Clinical Significance of Mast Cells in the Supraglottic Larynx of Children With Aerodigestive Disease

Objective To analyze the association of mast cells found on supraglottic biopsy of pediatric patients with common aerodigestive diseases. Study Design Cross-sectional study. Setting Tertiary care children’s hospital. Methods A total of 461 pediatric patients undergoing otolaryngology aerodigestive procedures provided consent between 2014 and 2019, and biopsies of the supraglottic larynx were collected at the time of their surgery. Pathologists reviewed biopsies for the presence and number of mast cells per high-power field. The patients’ electronic health records were reviewed for relevant demographic data and clinical diagnoses present at the time of biopsy. Multivariate logistic regression was used to assess the relationship of mast cells with odds of aerodigestive disease. Results Patients with mast cells in their biopsy had significantly higher odds of asthma (odds ratio [OR], 2.02; 95% CI, 1.17-3.46), gastroesophageal reflux disease (OR, 2.36; 95% CI, 1.47-3.77), laryngomalacia (OR, 2.98; 95% CI, 1.80-4.94), laryngeal anomalies (OR, 2.32; 95% CI, 1.52-3.55), and obstructive sleep apnea (OR, 2.16; 95% CI, 1.35-3.45). When mast cells were evaluated as a continuous variable, there was a nonlinear relationship between increasing mast cell count and odds of disease. Conclusions Mast cells are known to be associated with inflammatory conditions, though little is known about their presence in laryngeal inflammation. Results from our study demonstrate an association between mast cells in the pediatric larynx and asthma, gastroesophageal reflux disease, laryngomalacia, laryngeal anomalies, and obstructive sleep apnea. Our study also showed a nonlinear relationship between number of mast cells and odds of disease diagnosis.

RELATIONSHIP BETWEEN GLASGOW COMA SCALE AND AIRWAYS PROTECTIVE REFLEXES IN CEREBRO VASCULAR ATTACK PATIENTS

Introduction: The laryngeal cough reex (LCR) protects the supraglottic larynx from signicant aspiration of food or uids during inspiration or pharyngeal spillage during swallowing 1. The reex cough test (RCT), using nebulized tartaric acid solution, provides an effective stimulus to the receptors in the supraglottic mucosa, and, like a reex hammer or percussor, triggers a cascade of neurological activity in both craniospinal nerves and the central nervous system. The vagus nerve mediates the afferent component of the LCR. Aims And Objective:To nd the relation between glasgowcoma scale and airway protective reexes in Indian population. Materials And Methods: This study was a prospective observational study. Clinical history and examination is mandatory for selection of the eligible patients. All the procedure was done, only once a traumatically, in patients. Suction apparatus was made available all the time beside the patients in case they vomit. Procedure was done under supervision of senior physician. Result And Analysis: We found that in ≤5 GCS Group, 15(100.0%) patients had Intubation. In 6-8 GCS Group, 7(10.6%) patients had Intubation. In ≥9 GCS Group, 8(20.5%) patients had Intubation. Association of Intubation vs GCS Group was statistically signicant (p<0.0001). In ≤5 GCS Group, 15(100.0%) patients had Immediate Intubation. Summary And Conclusion: In our study, 11(9.2%) patients were Attenuated/ Diminished (Absent Cough and Gag reex) air way protective reexes checked later, 19(15.8%) patients were Not Applicable (As Pt Mechanical Ventilator) air way protective reexes checked later and 90(75.0%) patients were Patent (Present Cough and Gag reex) air way protective reexes checked later. Mechanical Ventilator was more in low GCS (≤5) which was statistically signicant.

Granulomatous Inflammation Causing Severe Supraglottic Edema and Airway Obstruction in a Pediatric Patient

A 12-year-old male with a family history of inflammatory bowel disease presented with sleep-disordered breathing and was found to have chronic, granulomatous swelling of the supraglottic larynx. His airway was managed with tracheostomy, regular interval laryngeal steroid injections, supraglottoplasty, and “pepper pot” CO2 laser resurfacing leading to eventual decannulation. Due to the non-necrotic nature of the granulomatous inflammation, as well as the patient’s family history of inflammatory bowel disease, the leading diagnosis was Crohn disease, but isolated laryngeal sarcoidosis could not be ruled out. There are only 13 reported cases of laryngeal manifestations of Crohn disease in the literature, with only 2 cases occurring in pediatric patients. This case report adds to this body of literature and discusses strategies for managing granulomatous supraglottic edema when definitive diagnosis is not fully clear.

Lymphoepithelial cell carcinoma of larynx masquerading as squamous cell carcinoma

<p class="abstract">Lymphoepithelial carcinoma is one of the common neoplasms seen to occur in nasopharyngeal subsite. Lymphoepithelial carcinoma (LEC) of the larynx is an uncommon entity; with 34 such cases reported in literature. Lymphoepithelial carcinoma (LEC) seems to behave in a fashion similar to nasopharyngeal carcinoma, except that most cases have not been associated with Epstein barr virus (EBV). We describe this patient with lymphoepithelial carcinoma (LEC) of supraglottic larynx who was treated with total laryngectomy and adjuvant radiotherapy and is on regular follow-up showed no evidence of local or distant metastasis.</p>

Potential benefits of adaptive intensity modulated proton therapy in nasopharyngeal carcinomas: a planning comparison study

Background To investigate potential advantages of adaptive intensity modulated proton beam therapy (A-IMPT) by comparing it to adaptive intensity modulated X-ray therapy (A-IMXT) for nasopharyngeal carcinomas (NPC). Methods Six patients with NPC treated with A-IMXT (step and shoot approach) and concomitant chemotherapy between 2015 and 2016 were selected. In the actual treatment, 46 Gy in 23fr fractions was prescribed using the initial plan and 24 Gy/12fr was prescribed using an adapted plan thereafter. New treatment planning of A-IMPT was made for the same patients using equivalent dose fractionation schedule and dose constraints. The dose volume statistics based on deformable images and dose accumulation was used in the comparison of A-IMXT with A-IMPT. Results The mean doses to the right parotid gland (p = 0.004), left parotid gland (p = 0.012), the oral cavity (p < 0.001), the thyroid gland (p = 0.047), the supraglottic larynx (p < 0.001), the glottic larynx (p = 0.001), the superior pharyngeal constrictor muscle (PCM) (p < 0.001), the middle PCM (p = 0.002), the inferior PCM (p < 0.001), and the cricopharyngeal muscle (p = 0.031) in A-IMPT are statistically significantly lower than those of A-IMRT with the statistical significance. The mean dose to the oral cavity, supraglottic larynx, and glottic larynx were all reduced by more than 20 GyE. Conclusion The adaptive approach is suggested to enhance the potential benefit of IMPT compared to IMXT to reduce adverse effects for patients with NPC.

Prevalence of Metastatic Neck Nodes

Background: Head and neck cancers include cancers of the lips, mouth, nasal cavity, paranasal sinuses, pharynx and larynx. Most of these cancers are squamous cell carcinomas (SCCs). The presence of metastatic cervical lymphadenopathy is of particular importance as with every single nodal metastasis, survival of the patient is reduced by one half. Objective: To see the prevalence of metastatic neck node. Methods: The prospective cross-sectional clinical study was carried out in the Department of ENT and Head Neck Surgery, Combined Military Hospital, Dhaka during March’2018 to March, 2019. All 100 patients were included in this study and were treated at the Department of Otolaryngology of Combined Military Hospital, Dhaka. Results: Total 26 cases were found parotid among them 8(30.8%) in metastatic neck node and 18(69.2%) in without metastatic neck node. Total 10 cases were found paranasal sinuses among them 1(10.0%) in metastatic neck node and 9(90.0%) in without metastatic neck node. Which were statistically significant (p<0.05) between two groups. Conclusion: In this study observed that majority of metastatic neck node were found pyriform fossa, supraglottic larynx, base of tongue which were 68.2%, 68%, 77.8% respectively. In oral cavity and parotid site also found 48.1% and 30.8% metastatic neck node. Bangladesh J Otorhinolaryngol; October 2019; 25(2): 102-107