The Laryngoscope
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In 2% to 3% of patients with cancer metastatic to cervical lymph nodes, a primary tumor will not be found despite exhaustive diagnostic efforts. The treatment for these patients includes cervical lymphadenectomy followed by radiation to areas with increased risk of harboring a mucosal primary. Wide-field radiation therapy increases the incidence of xerostomia and dysphagia. Localizing a primary tumor has thus both therapeutic and quality-of-life implications, allowing possible complete surgical excision, concentrated radiation therapy, and potential deintensification of adjuvant therapy. With improved visualization and freedom of motion, transoral robotic surgery (TORS) is an innovative surgical modality that allows resection of oropharyngeal subsites with minimal morbidity. ⋯ Unknown primary SCCA presents a diagnostic challenge to the head and neck surgeon. We present a small series of tumors that would have been treated as unknown primaries under traditional diagnostic and therapeutic algorithms. TORS base of tongue resection identified primary tumors in 90% patients with minimal morbidity.
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Laryngeal cleft is a rare congenital anomaly that is recently being diagnosed with increased frequency. The objective of this report is to present a comprehensive description of endoscopic laser repair of a laryngeal cleft, using both the carbon dioxide (CO(2)) laser via a micromanipulator (Carl Zeiss Microimaging Inc., Thornwood, NY) and the flexible CO(2) laser fiber (OmniGuide, Inc.; Cambridge, MA), from both an anesthesia and surgical perspective. Laryngoscope, 2013.
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To evaluate sites and characteristics of upper airway obstruction, as detected with drug-induced sleep endoscopy (DISE) in children with obstructive sleep apnea (OSA). ⋯ The oropharynx/lateral walls are the most common site of obstruction in children with single site obstruction. Combined oropharynx/lateral walls and velum obstruction was the most common sites of obstruction in children with multiple site obstruction. Children with grade I and grade II tonsils may suffer from complete airway obstruction. DISE is a useful tool to identify upper airway obstruction sites in addition to adenotonsillar hypertrophy.