Novel laryngoscopic strategies to improve evaluation of the site and extent of primary hypopharyngeal tumours.
OBJECTIVE
To investigate different strategies for displaying the hypopharynx and oesophageal entrance during laryngoscopy for hypopharyngeal cancer.


METHODS
A total of 113 patients with hypopharyngeal cancer underwent laryngoscopy prior to surgery. The hypopharynx was displayed by: (1) pulling the anterior cervical skin; (2) having the patient perform the Valsalva balloon-blowing manoeuvre; and (3) injecting oxygen through the biopsy channel to expose the oesophageal entrance. The effect of these methods on visualisation of primary tumour size and extent was assessed.


RESULTS
During pronunciation of the letter ‘e’, the hypopharynx was displayed in only 33 patients (29.2 per cent); with anterior cervical skin traction plus the balloon-blowing manoeuvre, the hypopharynx was displayed in 106 patients (93.8 per cent; p < 0.001). The combined strategy was superior especially when judging the extent of posterior pharyngeal wall and postcricoid invasion. Oesophageal entrance involvement was visible in 33 patients upon injecting oxygen through the laryngoscopic biopsy channel, and in 25 patients during radiological examination; laryngoscopy was superior to radiological examination in determining the extent of oesophageal entrance invasion (p = 0.003).


CONCLUSIONS
Adequate laryngoscopic display of the hypopharynx could increase the accuracy of pre-treatment hypopharyngeal cancer staging.
Department of Endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
X-G
XG
Ni
R-R
RR
Cheng
S-Q
SQ
Lai
L
L
Zhang
S
S
He
Y-M
YM
Zhang
G-Q
GQ
Wang
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods; D002294:Carcinoma, Squamous Cell / Q000145:classification / Q000175:diagnosis; D005260:Female; D006258:Head and Neck Neoplasms / Q000145:classification / Q000175:diagnosis; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000145:classification / Q000175:diagnosis* / Q000601:surgery; D007828:Laryngoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D000077195:Squamous Cell Carcinoma of Head and Neck; D014143:Traction / Q000379:methods; D014636:Valsalva Maneuver / Q000502:physiology*