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This chapter highlights a technique of airway evaluation which is readily available to the anesthesiologist, is minimally invasive, and may provide enough information to reduce the use of awake intubation by providing improved clinical information. Preoperative endoscopic airway examination (PEAE), uses the commonly available flexible intubation scope, and unlike use of the same instrument for awake intubation, requires minimal time and patient preparation because it is well tolerated by patients, mimicking an ordinary office ENT laryngoscopic examination. Patients presenting to the operating room under the care of an otolaryngologist for management (diagnostic or therapeutic) of an airway lesions have, in most cases, undergone a flexible endoscopy in the surgeon's office. PEAE may be performed in the preoperative clinic setting, holding area or operating room. Patients who present with invisible airway pathology (e.g. papillomas, supraglottic masses), which may compromise the clinician's ability to control the airway, can be more thoroughly assessed.
To determine the prevalence and type of human papilloma virus deoxyribonucleic acid (DNA) in cases of laryngeal squamous cell carcinoma.
Methods:
We analysed the prevalence of human papilloma virus infection in archived paraffin block specimens taken from 99 cases of laryngeal squamous cell carcinoma between 1990 and 2005, using polymerase chain reaction techniques. Biopsy specimens from five proven verrucous skin lesions were used as positive controls, and peripheral blood samples from five healthy volunteers were used as negative controls.
Results:
Four test samples were found to have inadequate deoxyribonucleic acid purity and were therefore excluded from the study. Human papilloma virus deoxyribonucleic acid was detected in seven of 95 cases of laryngeal squamous cell carcinoma (7.36 per cent). Human papilloma virus genotyping revealed double human papilloma virus infection in three cases and single human papilloma virus infection in the remaining four cases. The human papilloma virus genotypes detected were 6, 11 and 16 (the latter detected in only one case).
Conclusion:
In our series, a very low human papilloma virus prevalence was found among laryngeal squamous cell carcinoma cases. The human papilloma virus genotypes detected were mostly 6 and/or 11, and 16 in only one case. To the best of our knowledge, this is the first report of human papilloma virus prevalence in laryngeal squamous cell carcinoma, based on polymerase chain reaction genotyping in a Turkish population.
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