Patient: Description of the disease (main symptoms, onset) two months ago, throat discomfort, half a month ago, fiberoptic nasopharyngoscopy, microscopy, pathological diagnosis, squamous epithelial papillary hyperplasia, with moderate to severe atypical hyperplasia, limited by the material, not except for local infiltration, microscopy diagnosis of the epiglottis swelling,, on July 15, 2008, fiberoptic nasopharyngoscopy, microscopy, no bilateral nasal cavity There is no abnormality in the nasal cavity bilaterally, the posterior pharyngeal wall is scattered with left lymphatic vesicles, the root of the left side of the epiglottis is full, the laryngeal surface is uneven, the vocal cords, trachea, and phialopharynx are not abnormal bilaterally. The first thing I want to know is how to get the best out of the cyst.
Ma Lingguo, Department of Otolaryngology, Shenzhen People’s Hospital: First of all, from your description, it seems that there are two diseases.
The first disease is the nasopharyngeal examination and biopsy case report 2 months ago: squamous epithelial papillary hyperplasia, with moderate to severe atypical hyperplasia. If it is still severe atypical hyperplasia, we should consider complete surgical excision and send the excised material to pathology again. Because it is difficult to distinguish severe atypical hyperplasia from early cancer, it will become malignant sooner or later if left untreated.
The second disease is an epiglottic cyst, which has been removed surgically before and has recurred this time. The epiglottic cyst is a benign tumor and can be operated again by an experienced surgeon under microscopic laryngoscope.
I don’t know if the above answer is satisfactory. If you have any questions, please contact me again.
Patient: Hi Dr. Ma, I consulted you two days ago about my mother’s epiglottis cyst disease. Now, more than five months after laryngeal cancer surgery, she has been extubated for more than one month, and now her throat is very dry. Now my throat is very dry and I can’t cough up phlegm, and the phlegm is very sticky. I have taken many kinds of anti-inflammatory drugs, but they are not effective. Today we had a nasopharyngoscopy at the First Hospital of Jilin University, and what we saw under the microscope was. The laryngeal surface of epiglottis is not flat, the epiglottis is thickened, the surface of the vocal folds is smooth bilaterally, the vocal folds, the phial movement is good, and the pear-shaped fossa is clean. No abnormalities were seen in the nasopharynx. It is recommended to do pathology again, and the doctor who did the pathology said it is not good. Since the pathology results are not out now, I am now very worried, is this situation a bad disease? I am now very anxious, please can you tell me?
Ma Lingguo, Department of Otorhinolaryngology, Shenzhen People’s Hospital: Comprehensive second history statement, consider the main lesion as an epiglottis laryngeal surface swelling (surface is not smooth), the first pathology report is: severe atypical hyperplasia. The first pathology report was: severe atypical hyperplasia. The second biopsy was taken and the pathology results were not returned.
The preliminary diagnosis is: severe atypical hyperplasia on the surface of the epiglottis, with a high possibility of early malignant transformation.
It is recommended to wait for the pathology report. If the result is malignant, partial laryngectomy is feasible; if the result is still severe atypical hyperplasia, a small partial laryngectomy (or CO2 laser partial laryngectomy) is still needed, because it is difficult to distinguish severe atypical hyperplasia from early malignancy, and if not handled properly, it will eventually become laryngeal cancer after repeated episodes.
Patient: Thank you, Dr. Ma. I will go to get the pathology tomorrow, and I will contact you again.
Patient: Hi Dr. Ma, I have to trouble you. I got the pathology back today and it is squamous cell carcinoma. What should I do now, should I have surgery or chemotherapy, what is the success rate of surgery, and will it affect my speech much after surgery?
Ma Lingguo, Department of Otolaryngology, Shenzhen People’s Hospital: After reading the pictures, it should be laryngeal cancer (supraglottis type), the tumor originated from the left epiglottis surface and invaded the left aryepiglottis fold, the double vocal folds were not invaded. Further enhanced CT examination of the larynx and neck should be performed to understand the extent of tumor invasion and lymph node metastasis in the neck. Based on the information you provided earlier, it feels suitable for partial laryngectomy. A good surgeon can preserve the full function of the larynx while completely removing the tumor, i.e. no tracheal tube, can speak and eat normally after surgery. However, general surgeons may remove all or most of the larynx, which will result in wearing a tracheal tube for life, hoarse speech or even inability to speak and loss of articulatory function. Because the information is not complete, I can only provide the above-mentioned reference opinion.
Patient: Hello, Dr. Ma. Thank you for your guidance. I would like to call you. I am afraid you don’t have time. Now I have decided to have my mother’s surgery in our city hospital. I asked Professor Du from Changchun Medical University to do the surgery on next Wednesday. The professor said that she will be hospitalized tomorrow and do a full body checkup. Professor Du’s statement is basically the same as yours, that there is no problem to talk and eat after the operation, but temporarily she has to put down a tube to play a breathing role, and nothing else.
Patient: two haloes of unequal size are seen in the left lobe of the thyroid gland, the larger one is about 1.411.1cm is inhomogeneous and hypoechoic with clear boundaries and an intact envelope halo, the smaller one is about 0.8.0.5cm has a smooth echogenic envelope. In the right lobe of the thyroid gland, a hypoechoic aperture of size 0.65.0.4 with clear borders was seen. Ultrasound opinion: multiple thyroid masses (adenoma. My mother will have surgery tomorrow afternoon (July 30). The doctor said at first that she would have to do CT and did not dare to do the surgery, but later, after consultation, she said there was no relationship and agreed to do the surgery. Please reply quickly when you see it.
Ma Lingguo, Department of Otolaryngology, Shenzhen People’s Hospital: The thyroid swelling is small, benign and not related to laryngeal cancer.
If you look at the scope of laryngeal cancer, you should perform partial laryngectomy on the vocal cords, and the thyroid gland happens to be in the same surgical area, you can check the thyroid gland by the way during the operation and remove the thyroid tumor if necessary.
Professor Du must also be very experienced, you can consult him directly and have a good communication with him.
Wish your mother a speedy recovery!
Patient: Hello Dr. Ma. My mother had surgery at two o’clock this afternoon and the surgery was over at three forty. After the surgery, the doctor said it was a success. The thyroid cyst was not removed. I haven’t asked about the specific area where the surgery was done. I only know that the horizontal hemilaryngectomy. I’ll ask you when I understand. I would like to thank you in advance.
Patient: Hello Professor Ma, thank you very much for your help. The pathology results of my mother have been released today, and I will send you the pictures. The pathology diagnosis is: medium differentiated squamous cell carcinoma of the larynx No carcinoma is seen in the peripheral cut edge of the mass 2 lymph nodes in the posterior lateral wall of the euphragmus No carcinoma is seen. Please help me to confirm how long I can speak and how far I can reach in this condition according to your experience, and please give me guidance.
Ma Lingguo, Department of Otolaryngology, Shenzhen People’s Hospital: It has been almost a week since the surgery on the 30th, so you should be able to block the cannula to speak. In another day or two, you can pull out the gastric tube to enter the sticky food through the mouth, and you can consider pulling out the tracheal cannula after eating normally.
If you are more conservative, you can start to eat through the mouth 12 days after surgery, you can block the tracheal tube speech 3-7 days after surgery, and 15 days after surgery, you can pull out the tracheal tube and close the neck incision.
Patient: Dr. Ma. Hello. About the radiotherapy. Our doctor here said that radiotherapy is not necessary. And he said you can eat 20 days after surgery. Can Dr. Ma please tell me why radiotherapy is used?
Ma Lingguo, Department of Otolaryngology, Shenzhen People’s Hospital: After surgery for T1-T2 early-stage laryngeal cancer, radiotherapy is generally not needed, and postoperative radiotherapy cannot increase the cure rate of the tumor. From the previous information, your mother belongs to early stage laryngeal cancer. So radiotherapy is not needed. How many days you can eat after surgery, each hospital and each doctor has different understanding and viewpoints, so there is no need to think too much about it.
Patient: Hello Professor Ma, I would like to express my most sincere thanks for your guidance, which has helped me to know a lot about the treatment of my mother’s condition. However, the doctor allowed my mother to eat by mouth and let her eat bread and bananas, and although she could eat them, they were stuck in the throat and could not go down. After that, some could go down and some spurted out from the exit tube, resulting in the lower gastric tube that could not be pulled out, making me very anxious. I would like to ask Prof. Ma to give me guidance on the best way to eat by mouth, please.
Ma Lingguo, Department of Otolaryngology, Shenzhen People’s Hospital: You can remove the gastric tube and try to eat some small chaos and glutinous rice balls first, swallowing them with force, not chewing them, because food in the form of balls or lumps is not easy to choke into the trachea.
Patient: Hello: Professor Ma. Thank you for your concern about my mother’s condition. I saw the method you introduced after. I personally see that the method you described is very good. Today I consulted the doctor again. One doctor said that choking and coughing after horizontal hemilaryngectomy is a hurdle that every patient has to pass. You can figure out the position of eating, the dryness and shape of food, such as paste or liquid, whether it is better to eat from the left side or the right side, and so on. Would you say this method is also possible? If so. I would like to try both methods. Is it okay? Thank you so much.
Ma Lingguo, Department of Otolaryngology, Shenzhen People’s Hospital: The method of eating after surgery for horizontal hemilarynx has little to do with the eating posture. Now that the postoperative period has reached 30 days, the gastric tube should be removed and transoral feeding should be started. The method of starting transoral feeding is mainly based on my reply to you on the 20th of this month.
Whether or not the horizontal hemilaryngeal can be fed smoothly after surgery is mainly related to whether or not the patient is actively exercising and the surgeon’s surgical skill as well as the size of the tumor and the extent of surgical resection.
Patient: Thank you Dr. Ma. My mom ate a small bowl of noodles and a small bowl of chaos this evening. Still a little choked. But it’s okay. It’s okay. Thank you for your guidance.
Patient: Hello Dr. Ma. This evening I saw a white bubble below my mother’s throat tube. It was the size of a soybean. I don’t know what is going on. Please give me some guidance.
Ma Lingguo, Department of Otolaryngology, Shenzhen People’s Hospital: You have to ask your supervising doctor, it may be a pseudomembrane or secretion. Now if you can eat, you should pull out the tracheal tube so that the patient’s eating, coughing and other various conditions will be better.
Patient: Hello Dr. Ma. My mom’s supervising doctor said that the tube sleeve is worn. I am still choking on food. The tube sleeve has not been removed yet. I will consult you after the tube sleeve is removed.
Patient: Hello, Professor Ma. My mother is still choking badly when she eats, and her throat always feels dry and itchy. The attending doctor said that the tube sleeve cannot be removed yet. What should I do, Professor Ma? I am anxious for guidance, please.
Ma Lingguo, Department of Otolaryngology, Shenzhen People’s Hospital: You have already been told that you can remove the gastric tube and try to eat some small chaos and glutinous rice balls first, swallow them with force in one bite, do not chew them, because the food in a ball or lump is not easy to choke into the trachea. If there is a problem with eating the above food, further fiberoptic laryngoscopy should be done to find the cause, which may be related to surgery. If there is no problem to eat the above food, it means that the surgery is still successful, and then gradually transition to eating sticky food, thin gruel and drinking water. Whether the patient can eat smoothly after horizontal hemilaryngeal surgery is mainly related to whether the patient exercises actively and the surgeon’s surgical skill as well as the size of the tumor and the scope of surgical resection.
Patient: Hello, Professor Ma. I am the same Cai Sheng 123 who consulted you in the previous stage. It’s about my mother’s recent condition. My mother underwent horizontal hemilaryngeal surgery in August and was extubated in the hospital on December 10. Before that, she had not taken much salt for two months after the operation and had been taking phlegm medication. Her condition improved after treatment in the hospital. But for the last two months or so, I don’t know what the reason is. The medicine she took was like stimulating the location of the extraction tube. The redness and swelling, and the phlegm clicked hard. The drip also irritates the stomach. After the tube was removed, she couldn’t take any phlegm medicine. So I drank hot water every day to dissolve the phlegm, sometimes I could drink a thermos of water a day, but the other day I drank too much water. When I drank water, I got nauseous. After that, I didn’t drink much water for three days. At 5:00 am on the 4th, I couldn’t get the phlegm to click. The situation at that time was very dangerous. Almost couldn’t breathe. We rushed her to the hospital. When we arrived at the hospital, we gave her oxygen and Sympathetic. At the same time, some ranitidine was added. But after the ranitidine, she felt the swelling in her throat. Then I took omeprazole. The doctor stopped prescribing the medicine. I was discharged from the hospital last night. I had a laryngoscopy the day before yesterday. The results were no changes in the nasal cavity and nasopharynx, scattered lymphatic follicles in the posterior pharyngeal wall, and no congestion in the epiglottis. The left vocal cord was fixed and immobile. The surface was smooth. The right side was partially absent with fair motion. No abnormal changes were seen in the bilateral fossa ligamentosa. Bilateral edema of the fissure was more prominent. Now she can eat and drink water, but she can’t take medicine.
I think her throat is always swollen now. Is it related to the edema?
What can I do to help her? We are using nebulization for her phlegm now. Can’t get air. And oxygen.
When she sleeps for a long time, she is afraid of not being able to breathe. I always feel that my throat is swollen. It’s hard to get rid of sputum.
Ma Lingguo, Department of Otolaryngology, Shenzhen People’s Hospital.
Hello: I’m sorry for not replying in time as I was away on business during this period. After surgery, consider buying a nebulizer inhaler and do your own nebulization at home, once or twice a day. Only 20ml of saline and a gentamicin will do, if you talk more you can add a mucosolvan. If you are still not well, you should do a culture to find out the causative bacteria that cause coughing and you will get better quickly with the right symptoms. The redness and swelling of the throat area is related to the radiotherapy, and it needs to recover slowly.
Patient: Hello. Professor Ma. I am a family member of a laryngeal cancer patient, Cai Sheng 123, who consulted you in the previous stage. I have no choice but to come to you. Professor Ma, I have already bought a nebulizer for my mother, but the effect is not good, (she did not do radiation or chemotherapy). The sputum that comes out now is very dry and sticky, and it’s blocking her throat, so she has to breathe hard. Sometimes she has no energy at all. Can her current condition be a post-operative infection? In my mother’s case, do you use an aspirator? I’ll buy one myself to get away from the one I can use. Is it okay?
Patient: Hello, Professor Ma, this morning my mother couldn’t cough up her phlegm again. The phlegm is blocking her throat. The respiratory doctor said. Is it a fungal infection? I was told to use Dafukang, and now my mother’s tongue has very little mucus.
Ma Lingguo, Department of Otolaryngology, Shenzhen People’s Hospital: There is no radiotherapy for laryngeal cancer after surgery, which usually rarely occurs. It is recommended that you use a period of nebulized inhalation treatment. At the same time, laboratory test the dielectric, liver and kidney function and blood sugar. Sometimes, dielectric disorder, diabetes, etc. will also appear this situation. In addition, go to the respiratory department to do a sputum culture + drug sensitivity test to find the causative organisms that cause coughing and talk a lot, and you will get better quickly with the right symptoms.
Patient: Hello, Professor Ma. Thank you, the sputum culture was not done, the doctor said it had to be real sputum (my mother coughed out froth). Electrolyte disorder. It was also treated. My mom is not diabetic. These two days. My mother took some Chinese medicine. She can cough up phlegm and her throat is not so dry. Now it’s just that sometimes I can’t pull out my breath, my heart beats 80 to 90 times, and my blood pressure is still okay.
The people’s Hospital of Shenzhen, Department of Otolaryngology Ma Lingguo: you first do a fiber laryngoscopy, I have seen to know what causes breathing problems. If the vocal fissure is large enough, there is usually no dyspnea.
Patient: Hello. Professor Ma, my mother had a laryngoscopy 10 days ago. The result of the laryngoscopy is that there are no abnormal changes in the nasal cavity and nasopharynx bilaterally. There are scattered lymphatic follicles in the laryngeal wall. The epiglottis is not congested. The left vocal cord was fixed and immobile. The surface was smooth. The right side is partially absent. Movement is still possible. Bilateral fossa ligament is unchanged. Bilateral phial edema is more prominent. There is no fiberoptic laryngogram. Tonight her phlegm is blocking her throat again. Her breathing is fine, but I don’t know why she has so much phlegm. I don’t know why she has so much phlegm, but it’s still there after she coughs, and it gets blocked at night. 20 days ago, she almost lost her breath and couldn’t get it out, but then she was able to breathe on the way to the hospital, where she was given nebulizer and oxygen. There’s something else I need to ask you. Last time the doctor said that if it doesn’t work, we should reintubate. I would like to ask you if the reintubation will improve her breathing? Can the phlegm in her throat be resolved? Is it because her tube was removed too early, or her throat has not grown well? We really have no choice but to reintubate her. She has been coughing up sputum with great strength. Her breathing is fine. Now it is the problem of phlegm blocking her throat
Ma Lingguo, Department of Otolaryngology, Shenzhen People’s Hospital: According to the fiberoptic laryngoscopy, if the vocal fissure is wide enough for breathing, there is no need to reintubate her, but if the fissure is narrow enough for breathing, a new tracheotomy should be performed.
Patient: Thank you for your patient response.