Gabriel F. Tucker

Efficacy of bronchoscopic carbon dioxide laser surgery for benign strictures of the trachea

There have been conflicting reports in our literature concerning the efficacy of bronchoscopic carbon dioxide laser surgery for the treatment of benign strictures of the trachea. We have examined our experience in the management of this disease over a 2 1/2‐year period; in all cases, our initial management was performed utilizing the rigid, ventilating bronchoscope with the universal endoscopic coupler and carbon dioxide laser.

Histopathology of congenital subglottic stenosis

Three patients with congenital subglottic stenosis are presented and whole organ serial‐section studies of their larynges are discussed. A superiorly displaced first tracheal ring is observed to form a cartilaginous subglottic stenosis in one. This “trapped first ring” is demonstrated in horizontal, sagittal and coronal planes. Subglottic stenosis is a clinical diagnosis which describes multifarious histopathological forms of narrowing within the subglottic larynx.

Anatomy and development of the cricoid: serial-section whole organ study of perinatal larynges.

Whole organ serial-section study contributes to our understanding of neonatal intubation injury by demonstrating the previously undescribed “V” configuration of the posterior cricoid lamina; this may be readily correlated with subarytenoid paramedian intubation injury. This technique also permits detailed study of an anomalous larynx and permits the precise identification of a “tracheal” anomaly as a cricoid malformation. The need for a fetal staging system is reemphasized.

Some aspects of fetal laryngeal development.

Some aspects of morphological and physiological development of the fetal larynx are presented. Histochemical confirmation and determinations of fetal glandular activity are needed. Anomalous development of the larynx is still conjecture, but congenital cytsic formation with glandular development appears possible after the fifth month of human fetal life.

Cleft larynx with airway obstruction

Cleft larynx is a rare congenital anomaly becoming recognized and reported with increasing frequency. While it is most commonly associated with aspiration in newborns, airway obstruction can occur. We report two cases of upper airway obstruction due to a soft tissue mass related to the cleft. Since endoscopic findings of cleft larynx are subtle and easily overlooked, the technique of direct laryngoscopy is extremely important. In addition to recognition of the condition, embryology and treatment are also discussed.

Innominate Artery Compression of the Trachea in Infants with Reflex Apnea

Compression of the trachea by an anomalous innominate artery in association with reflex apnea is a frequent cause of respiratory arrest in infants. Once considered, tracheoscopy is mandatory to rule out this disorder. Surgical correction of this condition by innominate arteriopexy has proven to be a very effective method of management. Seventy-eight patients with tracheal compression by an anomalous innominate artery managed by the authors at The Childrens Memorial Hospital in Chicago between January 1977 and December 1979 are presented. In this series, 28 patients had a history of one or more episodes of reflex apnea; all of these patients underwent an innominate arteriopexy. A complete review of this syndrome and methods of its diagnosis are scrutinized. We agree with previous authors that reflex apnea is a definite indication for surgical correction of this vascular anomaly causing tracheal compression, but other indications are delineated.

“Occult” posterior laryngeal cleft

A previously undescribed deficiency of the posterior cricoid at the midline, wherein the mucosa overlying this deficiency is intact, is described. Clinically this presents as a variety of subglottic stenoses wherein the narrowing is primarily in the transverse subglottic diameter; the symptoms are, therefore, those of airway obstruction not laryngeal incompetence.

Revision of the clinical staging system for cancer of the larynx

The system for classification of laryngeal cancer was revised following a field study of 19 participating cancer clinics and hospitals in the United States and the T.N.M. Committee of the U.I.C.C. Study of records of 1,645 larynx cancer patients demonstrated that the best survival was experienced by patients with in‐situ carcinoma (Tis), 97%. When the tumor was limited to the region of origin (T1), survival was 94% for glottic cancers and 91% for supraglottic cases. As the tumor spread to other regions of the larynx but still confined to the larynx without fixation (T2), survival was 85%–82%; when the larynx was fixed, and tumor still confined to the larynx (T3), survival was 65%–74%, and as the tumor spread outside the larynx (T4) survival dropped to 40%–55%. When cervical lymph node metastases were not fixed, survival was ±50% (hemolateral, bilateral, or contralateral non‐fixed metastases). When the regional metastases were fixed, survival dropped to 21%. There were no survivors when the metastases were bilateral and fixed. Grouping the 4 “T”, 4 “N”, and 2 “M” categories into four stages, survival progressively decreased from 94% for Stage I, 85% for Stage II, 59% for Stage III, and 9% for Stage IV for the glottic cases. Similar survival for the supraglottic group was 91%, 82%, 49%, and 9%.

The Anterior Commissure Revisited

Reexamination of the anterior commissure from the perspective of semantics, the anatomy of tumor spread, and connective tissue histology and embryology has reaffirmed previously published findings. In addition, this investigation of the convergence of the various structures toward the anterior commissure has led to the hypothesis that the anterior subglottic larynx may have a midline embryological origin. Whether this area should be included in the “anterior commissure” or possibly better considered as an area to which anterior commissure tumors spread is as yet undetermined.

Intraoral and Cutaneous Juvenile Xanthogranuloma

A three-year-old male with histologically proven intraoral and cutaneous juvenile xanthogranuloma is described. In our review of the literature published in English we were unable to find a similar case report. The clinical and histologic features of this disorder are discussed.