Adult and pediatric laryngotracheal stenoses (LTS) comprise a wide array of various conditions that require precise preoperative assessment and classification to improve comparison of different therapeutic modalities in a matched series of patients. This consensus paper of the European Laryngological Society proposes a five-step endoscopic airway assessment and a standardized reporting system to better differentiate fresh, incipient from mature, cicatricial LTSs, simple one-level from complex multilevel LTSs and finally "healthy" from "severely morbid" patients. The proposed scoring system, which integrates all of these parameters, may be used to help define different groups of LTS patients, choose the best treatment modality for each individual patient and assess distinct post-treatment outcomes accordingly.

Despite advances in the diagnosisand treatment of head and neck cancer,survival rates have not improvedover recent years. New therapeuticstrategies, including immunotherapy,are the subject of extensive research.In several types of tumors, the presenceof tumor infiltrating lymphocytes(TILs), notably CD8+ T cellsand dendritic cells, has been correlatedwith improved prognosis. Moreover,some T cells among TILs havebeen shown to kill tumor cells in vitroupon recognition of tumor-associatedantigens. Tumor associated antigensare expressed in a significant proportionof squamous cell carcinoma ofthe head and neck and apparently mayplay a role in the regulation of cancercell growth notably by inhibition ofp53 protein function in some cancers.The MAGE family CT antigens couldtherefore potentially be used as definedtargets for immunotherapy andtheir study bring new insight in tumorgrowth regulation mechanisms. Between1995 - 2005 54 patients weretreated surgically in our institution forsquamous cell carcinoma of the oralcavity. Patient and clinical data wasobtained from patient files and collectedinto a computerized database.For each patient, paraffin embeddedtumor specimens were retrieved andexpression of MAGE CT antigens,p53, NY-OESO-1 were analyzed byimmunohistochemistry. Results werethen correlated with histopathologicalparameter such as tumor depth,front invasion according to Bryne andboth, local control and disease freesurvival. MAGE-A was expressed in52% of patients. NY-ESO-1 and p53expression was found in 7% and 52%cases respectively. A higher tumordepth was significantly correlatedwith expression of MAGE-Aproteins(p = 0.03). No significant correlationcould be made between the expressionof both p53 andNY-OESO-1 andhistopathological parameters. Expressionof tumor-associated antigendid not seem to impact significantlyon patient prognosis. As does thedemonstration of p53 function inhibitionby CT antigens of MAGE family,our results suggest, that tumor associatedantigens may be implicated in tumorprogression mechanisms. Thishypothesis need further investigationto clarify the relationship betweenhost immune response and local tumorbiology.

Most bronchoscopies and esophagoscopies are currently performed with flexible instruments by the respective specialist. Thus the field of bronchoesophagology is in danger of being fragmented; neither the pneumologist nor the gastroenterologist have the complete overview of the upper respiratory and digestive tract. This review shows that number of pathologic conditions in the ENT area and the mediastinum involve the upper respiratory as well as the digestive tract, and thus underscore the need for combined tracheobronchial and esophageal endoscopy. Mastering of rigid and flexible endoscopy is mandatory to be efficient in diagnostic and therapeutic bronchoesophagoscopy. The ENT specialist is in the best position to maintain an overview of this whole field. New developments in bronchoesophagoscopy are presented and discussed in terms of cost effectiveness.

To examine the incidence of subglottic stenosis in children with congenital heart disease undergoing surgical repair and the contributing factors to such a complication.A retrospective chart review.Tertiary care children's hospital heart center.Children with congenital heart disease undergoing cardiac surgical repair and presenting with subglottic stenosis in the postoperative period.The authors reviewed their practice for a 4-year period (2002-2005) and identified 17 of 809 children <2 years old with congenital heart disease diagnosed with significant subglottic stenosis in the postoperative period. The incidence was 2.3% in children <1 year old and 2.1% in children <2 years old; the overall incidence was 1.08% in all children <18 years old (17/1,572) undergoing cardiac surgical repair in the same time period. Intubation duration of <24 hours had an incidence of 0.58% compared with 16% in those intubated for >96 hours. The common use of cuffed endotracheal tubes (783/809 children <2years) did not result in an increased risk of subglottic stenosis in the authors' practice.Subglottic stenosis is an uncommon complication in children undergoing surgical repair of congenital heart defects. The most important risk factors are younger age and prolonged postoperative ventilation. Early diagnosis, referral, and intervention resulted in a favorable outcome in most of the authors' patients.

OBJECTIVE:To study the histopathology of subglottic stenosis in children of different ages after treatment during different periods of time, with or without laser application. Partial resection of the anterior cricoid with adhering stenotic subglottic area in the live young patient provides unique material for studying wound healing and scarring processes.METHODS:25 specimens obtained from partial cricotracheal resection (PCTR) in children, were histologically processed and stained with Haematoxylin and Eosin, Resorcin and Fuchsin (for elastic fibers), and immunohistochemical staining (for the presence of macrophages).RESULTS:All specimens were found to have severe and sclerotic scarring with squamous metaplasia of the epithelium, loss of glands and elastic mantle fibers (tunica elastica), and dilation of the remaining glands with formation of cysts. Also, the cricoid cartilage was affected on the internal and external side, with irreversible loss of perichondrium on the inside and resorption by macrophages of cartilage on both sides. Detrimental effects of laser therapy were demonstrated in four cases. The normal intercellular matrix was completely destroyed and the number of chondrocytes in the cartilage structure diminished.CONCLUSION:Wound healing after laryngeal injury is a process of intense restoration and reorganization of the various tissues involved. This process, however, does not guarantee complete repair. In the severe cases irreversible scarring has replaced normal tissues. There seems to be no direct relationship between the length of the post-lesional period, the age of the patient and the severity of the stenosis. When subglottic stenosis has developed and the majority of the tissues is replaced by dense fibrous tissue, PCTR is strongly indicated to achieve renewed patency of the airway.

A pediatric case of Langerhans cell histiocytosis leading to severe and recurrent subglottic stenosis, ultimately necessitating partial cricotracheal resection, is presented and the literature on this very rare disorder is briefly reviewed.

Unter dem Titel “Die Chirurgie der erworbenen laryngotrachealen Stenosen im Kindesalter” beschreiben die Autoren M. Vollrath et al. in diesem Heft (s. Seite 457) ihre Erfahrungen mit 10 laryngotrachealen Rekonstruktionen, die zwischen 1988 und 1998 wegen hochgradiger subglottischer Stenosen (Grad II: 3 Fälle, Grad III: 7 Fälle) bei 2- bis 7jährigen Kindern durchgeführt wurden. Im Diskussionsteil der Arbeit werden anhand einer Literaturübersicht Ätiologie und Inzidenz der laryngotrachealen Stenosen beim Kind sowie die (manchmal tödlichen) Risiken einer Entlastungs-Tracheotomie beim Kleinkind dargestellt. Darüber hinaus werden alle Techniken der laryngotrachealen Rekonstruktion detailliert beschrieben.

The purpose of the present study was to correlate the wavelength of the irradiation source with the phototoxic activity of tetra(m-hydroxyphenyl)chlorin (mTHPC) in healthy and neoplastic mucosae. The hamster tumour model for early squamous cell carcinoma was used in these experiments. In vitro and in vivo studies have shown that mTHPC absorbs significantly at 652 nm (1, 2). This wavelength is used currently in clinical mTHPC photodynamic therapy (PDT) trials. In order to study the wavelength dependence of the phototoxic effect on normal and tumour tissues, irradiation tests were performed 4 days after injection of 0.5 mg kg(-1) mTHPC. An argon-ion pumped dye laser was used as the light source. The light dose of 12 J cm(-2) was delivered at a light dose rate of 150 mW cm(-2). The wavelength was varied between 642.5 and 665 nm at 2.5-nm increments. The PDT damage was evaluated in serial Haematoxylin and Eosin stained sections using a tissue-damage scale. Light between 647.5 and 652.5 nm induced the highest damage to both the healthy and tumour mucosae. At wavelengths equal to or below 645 nm, and equal to or above 655 nm, tissue damage decreased. Wavelengths below 642 nm and above 660 nm did not induce any visible tissue damage. These results suggest that the in vivo optimal wavelength range for PDT with mTHPC is between 647 and 652 nm. This information is essential for selecting an appropriate light source.

De 1983 à 1992, nous avons traité 34 cas de carcinome glottique (Tis et T1) par chirurgie endoscopique au laser CO2. 8 cas ont dû subir un traitement complémentaire en raison d’une résection incomplète et 3 cas ont présenté une récidive. Dans 2 cas, le traitement de rattrapage après cordectomie au laser CO2 a consisté en une laryngectomie totale. Aucun patient n’est décédé des suites de son cancer du larynx. La cordectomie au laser constitue une modalité thérapeutique efficace du point de vue oncologique à condition de respecter rigoureusement les indications (absence d’atteinte de la commissure antérieure du larynx, absence d’atteinte du processus vocal et du fond du ventricule de Morgagni). Le degré de dysphonie est directement dépendant de l’importance de l’exérèse.

Le traitement photodynamique de 57 carcinomes épidermoïdes superficiels du pharynx [10], des bronches [21] et de ľœsophage [26] a été évalué chez 35 patients porteurs de polylocalisations carcinomateuses synchrones ou métachrones des voies aérodigestives supérieures.

Cette étude porte sur 246 ulcères « peptiques » de ľœsophage classés selon les données endoscopiques en quatre types (ulcère de Wolf, ulcère de Lyall, ulcère de Savary et ulcère de Barrett). Elle démontre que tous ces ulcères sont en règle générale provoqués par le reflux gastro-œsophagien pathologique et non pas par la muqueuse cylindrique hétérotopique du bas-œsophage. De plus, elle prouve que de nombreux ulcères de Barrett se développent comme la totalité des ulcères jonctionnels sur la muqueuse épidermoïde de ľœsophage.