James H. Brandenburg

Vocal cord augmentation with autogenous fat.

Since 1987, the authors have used a new technique for the augmentation and medialization of the paralyzed vocal cord. Eleven patients with paralyzed vocal cords and one patient with a surgical defect of the vocal cord have been treated with intracordal injections of autogenous fat harvested by suction from the abdominal wall.

Laser Cordectomy or Radiotherapy: Cure Rates, Communication, and Cost

Health care costs have risen dramatically in recent years. Cost-containment strategies have become necessary to ensure that adequate medical care is accessible to all who need it. These strategies Include choosing the least costly of several treatment modalities with equal efficacy. Radiotherapy has been considered by some as the treatment of choice for early glottic tumors. Rationale for this is based on two major assumptions: That cure rates are equal for radiotherapy and surgery, and that voice preservation and quality is superior with radiotherapy. Implicit In these assumptions is the idea that cost of therapy should not be a factor in selecting an alternative. This study presents a literature review of cure rates for laser cordectomy and radiotherapy for T1 glottic cancers. An objective voice analysis was performed on 14 patients with T1 glottic cancers treated with laser cordectomy and the results were compared to a group of 20 patients treated with radiotherapy for similar early tumors. Finally, the average total cost of each modality was calculated and compared. Our findings indicate that: (1) cure rates are equivalent; (2) voice quality after laser cordectomy is as good as that noted after radiotherapy; and (3) total cost of therapy is much less for laser cordectomy than for radiotherapy. We advocate laser cordectomy rather than radiotherapy for most early glottic tumors. Laser cordectomy offers the same cure rate and quality of voice as radiotherapy for early T1 glottic carcinomas, and at our institution laser surgery is significantly less expensive.

Laser Cordotomy versus Radiotherapy: An Objective Cost Analysis:

This study presents a cost analysis of and comparison between laser cordotomy and external beam irradiation for the treatment of early glottic carcinoma. It compares the curative results of the two modalities from data of a retrospective study at my institution and a literature review of published cure rates. It also reviews the results of objective voice assessments in cases representing both treatments. The findings of this study indicate that the cure rates are equivalent and that voice quality obtained after laser cordotomy is comparable to that obtained after irradiation, yet the total cost of external beam radiotherapy is significantly higher than that of laser surgery. Hence, the findings of this study provide strong support for initially treating early glottic tumors with laser surgery.

An Objective Assessment of Voice Production after Radiation Therapy for Stage I Squamous Cell Carcinoma of the Glottis

Radiation therapy has been the primary treatment for early glottic carcinoma, especially when restoration of normal voice is essential; yet objective evidence of the status of vocal function after treatment is lacking. The purpose of this study was to assess vocal characteristics of patients with glottic carcinoma after they had undergone radiation therapy. Twenty males, who had previously been treated with external beam irradiation for T1NOMO squamous cell carcinoma with no subsequent evidence of recurrence, volunteered for this study. Laryngovideostroboscopic, acoustic, aerodynamic, and perceptual measures of vocal function were used to determine the characteristics of voice production. Acoustic indices were compared to those of a normal group of 30 age-matched volunteers, and the other measures were compared to established values reported in the literature. On acoustic analysis, the study group was characterized by significantly worse voice production than their counterparts. A high degree of intersubject variability was noted that could not be accounted for in terms of variables in treatment and medical history. The aerodynamic, spectral, and video-stroboscopic findings correlated well; this indicated a poor vibratory source, characterized by diffuse stiffness. Further work is necessary in order to compare vocal function after endoscopic laser and conventional conservative excision.

Vocal cord injection with autogenous fat: a long-term magnetic resonance imaging evaluation.

Since 1987, the senior author has injected autogenous fat into paralyzed or atrophic vocal cords as an alternative to alloplastic substances for vocal cord augmentation and medialization.

An epidemiologic study of oral cancer in a statewide network

A case-control study was conducted to investigate the risks of male and female oral, oropharyngeal, and hypopharyngeal cancer associated with poor oral health, mouthwash use, occupation, histories of tobacco and alcohol use, and other factors. Data were collected from all newly diagnosed patients entered into the Wisconsin Head and Neck Cancer Network over an 18-month period (N = 623). The prevalence of painful or ill-fitting dentures was significantly higher among males and females with oral cavity cancer. Relative risks for painful dentures were 5.97 (males) and 1.60 (females); for ill-fitting dentures, the relative risks were 3.15 (males) and 2.15 (females). For males, high relative risks of oropharyngeal cancer were also found to be associated with these indicators of poor dentition. Other indicators of poor oral health, including toothbrushing frequency and prevalence of broken teeth, were not associated with oral cancer. Mouthwash use was not found to carry a risk of oral cavity, oropharyngeal, or hypopharyngeal cancer. The risks of upper aerodigestive cancers with smoking and alcohol were confirmed for males, and lifetime use patterns were explored. Notable sex differences in exposure to alcohol and tobacco were found. There was little evidence that past alcohol use was related to female oral cancer.

Dedifferentiated Chondrosarcoma of the Larynx with Regional and Distant Metastases

Chondrosarcoma of the larynx is an unusual tumor, with only approximately 200 cases having been reported. This tumor is relatively nonaggressive and tends to remain localized in the larynx. Two cases with aggressive clinical behavior manifested by regional or distant metastasis are presented. In the first case, cervical node metastasis appeared 6 months after total laryngectomy. A dedifferentiated chrondrosarcoma was identified by pathologic examination. In the other case, clavicular metastasis developed 7 years after initial local excision. Despite additional treatments, the patient later developed cervical node, lung, and vertebral metastasis. Transformation from low-grade to dedifferentiated chondrosarcoma was verified by pathologic examination. We believe this case to be the first reported laryngeal chondrosarcoma with bone metastasis. A review of the literature regarding regional and/or distant metastasis of laryngeal chondrosarcoma, including the present observations, reveals a total of 20 cases. In all cases, tumor grade has been directly correlated with the development of metastasis.

Significance of apparent intratympanic meningiomas

Meningioma is the most common tumor of the central nervous system, but it has only been reported in 79 patients to involve the temporal bone. The 4 cases presented here show striking clinical similarity to a subgroup of 20 meningiomas reported to be entirely intratympanic; however, in each instance the extent, origin, and potential of the disease was not initially evident.

Coronal Sections of Larynges from Radiationtherapy Failures: A Clinical-Pathologic Study

Serial coronal sections of 89 wide-field laryngectomies were examined. Twenty were specimens obtained from laryngectomies to treat patients for whom primary radiation therapy failed to cure early laryngeal cancer. These specimens were compared to 69 specimens from laryngectomies for T3, and T4, laryngeal cancers. The irradiation-failure group showed a significantly greater invasion of cartilage and extension into subglottic areas. The extension of tumors along blood vessels and mucous glands appeared to contribute to the spread of tumors in the irradiation-failure group. These findings have implications for the surgical management of irradiation failures in the treatment of laryngeal cancers.

Sulcus vocalis in laryngeal cancer : a histopathologic study

The incidental finding of sulcus vocalis in surgical specimens of patients with laryngeal cancer prompted this review. Sulcus deformities were histologically identified in 28 (48%) of 58 whole‐mount coronal serial‐sectioned laryngeal specimens procured from laryngeal cancer patients. The lesions were analyzed, described, and graded. A control group of 20 larynges, obtained from autopsies of patients without known laryngeal pathology, were similarly processed, and whole‐mount histologic sections were studied. Four of these specimens (20%) also demonstrated sulcus deformities. In the control group, the shape and location of the sulci were similar, but the lesions were smaller than in the cancer group. The sulcus lesions revealed chronic inflammation of the subepithelial tissues with vascular ingrowth and fibrosis of the superficial lamina propria (Reinkes space); in the cancer group the sulcus was usually on the opposite vocal fold, where irritation from the tumor might be anticipated. Although the etiology of the sulci remains controversial, these findings suggest that irritation and inflammation might play a role in the pathogenesis of sulcus vocalis.