The morphologic development of the human larynx during the first years of life is poorly understood to date. This study used plastinated whole organ serial sections to determine the growth and structure of the infant larynx. The larynges of 43 children 1 to 60 months old were plastinated. Whole organ serial sections were obtained by cutting the resulting specimen with a diamond band saw. The slices were then submitted to computer-assisted morphometric investigation. We found that the subglottic airway rapidly increases in size during the first 2 years of life. Further growth follows a linear mode. The relative proportion of the mucosal lining decreases likewise. In contrast to that in adults, and comparable to that in most mammals, the cartilaginous glottis accounts for 60% to 75% of the vocal folds' length at <2 years. No sexual dimorphism of the larynx exists during childhood. This study supplies detailed morphometric data on the growth and structure of the human larynx during the first years of life. It is the first to use plastinated whole organ serial sections for morphology of the pediatric larynx. Therefore, this study provides quantitative anatomic data of clinical interest that have not been available to date.

A total of 79,000 patients per year are treated for olfactory dysfunction in German hospitals. The vast majority of these disorders (72%) is caused by sinunasal diseases. The quality control of therapeutic strategies is urgently needed.

No abstract

Early detection of local and regional recurrence is the main goal during follow-up of patients with larynx and pharynx cancer. Hypothyroidism occurring in those patients stays frequently undiagnosed as screening for hypothyroidism is not part of the routine follow-up. This study was performed to assess the prevalence of hypothyroidism in these patients. We included 120 patients (106 male, 14 female) with larynx or pharynx cancer treated more than 2 months earlier (mean = 41 months) in the study. Cancer treatment consisted of either surgery (n = 44), radiotherapy (n = 15), or surgery combined with postoperative radiotherapy (n = 61). In all patients, thyroid function studies (thyrotropin [TSH], free triiodothyronine [FT3], and free thyroxine [FT4]) were performed. Twenty-six of all patients (22%) were hypothyroid; in two patients hypothyroidism was diagnosed postoperatively and these two patients were on replacement therapy with thyroid hormones. The highest rate of hypothyroidism (34%) was present in patients treated with surgery combined with radiotherapy, whereas among patients treated with surgery only 7% were hypothyroid (p < 0.001). There was no difference in the duration of follow-up between therapy and inclusion in the study between those two groups. Two of 15 patients treated only with radiotherapy were diagnosed hypothyroid, but in this group the latency was shorter (p < 0.05). The results indicate that thyroid function studies should be routinely performed in the follow-up of head and neck cancer patients, especially if radiotherapy was part of the treatment.

204 patients with carcinoma in situ or infiltrating carcinoma of the larynx were treated with transoral laser partial laryngectomies and, in selected cases, staged neck dissections and postoperative radiotherapy. 169 tumours were glottic, 28 supraglottic and 7 subglottic in origin. Up to now, 21 local and regional recurrences were diagnosed. 16 patients presented with recurrent tumour in the larynx, 3 in the larynx and in the cervical lymph nodes, and two in the neck only with no recurrence at the site of the primary. Out of 19 recurrences in the larynx, 10 were found at the anterior commissure, 5 in the transglottic space, 1 in the arytenoid region and two in the supraglottis. The vast majority of all recurrences were discovered during the first two years after primary treatment. 14 patients were treated with total laryngectomy, two with a second transoral laser resection, one with supraglottic laryngectomy, one with subtotal laryngectomy and two with neck dissections. One patient refused further treatment. 5 patients have so far died due to uncontrollable tumour spread. The analysis of local recurrences demonstrates, that deeply infiltrating tumours at the anterior commissure cannot be steadily removed by transoral laser surgery. Future development of transoral procedures must either focus on complete transoral resection of the anterior part of the thyroid cartilage or at least achieve thermal sterilisation of this area.