الفهرس 
Anatomy of Pre-epiglottic space and its relationOnly 14 pages are availabe for public view
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Abstract
Laryngeal carcinoma is the eleventh-most common form of cancer among men worldwide and Laryngeal cancer is the one of the most common malignant neoplasia of the head and neck. It accounts for 1.0-2.0% of all cancer and 11.0-22.0% of head and neck cancer (Huang, 2003).
In Egypt, laryngeal cancer represents 5.7% of all body malignancies and 38.7% of the head and neck malignancies (Farghaly, 1991) Moreover, it remains the second most common respiratory cancer after lung cancer worldwide (Cattaruzza, 1996 and Mohammad et al., 2003).
It is widely accepted that tumoral invasion of the pre-epiglottic space (PES) has a significant prognostic importance in supra-glottic laryngeal carcinomas. The lymphatics of the supra-glottic larynx drain to cervical lymph nodes via the PES, since the supra-glottic larynx is an embryological unit that contains the PES, malignant lesions of this region must be resected with en bloc surgery, including the PES. Tumors with PES invasion are already considered to be T3 in TNM staging (Dursun et al.,1997).
The management of T3 carcinoma involving the pre-epiglottic space is still a subject of great controversy. There are many reasons for this controversy persisting but one of the most significant is that most studies have tended to report the results of either radiotherapy or surgery but seldom both together.
The options for treatment of T3 squamous cell carcinoma which spreads to the pre-epiglottic space are expanding and now include total laryngectomy, near-total laryngectomy, partial laryngectomy: laryngectomy and postoperative radiotherapy, radiotherapy alone with laryngectomy reserved for local recurrence, and induction chemotherapy followed by radiotherapy in responders (lima et al., 2006).
Our study was a search for evidence to conduct a systematic review to evaluate the value of pre-epiglottic space invasion on the management and prognosis of supra-glottic carcinoma patients.
The study included the published medical articles concerning invasion of the pre-epiglottic space in supra-glottic carcinoma patients and its prognosis, in English language, conducted on human subjects in Pub med (Medline data base).
Our search yielded 134 studies, but only 30 studies that were relevant to the target and Only 4 of them fulfilled the inclusion criteria.
In this study we collected data of 292 patients of supra-glottic carcinoma from the selected articles, 142 patient with PES invasion and 150 patients with PES non-invasion.
By using the Review Manager (RevMan) software in comparing between the risk ratio for PES involvement versus PES non-involvement as regards over all survival, we found that there were 96 cases survived from136 patients with PES invasion and there were 75 cases survived from 93 patients with PES non-invasion, it was 0.59 with 95% confidence interval of 0.21 to 1.67. However, this was statistically non significant (P = 0.32).
This result showed that the PES invasion in supra-glottic carcinoma has no effect on survival and so was not considered to be a significant prognostic factor.
And when comparing between the risk ratios for PES involvement versus PES non-involvement as regards recurrence, we found that there were 9 cases who had a recurrence out of 23 patients with PES invasion and there were 8 cases who had a recurrence out of 70 patients with PES non-invasion, it was 2.92 with 95% confidence interval of 1.1 to 7.73. This was statistically significant (P = 0.03).
This means that the recurrence rate is higher in PES non-involvement than the PES involvement patients. This may be due to other risk factors and other tissues which were invaded in those patients without PES –involvement, that resulted in this insignificance regarding survival, and on the other hand the increasing rate of recurrence in the group without PES involvement.