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PubMed2003

Voice rehabilitation after laryngectomy with the Provox voice prosthesis in South Africa.

A study was undertaken to determine whether the Provox voice prosthesis provides good voice rehabilitation following a total laryngectomy in the urban, suburban and rural populations served by a tertiary referral hospital in South Africa. Between 1995 and 1999, a cohort of 128 patients at Tygerberg Hospital was rehabilitated with the Provox voice prosthesis after laryngectomy. In 104 patients primary placement of the prosthesis was done at the time of the laryngectomy. Mean device life and adverse events were determined. Voice quality was assessed subjectively in 104 patients and objectively in 26 patients. The mean device life was 303 days and adverse events occurred in 16 patients. Subjectively, 77 of 104 patients had a good voice, and objectively 22 of 26 patients had good voice intelligibility. The Provox voice prosthesis provides good voice rehabilitation following total laryngectomy, with minimal complications, in the population served by Tygerberg Hospital.

Adult↗
PubMed2004

Bacterial colonization of laryngectomy stomas.

Infections with organisms resistant to conventional antibiotics are of increasing concern. This observational study investigates the bacterial colonization of the peristomal area of laryngectomy patients. Thirty-two consecutive patients who had previously undergone laryngectomy were recruited from the Head and Neck Clinic of a teaching hospital. Swabs were taken from the laryngectomy stoma site, the mouth and both nasal cavities. Microbiological culture and isolation were performed following standard procedures. Despite no clinical sign of infection, 27 patients were found to be carriers of one or more organism (84.4 per cent). Staphylococcus aureus was detected in the peristomal area of 15 patients (46.9 per cent). Methicillin-resistant Staphylococcus aureus (MRSA) was isolated in seven (21.9 per cent) cases. In this series the authors found a high incidence of colonization with potentially pathogenic bacteria in laryngectomy stomas with no clinical signs of infection. In a significant number of patients, Gram positive organisms were identified that could potentially cause cellulitis or wound infections.

Aged↗
PubMed1990

Supracricoid laryngectomy with cricohyoidopexy: a partial laryngeal procedure for selected supraglottic and transglottic carcinomas.

The partial horizontal supracricoid laryngectomy with cricohyoidopexy consists of resection of the whole thyroid cartilage and paraglottic space, as well as the epiglottis and the whole pre-epiglottic space. The cricoid cartilage, the hyoid bone, and at least one arytenoid cartilage are spared. Sixty-eight patients with squamous cell carcinoma of the supraglottis who underwent this procedure during the period from 1974 through 1986 are presented. Conventional horizontal supraglottic laryngectomy was contraindicated in all cases. All but three patients (95.4%) recovered physiologic deglutition, and none required a permanent tracheostomy. The 3-year actuarial survival rate was 71.4%. No local recurrences were encountered. The indications for the procedure are carcinomas of the supraglottis that 1. involve the glottis and anterior commissure, 2. invade the ventricle, 3. present with a marked limitation of true vocal cord mobility (transglottic lesions), and 4. invade the thyroid cartilage. The procedure is presented as a useful alternative to radiation therapy, horizontal supraglottic laryngectomy, and total laryngectomy in select cases of supraglottic carcinoma.

Adult↗
PubMed2004

[Effect of the extents of surgical resection in total laryngectomy on esophageal voice and speech rehabilitation].

The study of functional results of total laryngectomy cannot be separated from articulation of esophageal voice and speech. To achieve success of phoniatric rehabilitation in laringectomized patients, it is necessary to be well aware of pathological sequelae of the very operation, long-term adverse effect of oncological risk factors as well as postoperative anatomo-physiological changes. Anatomic results of total laryngectomy depend on the type of surgical intervention and probable radiotherapy. The extent of surgical procedure, primary dictated by oncological indications, has the essential effect to articulation of esophageal voice and speech. If possible for oncological reasons, hyoid bone should be particularly left intact. Extensive surgical interventions of hypopharynx and the base of the tongue during laryngectomy, neck dissection--especially the radical one, and subsequent radiotherapy, all of them significantly reduce the possibility to produce esophageal voice and speech. Total laryngectomy eliminates the creator of voice and vibrations, which are acoustically perceived as esophageal voice, proceeding at the level of pharyngoesophageal junction. For this reason, the quality of newly created vibrating narrowing is especially important.

Adult↗
PubMed2001

Laryngectomy clinical pathway: development and review.

OBJECTIVE: The goal of the study is to determine if the implementation of a protocol for the preoperative and postoperative care of patients receiving a laryngectomy for cancer of the larynx or hypopharynx (i.e., laryngectomy clinical pathway) reduced length and cost of hospital stay without increasing complication rates. DESIGN: This study is a comparison of the perioperative course of two groups of laryngectomy patients. Data were collected retrospectively from the records of patients operated on before the implementation of the clinical pathway as the institutional historical control. Comparison was made with data collected prospectively on patients operated on after the implementation of the clinical pathway. SETTING: The study was performed at a mid-sized teaching hospital associated with two regional cancer centres. All surgeries were performed by one of two otolaryngology-head and neck surgeons and residents under their supervision. METHODS: The demographic, patient, tumour, treatment, dietary, and complication data were analyzed. Fisher's exact (two-tailed) statistical test was used for parametric data and Wilcoxon scores for nonparametric data. MAIN OUTCOME MEASURE: The principal outcome measure was the length of postoperative inpatient stay. Secondary outcome measures were readmissions and postoperative complications. RESULTS: There was a statistically significant decrease of 6.7 days in the mean length of hospitalization in the clinical pathway group even when taking postoperative readmissions into account. There was no concomitant increase in surgical complications. The mean reduction in hospital cost per case was calculated to be $3,420 (Can). CONCLUSIONS: Application of a clinical pathway for patients receiving laryngectomy is both feasible and effective.

Case-Control Studies↗
PubMed1998

[Supraglottic laryngectomy with or without one arytenoid in epiglottic carcinoma. A report of 40 cases].

OBJECTIVE: Supraglottic laryngectomy with or without one arytenoid is a functional laryngectomy suitable for treatment of epiglottic squamous carcinoma. This procedure consists of resection of the thyroid cartilage, epiglottis and the entire preepiglottic space. METHODS: Between 1990 and 1996, supraglottic laryngectomy was used to treat 40 patients with epiglottic carcinoma. The data were collected by a review of patient records and follow-up. The cancers were in stages T1(17), T2(17) and T4(6) according to the 1987 UICC cancer staging criteria. RESULTS: Twelve ipsilateral and one bilateral functional neck dissection were performed simultaneously of which 7 patients had metastasis in lymph nodes. No patient died postoperatively. Only 8(20%) had slight aspiration before the 20th day. All patients had decannulated. Twenty-nine cases received radiotherapy and chemotherapy. A follow-up analysis showed survival rate of 74% at 3 years. CONCLUSION: We propose supraglottic laryngectomy for the surgical treatment of early supraglottic carcinomas, which could acquire almost normal laryngeal function.

Adult↗
PubMed2000

Speech rehabilitation using a voice prostheses following laryngectomy.

The most serious consequence for patients following laryngectomy is the restriction of verbal communication. Since the introduction of laryngectomy significant concerns have already been focused on the field of speech rehabilitation. The operational procedures for the speech rehabilitation include training of the oesophageal voice speech and the voice prostheses. Speech prostheses are available in our hospital since 1983. The speech quality of the speech prostheses is compared with the classical oesophageal voice or to the voice by means of a Provox speech help. Bacteriological and mycological colonisation as a function of the length of implantation are defined. Our approach to the voice rehabilitation after a laryngectomy by use of a spacer during the laryngectomy has proven successful. As a result patients do not fall into a "hole" of non verbal communication. The aim of our efforts is always to create a functioning oesophageal voice after leaving the care of the hospital.

Bacteria↗
PubMed1998

[Laryngeal reconstruction after near-total laryngectomy].

OBJECTIVE: To reduce the rate of near-total laryngectomy and reconstruct laryngeal function. METHOD: A retrospective review was made on 19 patients treated by near-total laryngectomy and laryngeal reconstruction from 1991 to 1996. Eight patients were male and 11 were female. The age range was from 40 to 74 years, with a mean age of 57.6. Two cases were in stage II, 9 cases stage III, 8 cases stage IV. The characteristic of this operation is to remove hyoid bone and reduce aspiration. RESULTS: Speech function in all patients was good. Deglutition in most patients was good. Five patients breathed through the larynx after decannulation. Fourteen patients respired through tracheostoma because of stenosis of laryngeal cavity. Among them, 10 cases did not need cannula for their wide tracheostomas, 4 cases needed cannula. Three-year survival rate was 78.6%(11/14), 5-year survival rate was 75%(3/4). CONCLUSION: Laryngeal reconstruction near-total laryngectomy is helpful to restore laryngeal function and decrease the rate of total laryngectomy.

Adult↗
PubMed2001

Voice analysis after the partial laryngectomy in patients with the larynx carcinoma.

The paper presents 170 cases of patients with the larynx carcinoma after the partial laryngectomy. According to the procedure which we used, vertical, horizontal and subtotal supraglottis laryngectomies were distinguished. Voice pattern was analysed with the use of subjective and objective spectrography. The lowest degree of dysphonia was found in patients after the horizontal laryngectomy, while the highest degree dysphonia in those after subtotal supraglottis laryngectomy.

Aged↗
PubMed1975

Vocational adjustment after laryngectomy.

The vocational adjustment of 130 persons after laryngectomy was examined by a semistructured questionnaire which elicited responses on 26 measures including vocational plans, work values, remotivation to work, realism, rehabilitation outlook and speech characteristics. Responses were coded according to the Goldberg Scale of Vocational Development with reliabilities ranging between 0.80 and 0.99. Prior to laryngectomy, 30 persons were unemployed or retired, and 100 persons were employed. After laryngectomy, of the 100 employed persons, 51 remained employed, 31 retired, and 18 were too disabled to work. Higher work values, higher remotivation, greater realism, optimistic rehabilitation outlook, previous employment and previous social involvement correlated positively with employment after laryngectomy (p less than 0.05). The continued employment of 50% of laryngectomees compares favorably with that reported in other studies. Persons who developed the basic ability to cope realistically with their disability had the best chance of continuing employment. Persons with an optimistic outlook about the future course of their disease were more likely to return to employment. This group constitutes a productive clientele for vocational rehabilitation.

Activities of Daily Living↗
PubMed2002

[Comparison of the state of acceptance by patients after total and partial laryngectomy].

In this study authors asked about 400 patients (or their families) after surgery procedures because of larynx carcinoma. The questions was connected with acceptance the postoperative state. We collected 170 answers on the question, 137 from patients after total laryngectomy and 33 after partial laryngectomy. On of the question exactly sounded: how patients accepted their postoperative state? They had 3 answers: not content, agreed with the injury or content with the treatment. The results was very astonished: from extreme discontent patients to very satisfied. The most acceptable from the patients point of view is the partial laryngectomy. Even if that sparing operation is enough for some time patient is more satisfied than after total laryngectomy. The acceptance for the total operation is lower, but grows together with a time alive's. The important conditions of acceptance the injuries after the total operations are the awareness of the threats because of the condition, the possibilities of the treatment and it's choice and the knowledge about a rehabilitations after surgery and possibilities to achieve it. The acceptance of the injuries depends on the acceptance this patients by society.

Adaptation, Psychological↗
PubMed2001

[Study of the reconstruction methods after vertical partial laryngectomy for glottic carcinoma of the larynx].

OBJECTIVE: To study the reconstruction methods after vertical partial laryngectomy for glottic carcinoma of the larynx. METHOD: 58 cases with glottic carcinoma of the larynx were treated with vertical partial laryngectomy or extended vertical partial laryngectomy. The clinical materials of these cases were retrospectively studied. RESULT: The total decannulation rate was 93.1% and the 3- and 5-year survival rates were 87.2% and 80.5% respectively. The voice was socially acceptable in 93.1%(54/58) of the patients. Aspiration was only 3. All resumed mouth-food-taking. CONCLUSION: The reconstruction methods after vertical partial laryngectomy were mainly decided by the extent of the laryngeal defect. If the laryngeal defect of the framework was small, the pedicle muscular flap was the best reconstruction method in comparison with other reconstruction methods. If the laryngeal defect of the framework was too big, allograft nasal septal cartilage or epiglottic laryngoplasty should be performed.

Aged↗
PubMed2000

[Voice rehabilitation of modified Amatsu operation after total laryngectomy].

OBJECTIVE: To evaluate voice rehabilitation of one stage tracheoesophagus shunt operation after total laryngectomy. METHOD: One stage voice rehabilitation of 20 cases for post total laryngectomy was performed with modified Amatsu tracheoesophgeal shunt operation. RESULT: 16 cases developed speech with voice rehabilitation among 20 cases of postlaryngectomy. CONCLUSION: One stage tracheoesophageal shunt voice rehabilitation applie to all patients with total laryngectomy and with unilateral or bilateral neck dissection at the same time of total laryngectomy and with radiation therapy. The technique is easy and safe. It can resolve the problem of restoration of voice.

Adult↗
PubMed1999

[Supraglottic horizontal partial laryngectomy].

OBJECTIVE: To evaluate the supraglottic horizontal partial laryngectomy in the treatment of laryngeal cancers. METHODS: Some researches and modifications are performed on the standard supraglottic horzontal partial laryngectomy: the wounded area in the laryngeal cavity is covered with the lateral membrane of thyroid cartilage; the laryngeal cavity is closed as its anterior wall by folding and sewing up the sternohyoid muscles. From 1983 to 1993, 92 patients (80 men and 12 women) with quamous cell carcinoma of larynx were treated with supraglottic horizontal partial laryngectomy. The patients age ranged from 39 to 72 years; 72% aged from 50 to 59. There were 72 cases (78.3%) in the stages III and IV. RESULTS: The 3 and 5 year survival rates of the patients were 75% and 72% respectively. Most cases have acquired good speech and swallow function with 2-4 weeks; 84.8% (78 patients) were extubated. CONCLUSION: The authors believed that partial laryngectomy was safe and beneficial to some patients with laryngeal cancers.

Adult↗
PubMed2000

[Partial laryngectomy for T3 glottic carcinoma].

OBJECTIVE: To explore the possibility of partial laryngectomy for T3 glottic carcinoma and selection of reconstruction methods. METHODS: From January 1986 to January 1994, 78 patients with T3 glottic carcinomas were treated by partial laryngectomy. The operative techniques and the reconstruction methods were retrospectively analyzed. RESULTS: The overall 3 and 5 years survival rates were 88.5% and 75.6% respectively. The local recurrence rate was 15.4%. The reconstruction methods for laryngeal defect repariring following partial laryngectomy were the use of pyriform sinus mucosa with thyroid perichondrium, epiglottic cartilage and bi-pedicaled and bi-muscular flap of strap muscle. The function of respiration, phonation and deglutition recovered well. CONCLUSION: The partial laryngectomy is suitable for T3 glottic carcinoma. The selection of reconstruction method is based on the size of laryngeal defect.

Adult↗
PubMed2000

[The application of epiglottis in laryngeal function reconstruction after partial laryngectomy].

OBJECTIVE: To observe the appliance value of epiglottis in laryngeal function reconstruction after partial laryngectomy. METHODS: Thirty-two cases of glottic and superglottic carcinomas of larynx had conducted partial laryngectomy and the laryngeal function was reconstructed using epiglottis from December. 1992 to January 1996. RESULTS: Nineteen of the twenty-one glottic carcinomas and five of eleven supraglottic carcinomas were decannulated and recovered with laryngeal functions. All the patients rehabilitated deglutition in 14-18 days after surgery. None presented complication of aspiration. CONCLUSIONS: Epiglottis has many advantages in partial laryngectomy and the laryngeal reconstruction. It is easy to approach, apply and heal in short period. It also prevents aspiration and improves the decannulation rate as well as the quality of life in partial laryngectomy patients.

Adult↗
PubMed2002

[Quality of life following laryngectomy].

OBJECTIVE: To assess the quality of life and relevant factors following laryngectomy. METHODS: Quality of life was evaluated in 42 laryngeal cancer and hypopharyngeal cancer patients following laryngectomy and in 38 controls. The assessment included General Quality of Life Inventory, University of Washington Quality of Life Head and Neck Questionnaire and a study specific questionnaire. RESULTS: The laryngectomized patients reported significant lower scores of quality of life than the controls in many aspects of physical health, psychological health and social function dimensions. For patients, the most important dimension affecting quality of life was psychological condition, and the others were physical function, social function, and economic condition in turn; while for the controls, they were of opposite order. The significant factors affecting quality of life in patients following total laryngectomy were their concern about prognosis, disfigurement, decannulation, employment, speech and breathing conditions. The most important factor affecting psychological condition was physical function, while psychological condition was the most important factor affecting social function. Items ranked in the top five included those related to physical function, economic condition, psychological condition, social situation and social communication. CONCLUSION: More attention should be paid to research about quality of life. The quality of life of patients undergone laryngectomy is affected by many factors. Through the integration of psychological, clinical and social interventions, the quality of life of patients may have an overall improvement.

Adult↗
PubMed2002

[The management of stomal recurrence after laryngectomy].

OBJECTIVE: To study effective prevention and treatment of stoma recurrence after laryngectomy. METHODS: A retrospective review of 23 patients with stomal recurrence after laryngectomy was conducted. Among all 23 cases, 20 cases were referred to Cancer Hospital of Chinese Academy of Medical Science from other hospitals. The etiopathology of stomal recurrence after laryngectomy, feasibilities of various kinds of operative treatment and outcomes of clinical management in this series were analyzed. RESULTS: The subglottic extension and invasion of paraglottic portion of laryngeal cancer and peritreacheal metastasis may result in stomal recurrence. The survival period of 18 cases surgically treated was longer than that of 5 cases untreated or irradiated and/or chemotherapied. The 1- and 5-year survival rates were 40.7% and 20.4%, respectively. The common complication was pharyngeal fistula. Surgical treatment may relieve local pain, improve breathing, resume swallowing and decrease cancer ulcer bleeding. CONCLUSIONS: The overall prognosis of peristomal recurrence after laryngectomy was awful and dismal. Prevention should be stressed in surgical treatment of the subglottic extension, invasion of paraglottic portion and peritreacheal node metastasis. A proper surgical treatment in some cases of stomal recurrence would prolong the lifetime and advance the life quality of the patients.

Adult↗