing health care system efficacy. 

 

Table 1- Occupational distribution

 

PROFESSION

M

F

Physical work  

21

2

Manager

10

 

Driver

7

 

Office Administrator

5

2

Professor

5

2

Hair Dresser

2

1

Musician

1

 

Actor

1

 

Tailor

1

 

Journalist

1

 

Agricultural

1

 

Nurse

1

 

MD/ Radiologist

1

 

Tractor driver

1

 

Without job

1

 

 

 

Table 2- Distribution of absent mucosal wave finding

 

Absent mucosal wave

 

  • Carcinoma in situ      /                                                                          2  M       2 F
  • Ca planocellularae microinvasivum /                                                 2 M
  • Ca planocellularae G1 NG 1  /                                                            1 M
  • Laryngitis chr parakeratotica +Hyperplasio abnormalis/                  1 M  

 

 

Table 3- Distribution of absent vibrations finding

 

Absent vibrations

 

  • Ca planocellularae invasivum G2 NG  2 /                                         22 M     3 F
  • Ca planocellularae infiltrativum G2 NG 2/                                      15  M    
  • Ca planocellularae invasivum G3 NG 3 /                                            3 M 
  • Ca planocellularae G1 NG 2 /                                                             2 M
  • Ca corneum  /                                                                                                   1 F
  • Ca planocellularae infiltrativum G2 NG 3 /                                        1 M     1 F
  • Ca planocellularae microinvasivum                                                  1 M
  • Laryngitis chr parakeratotica + Hyperplasio simplex                          4 M
  • Laryngitis chr                                                                                        2 M   
  • Oedema /                                                                                                1 M                                                                           
  • Polypus                                                                                                  1 M
  • Papilloma cum High grade dysplasio 1 /                                               1 M

 

 

 

Table 4- Treatment distribution

 

 SURGICAL TH

M

F

Open Chordectomy

26

4

Laser Chordectomy tip 3

4

1

Radioth

4

1

Laryngect. tot.

4

 

Lar. part. front.

2

 

L. part. + Radio.

2

1

Chordect. dist.

2

 

Haemilaryngect.

2

 

Glottectomy

2

 

L. part. choris.

1

 

 

 

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