Few studies have examined the association between ABO blood grouping and head and neck cancer. This retrospective review examined the association between blood group and laryngeal cancer incidence and patient mortality.

Of 271 patients treated for squamous cell laryngeal carcinoma (1997–2002), 143 patients with supraglottic, glottic and subglottic tumours were included; 128 patients were excluded. The blood group characteristics of patients and healthy blood donors were compared.

There was no significant correlation between blood type and laryngeal carcinoma incidence or mortality. Type A blood was commoner in African Americans with laryngeal cancer than Caucasian patients, but not significantly so. As expected, five-year survival rates were lower in patients with more advanced stage cancer (p < 0.0001).

Although our findings show no association between blood group and five-year survival, these results are inconclusive, and warrant further study of the association between blood type and laryngeal (and other) head and neck cancers.

Some researchers have suggested that Epstein–Barr virus may play a role in the pathogenesis of laryngeal malignancies. In order to clarify the role of cytokines in this disease context, the current study aimed to determine the serum levels of cytokines in Epstein–Barr virus DNA positive patients with laryngeal carcinoma.

The study included 10 patients with diagnosed laryngeal carcinoma and Epstein–Barr virus DNA positive tumour tissue samples. The control group comprised 10 Epstein–Barr virus DNA negative patients diagnosed with laryngeal carcinoma, 10 patients with acute Epstein–Barr virus infection and 10 healthy individuals.

Serum cytokine levels were determined by enzyme-linked immunosorbent assay.

The Epstein–Barr virus DNA positive and negative laryngeal carcinoma patients showed no differences regarding serum levels of the following cytokines: interleukins 1β, 2, 6 and 12, tumour necrosis factor α, and interferon γ. However, serum levels of interleukin 10 and transforming growth factor β1 were significantly higher in Epstein–Barr virus DNA positive laryngeal carcinoma patients compared with Epstein–Barr virus DNA negative laryngeal carcinoma patients (p < 0.05).

Our results suggest that the cytokines interleukin 10 and transforming growth factor β1 may act as growth factors in Epstein–Barr virus related laryngeal carcinoma. These cytokines may thus represent potential targets for molecular therapeutic treatment for laryngeal carcinoma; they may also be useful as indicators of disease prognosis.

Telomere length must be maintained throughout cancer cell progression and proliferation. In most tumours, telomerase activity maintains telomere length. Therefore, telomerase is a target for cancer treatments. However, some cancer cells maintain telomere length through an alternative mechanism termed ‘alternative lengthening of telomeres’. To determine how telomerase inhibition relates to the initiation of the alternative lengthening of telomeres pathway, we investigated telomerase activity and telomere maintenance in Hep-2 cells with and without reduced telomerase activity.

We investigated telomerase activity levels in a normal Hep-2 cell line and in residual cells following telomerase inhibition treatment. Additionally, we looked for expression of a marker protein for the alternative lengthening of telomeres mechanism.

In the residual cells, telomerase activity was eliminated. However, these cells had higher levels of the alternative lengthening of telomeres biomarker, suggesting an alternative mechanism for telomere maintenance following telomerase inhibition. These results could have a major impact on the design of new cancer treatments.

This study aimed to clarify the local immune status in the larynx in the presence of infection or carcinogenesis associated with human papilloma virus.

Cytological samples (for human papilloma virus detection) and laryngeal secretions (for immunoglobulin assessment) were obtained from 31 patients with laryngeal disease, during microscopic laryngeal surgery. On histological examination, 12 patients had squamous cell carcinoma, four had laryngeal papilloma and 15 had other benign laryngeal disease. Cytological samples were tested for human papilloma virus DNA using the Hybrid Capture 2 assay.

High risk human papilloma virus DNA was detected in 25 per cent of patients (three of 12) with laryngeal cancer. Low risk human papilloma virus DNA was detected only in three laryngeal papilloma patients. The mean laryngeal secretion concentrations of immunoglobulins M, G and A and secretory immunoglobulin A in human papilloma virus DNA positive patients were more than twice those in human papilloma virus DNA negative patients. A statistically significant difference was observed between the secretory immunoglobulin A concentrations in the two groups. Patients with laryngeal cancer had higher laryngeal secretion concentrations of each immunoglobulin type, compared with patients with benign laryngeal disease. The study assessed the mean laryngeal secretion concentrations of each immunoglobulin type in the 12 laryngeal cancer patients, comparing human papilloma virus DNA positive patients (n = 3) and human papilloma virus DNA negative patients (n = 9); the mean concentrations of immunoglobulins M, G and A and secretory immunoglobulin A tended to be greater in human papilloma virus DNA positive cancer patients, compared with human papilloma virus DNA negative cancer patients.

These results suggest that the local laryngeal immune response is activated by infection or carcinogenesis due to human papilloma virus. The findings strongly suggest that secretory IgA has inhibitory activity against infection or carcinogenesis associated with human papilloma virus in the larynx.

This study sought to evaluate the incidence, aetiology, clinical features and treatment modalities for laryngocoele formation after supracricoid partial laryngectomy.

The medical charts of 62 patients who had undergone supracricoid partial laryngectomy were reviewed.

Three patients developed laryngocoele, giving an incidence of 4.8 per cent. Two of these patients presented with a cervical mass, dyspnoea and fever. The mobility of the arytenoids was disturbed on the involved side. The third patient was admitted complaining only of a compressible cervical mass. In all patients, diagnosis was made by computed tomography scan. The transcervical surgical approach was preferred for resection.

Laryngocoele can occur as a late complication of supracricoid partial laryngectomy. Remnants of the laryngeal ventricle may be the cause of laryngocoele formation. The integrity of the laryngeal ventricle in the resected specimen should be routinely checked in order to avoid this rare complication. Clinicians should be aware that, following supracricoid partial laryngectomy, a cervical mass presenting with dyspnoea and disturbance of arytenoid mobility does not always indicate tumour recurrence.

To review early oncological outcomes following transoral CO2 laser resection of laryngeal and hypopharyngeal squamous cell carcinoma.

Retrospective review of hospital electronic database.

Large district general hospital in England, UK.

Patients' three-year disease-specific survival and disease-free survival were evaluated, including post-operative complications, voice quality and swallowing status.

Seventy-seven patients (16 women and 61 men) were identified. Transoral laser excision of squamous cell carcinoma of the larynx was undergone by 65 patients, and the same procedure in the hypopharynx by 12. Patients with laryngeal cancer had statistically better disease-specific survival than those with hypopharyngeal cancer (p = 0.021), although the cumulative disease-free survival probability was 0.71 for both larynx and hypopharynx groups. Patients who underwent laryngectomy following failed laser treatment or as a salvage procedure had poorer outcomes.

The overall results of this study were comparable with those of other, larger studies. At three-year follow up, cumulative disease-specific survival probabilities were 0.92 and 0.71 for laryngeal and hypopharyngeal squamous cell carcinoma, respectively.

Fascin is an actin-binding protein which is expressed in the basal areas of healthy squamous epithelium. Although overexpression of fascin has been shown in many tumours, the relationship between fascin and laryngeal squamous cell carcinoma has not previously been investigated, to the best of our knowledge. This study aimed to investigate the relationship between fascin expression and tumour behaviour in 30 cases of laryngeal squamous cell carcinoma.

For all lesions, a section of paraffin-embedded tissue was immunohistochemically stained for fascin. The percentage of positive, stained cells was scored from one to five (one = 0–5 per cent, two = 6–25 per cent, three = 26–50 per cent, four = 51–75 per cent and five = 76–100 per cent), and the staining intensity from one to three (one = mild, two = moderate and three = strong). A total immunohistochemical fascin expression score was obtained by multiplying the staining percentage and intensity. The relationship between the total fascin score and each case's age, sex, tumour localisation, tumour–node–metastasis stage and differentiation was evaluated statistically.

Various amounts of fascin expression were observed in all cases. There was a statistically significant relationship between high levels of fascin expression (i.e. a total fascin score of 10 or more) and the cases' tumour stage (p = 0.022), node stage (p = 0.024) and clinical stage (p = 0.014). In addition, worsening tumour differentiation was associated with an increasing fascin score, but this finding was statistically insignificant.

These results suggest that laryngeal squamous cell carcinomas with high levels of fascin expression may be more aggressive than those with low expression levels. Further studies with larger series are needed to support these results and to clarify rationales.

Verrucous carcinoma occurs infrequently in the vocal folds. This tumour has an excellent prognosis with proper treatment. Management strategies include surgery, radiotherapy or both.

To evaluate the long-term results of type I and II laser cordectomy for the treatment of verrucous carcinoma of the vocal folds.

We reviewed the files of 18 patients with verrucous carcinoma of the vocal folds treated by type I or II laser cordectomy in our department from 1989 to 2006, and recorded clinical and outcome data.

None of the patients had any major post-operative complications. All had a subjectively satisfactory quality of voice, with no morbidity. Patient follow up ranged from three to 228 months (mean, 48 months). Five patients were treated with post-operative radiotherapy for persistent disease, of whom four underwent repeated surgery due to recurrence.

Type I or II laser cordectomy is a safe, feasible, secure method of treating verrucous carcinoma of the vocal folds. There were no major complications in our patient series. Most recurrent disease was manageable locally with repeated surgery.

This paper evaluates the feasibility of transoral, endoscopic resection of macroscopically localised, low grade, subglottic chondrosarcoma.

Retrospective case study including patients diagnosed with low grade, subglottic laryngeal chondrosarcoma. Tumours were resected endoscopically via direct laryngoscopy with microlaryngeal technique, under jet ventilation. The post-operative course, vocal fold function, airway patency and oncological results were evaluated.

Two male patients aged 49 and 60 years underwent endoscopic, translaryngeal, en bloc resection of low grade chondrosarcoma of the cricoid cartilage. Extubation was performed immediately after surgery. Neither patient required tracheostomy or developed subglottic stenosis. No tumour recurrence was noted after an average follow up of 10.5 months. Voice quality was stable and dyspnoea improved.

Transoral, endoscopic resection of low grade, subglottic chondrosarcoma is a viable technique with good functional outcomes. Extensive resection of subglottic disease is possible, which may afford patients an alternative to total laryngectomy.

We report an extremely rare case of distant metastasis to the rectus femoris muscle from a laryngeal squamous cell carcinoma.

We present a case report and a review of the world literature concerning distant skeletal muscle metastasis from head and neck squamous cell carcinoma.

The patient showed no evidence of distant muscular recurrence at follow up after 21 months; however, two years later he died from brain and suprarenal metastases.

This report describes the first case of haematogenous distant metastasis to the left rectus femoris muscle from a laryngeal squamous cell carcinoma, without evidence of cervical lymph node metastases. To the best of our knowledge, this is the second reported case of muscular distant metastasis without cervical lymph node involvement. Although the prognosis associated with skeletal muscle metastasis is considered to be poor, surgical excision may be indicated for an isolated muscular metastasis.

Positron emission tomography with 18F-fluorodeoxyglucose (18FDG) has been increasingly used in the diagnostic investigation of patients with neoplasms of the head and neck. Positron emission tomography and computed tomography have also proven useful for surveillance of thyroid cancers that no longer concentrate radioiodine. However, certain benign or inflammatory lesions can also accumulate 18F-fluorodeoxyglucose and lead to misdiagnosis.

We review and discuss the pitfalls of using positron emission tomography and computed tomography for surveillance of thyroid cancer.

We present the case of a 48-year-old woman who was diagnosed with a laryngeal neoplasm on integrated positron emission tomography and computed tomography scanning, after a routine ultrasound demonstrated an enlarged thyroid nodule. On physical examination, she had a laryngeal mass overlying an immobile vocal fold. The mass was biopsied and found to harbour a Teflon granuloma.

Positron emission tomography positive Teflon granulomas have previously been reported in the nasopharynx and vocal folds, and should be considered in the differential diagnosis of patients who have undergone prior surgery involving Teflon injection. It is important for otolaryngologists and radiologists to recognise potential causes of false positive positron emission tomography and computed tomography findings, including Teflon granulomas.

The tracheoesophageal puncture technique of voice restoration enables successful voice rehabilitation after total laryngectomy. Because post-operative voice quality can vary significantly, depending on which type of hypopharyngeal repair is chosen, the aim of this study was to evaluate the effect of such repair on tracheoesophageal puncture voice after total laryngectomy.

Prospective, clinical study.

Otolaryngology department, Tanta University, Egypt.

Tracheoesophageal puncture voice was quantitatively and qualitatively evaluated in 40 patients using a Provox 2TM prosthesis after standard total laryngectomy. The patients were divided, according to the type of hypopharyngeal repair, into four groups of 10 cases each, as follows: group one, pharyngoesophageal myotomy; group two, pharyngeal plexus neurectomy; group three, non-muscle vertical repair; and group four, transverse repair. These surgical groups were compared with each other with respect to different voice parameters.

Patient profiles were almost equivalent in all surgical groups. The mean values of most of the parameters of quantitative tracheoesophageal puncture voice did not differ significantly, comparing the four surgical groups; however, a slightly significant difference was observed regarding loud intensity in the non-muscle repair group, and soft and loud jitter in the transverse repair group. Mean values for qualitative measures of intelligibility and communicative effectiveness did not show significant difference. However, a slightly significant difference was observed regarding fluency, word correctness, speaking rate and wetness, with higher values for all these parameters except wetness in the myotomy group, and higher values for wetness in the non-muscle repair group.

The four hypopharyngeal repair types – primary pharyngoesophageal myotomy, pharyngeal plexus neurectomy, non-muscle vertical repair and transverse hypopharyngeal repair – were almost equivalent in prevention of pharyngoesophageal spasm in total laryngectomy patients who had undergone primary tracheoesophageal puncture for voice restoration.

We have performed supracricoid laryngectomy with cricohyoidoepiglottopexy or with cricohyoidopexy for tumour (T) stage T2 and T3 laryngeal cancer cases and some T4 cases. We report the clinical symptoms and management, using this technique to avoid complications.

Among patients undergoing the procedure, two cases manifested laryngeal chondritis following laryngectomy with cricohyoidoepiglottopexy. This complication was caused by C3–4 cervical osteophytes physically contacting the cricoid cartilage. Laryngeal microlaryngoscopy was performed, which revealed white, necrotic tissue in the posterior wall of the pharynx and persistent oedema of the neoglottis.

When encountering a patient with an excessive osteophyte formation at the level of C3–4, one needs to take extra precautions when undertaking laryngectomy with cricohyoidoepiglottopexy or with cricohyoidopexy.

To improve case selection for near-total laryngectomy by identifying the causes of poor oncological and functional outcomes.

Analysis of prospectively accrued data for 28 consecutive cases of near-total laryngectomy undertaken between 1996 and 2005 at a tertiary care centre. We analysed the impact of tumour extent and location, patient physiological status, and surgical technique on disease-free survival and on functional outcome.

Patients' average four-year Kaplan–Meier disease-free survival was 74 per cent (95 per cent confidence intervals, 46–89 per cent). Eighty-two per cent of patients had good to excellent functional outcomes. Pre-operative tumour extension to the ipsilateral arytenoid significantly compromised disease-free survival (patients with this development had a two-year survival of 40 per cent; p = 0.001). Internal communicating fistula formation (i.e. a fistula between the neopharynx and myomucosal shunt lumens) occurred in five of 28 cases and was uniformly associated with a poor functional outcome (i.e. lack of phonation with or without aspiration). Fistula formation was significantly more likely in cases with tumour involving the ipsilateral arytenoid and the ipsilateral subglottis.

Significant disparity exists for the functional outcome of near-total laryngectomy in patients who develop post-surgical internal fistula, compared with those with uneventful healing. Tumour involvement of the ipsilateral arytenoid compromises the oncological and functional results. Tumour extension to the subglottis may compromise functional outcome. Near-total laryngectomy should be avoided in cases with ipsilateral arytenoid involvement, and undertaken with caution in cases with subglottic extension.

The management of advanced laryngeal cancer has evolved in the last century, from total laryngectomy to chemoradiation. The aim of this study was to examine our experience with supracricoid partial laryngectomy as a possible solution for patients with advanced laryngeal tumours, with a focus on the oncological safety of the procedure and the functionality of the preserved larynges.

We reviewed the medical records of patients with laryngeal cancer who had undergone primary or salvage supracricoid partial laryngectomy at our department between 1998 and 2004.

Twenty-three patients treated with supracricoid partial laryngectomy for endolaryngeal squamous cell carcinoma were identified. Median follow-up time was 35 months. Twelve patients had advanced laryngeal tumours. Eight patients were radiation failures. These factors were not associated with increased local recurrence or with decreased survival.

Supracricoid partial laryngectomy appears to be a feasible option for the treatment of laryngeal tumours, even in the advanced stage or after failure of radiation therapy.

Radiological imaging plays an indispensable, complementary role to endoscopy in the pre-therapeutic assessment of laryngeal cancer. We evaluated the reliability of radiological imaging in determining the extent of cancer and surgical resection, by comparing the results of pre-operative computed tomography and magnetic resonance imaging with those for post-operative pathological analysis.

Twenty-nine patients who had undergone laryngeal cancer surgery with a diagnosis of supraglottic cancer were reviewed. Imaging reliability was assessed for separate subunit regions of the supraglottic area, the glottic area and the cartilage.

The false diagnosis rate for all subunits was 25 per cent. The rate of false diagnosis associated with overstaging was 21 per cent. The rate of false diagnosis associated with understaging was 4 per cent.

In order to give the best chance of laryngeal preservation, especially in the case of false positive laryngeal subsites, computed tomography and magnetic resonance imaging should be combined with pre-operative endoscopy and intra-operative frozen section diagnosis.

Vocal results after endoscopic cordectomy have not yet been well defined. The aim of this study was to assess the vocal function of patients who had undergone CO2 laser cordectomy.

Retrospective, observational and control group study, conducted in a tertiary care medical department.

One hundred and thirty-five male patients (age range 36–83 years) underwent different types of endoscopic cordectomy. Forty age-matched, euphonic male subjects were selected as controls. Patients were classified according to the main site of the phonatory neo-glottis. Outcome measures were maximum phonation time, vocal intensity and harmonic/noise ratio. Mann–Whitney and rank Spearman tests were used for statistical analysis.

Findings indicated statistically significant differences for all parameters, comparing patients and controls (p<0.001), and a direct positive relation between type of functional compensation and outcome measures in the study patients (p<0.001).

The results indicate that functional compensation and outcome measures were related, and that no functional compensation enabled the study patients to achieve a voice quality comparable with that of controls.

To determine the correlation between expression of cyclooxygenase-2, vascular endothelial growth factor and matrix metalloproteinase-2, in patients with laryngeal carcinoma.

The study included 85 primary laryngeal squamous cell carcinoma cases. Expression was assessed using Envision immunohistochemical stains for cyclooxygenase-2, vascular endothelial growth factor and matrix metalloproteinase-2.

A tissue microarray containing samples from the 85 primary laryngeal squamous cell carcinoma cases was assembled. Immunohistochemical testing for cyclooxygenase-2, vascular endothelial growth factor and matrix metalloproteinase-2 was performed. Using Pearson correlation, expression of these proteins was compared with the following clinicopathological variables: age, sex, clinical tumour–node–metastasis staging, and prognosis. Three-year survival curves, factored by cyclooxygenase-2, vascular endothelial growth factor and matrix metalloproteinase-2 expression, were generated for overall survival, by Kaplan–Meier analysis.

The expression of cyclooxygenase-2 significantly differed between patients with different pathology, tumour–node–metastasis stage and prognosis. A marked difference in vascular endothelial growth factor expression was seen between two histological grade groups. Expression of matrix metalloproteinase-2 protein statistically significantly differed between patients with different tumour–node–metastasis stages, lymph node metastases and three-year survival rates. The expression of cyclooxygenase-2 in laryngeal carcinoma tissue was found to be associated with the expression of matrix metalloproteinase-2.

Cyclooxygenase-2 and matrix metalloproteinase-2 may act as clinical prognostic indicators of tumour growth and differentiation in laryngeal carcinoma.