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At least 235 records · Page 13Linked to original sources
PubMed1985

[Reconstructive sub-total laryngectomy according to Labayle. Clinical experience on 21 cases].

In this paper the authors report the functional and oncological results regarding 21 patients suffering from laryngeal carcinoma, who underwent surgery at the University of Parma's ORL Clinic - between 1975 and 1984 - for sub-total reconstructive laryngectomy using the Labayle method. This process provides for not just the radical removal of the laryngeal tumor, but also for restoring basic functions such as respiration, phonation and swallowing. To this end, during the destructive phase, the cricoid cartilage (partially or wholly) and one or both of the arytenoids are retained. The application of this method is situated somewhere between the classic total laryngectomy and the conservative supraglottic, at times finding itself in natural opposition to the expanded supraglottic the lateral-front, the hemilaryngectomy, the crico-ioidopesia and the Serafini-type total laryngectomy. Since it doesn't concern a total laryngectomy in the strict sense of the word, the operation presents general counterindications that are relative - and which exist for that matter in all laryngeal surgery, functional or reconstructive - and local counterindications that are absolute. In addition to the, elective indications are dictated critically. The surgical act, illustrated in detail, consists in a period of approach or preparation, a period of destruction and a period of reconstruction. The results obtained from the series of cases followed are wholly satisfactory from both the functional and oncological point of view: the parameters evaluated - respiration, phonation and swallowing - were totally restored in the majority of cases. Swallowing in just two patients was insufficient, as was respiration in one. Concerning the oncological results, if we exclude 4 cases of the 21 considered which do not have a follow-up of more than three years, there have been no clinical signs of a recurrence of the tumoral disease in the remaining 17, of which 15 have been under observation for more than 5 years. The survival rate, up to the first months of 1985, is 70.5%.

Adult↗
PubMed1987

[Coordinating breathing and swallowing following laryngectomy].

Integrated study of respiration and deglutition includes 48 healthy examinees and 22 patients after laryngectomy. Laryngectomy changes the relationship between breathing and swallowing. In healthy subjects 70.68 per cent of swallows occurs during the expiratory phase and more than 80 per cent are followed by expiration. In the patients after laryngectomy 58.01 per cent of swallows coincide with the end of the expiration end the beginning of the inspiration and near 80 per cent of swallows are followed by inspiration. Laryngectomy eliminates necessity for specific coordination of breathing and swallowing and makes possible manifestation of the central neural control.

Adolescent↗
PubMed1980

Partial laryngectomy following irradiation.

Partial laryngectomy after full course of irradiation was performed in 65 patients as a salvage for residual tumors and local recurrences. The results are reviewed and compared to results obtained by primary operation. It appears that in glottic lesions excellent results by vertical laryngectomy may be obtained without increased complication rate due to irradiation. In supraglottic tumors horizontal laryngectomy is accompanied by increased postoperative morbidity and severely impaired function to such a degree that total laryngectomy is the operation of choice for irradiation failures in supraglottic recurrences.

Adult↗
PubMed1994

[Near-total laryngectomy in the treatment of advanced laryngeal and hypopharyngeal carcinoma].

Near-total laryngectomy was first introduced by RB Pearson in 1980. In this report, 14 cases (T3, T4 laryngeal cancer 10 cases, pyriform fossa 3, cervical esophagus 1) treated with near-total laryngectomy. The speech function was obtained in 12/14 (85.7%) within 2 to 5 weeks, all cases had good swallowing. 2-year survival rate is 78.6%. The authors believed that such surgical technic is most indicated in the cases when regular partial laryngectomy can not be performed and in elderly cases who would have the risk with partial laryngectomy.

Aged↗
PubMed1996

Results of treatment of inoperable recurrences of laryngeal cancer after total laryngectomy.

BACKGROUND/PURPOSE: The results of conventional radiotherapy in patients with inoperable recurrence of laryngeal cancer after total laryngectomy are bad. Therefore experimental methods including neutron therapy and combination of chemo- and radiotherapy have been used. This presentation evaluates results of different treatment modalities in patients with inoperable recurrences of laryngeal cancer after total laryngectomy. PATIENTS AND METHODS: Forty-two patients with inoperable recurrences of laryngeal cancer after total laryngectomy were treated. Thirty patients received radiotherapy alone, and 12 patients received multidrug chemotherapy and radiotherapy. Patients were irradiated with cobalt-60 beam, neutron beam and with mixed cobalt-60 and neutron beam. The tumor dose in cobalt-60 therapy was 60 Gy in 20 to 30 fractions. In 8 patients additional dose of 10 to 20 Gy in 5 to 10 fractions was given to the reduced field. The doses used in neutron irradiation varied from 10 to 13 Gy in 5 to 20 fractions. RESULTS: In 20 patients (47.6%) complete regression after therapy was observed, but only 9 (21.4%) patients survived without evidence of disease at 2 years after radiotherapy. In patients treated with radiotherapy alone the 2-year disease-free survival was observed in 16.7% and in patients who received induction chemotherapy with Cisplatin followed by radical irradiation the 2-year disease-free survival was observed in 40%. CONCLUSION: The results of therapy of inoperable recurrence of laryngeal cancer after total laryngectomy remain bad. Radiotherapy combined with multidrug chemotherapy including cisplatin may contribute to some improvement of the patients survival.

Adult↗
PubMed1996

[Speech rehabilitation following total laryngectomy with tracheo-esophageal puncture].

Speech rehabilitation after total laryngectomy has often been neglected, and traditional methods of esophageal voice production are frequently unsuccessful or disappointing. The development of the tracheoesophageal puncture (TEP) technique and the valved voice prosthesis by Singer and Blom in 1979 offered patients an alternative method for laryngeal speech rehabilitation. This technique is now used successfully in an increasing number of patients after total laryngectomy. We present our experience with TEP since 1988 in 8 men and 1 woman, aged 50-86 years, who had adequate follow-up. In 5, primary TEP was performed at the same time as the total laryngectomy; in 4, secondary puncture was performed 12-18 months after primary surgery. 1 had serious operative complications, 2 had minor complications, 1 had long-term problems which necessitated discontinuing use of the prosthesis, while 8 achieved satisfactory voice use and could communicate effectively. We hope that further experience with TEP in Israel will confirm its effectiveness for speech rehabilitation after total laryngectomy.

Aged↗
PubMed1997

[Pulmonary complications after partial laryngectomies for cancer].

The material of patients after partial laryngectomies due to the laryngeal cancer in light of pulmonary complications was analyzed. Patients were divided into two groups depending on kind of performed operation. The first group consisted of patients after vertical laryngectomies, the second after horizontal operations. The important protective function of the larynx in comparison with lower airway was emphasized. It was pointed out, that after horizontal laryngectomies this protective mechanism becomes not sufficient. Cases of aspiration pneumonia as a result of horizontal operations were introduced. The important contraindications to the horizontal laryngectomies were presented.

Aged↗
PubMed1996

[Reconstructive subtotal laryngectomy in the treatment of laryngeal cancer].

Surgical techniques of sub-total reconstructive laryngectomies can often prevent the serious impairment of total laryngectomy without having to relinquish oncological radicality. The aim of the present work has been to report on the experience in this field accrued in the ENT Department of the University of Modena from 1987 to 1992. During this period 54 subtotal laryngectomies were performed. Of these, 13 were crico-hyoido-epiglotto-pexies (C.H.E.P.) and the remaining 41 were crico-hyoido-pexies (C.H.P.). The criteria suggested in the literature was adopted for tumor evaluation, surgical indications and contraindications. All the patients had a follow-up of at least 2 years and 31 of them have had at least 5 years of follow-up. There were 9 deaths: 3 due to intervening illnesses, 2 from second primary tumors and 4 from tumor and/or node recurrences. The overall survival was 83.3% at 2 years and 77.6% at 5 years. Determinate survival (ruling out those who had died because of intervening illnesses) were 88.2% and 80%, respectively. There were 11 neoplastic repetitions of which 2 were of the primary tumor, 2 of the primary tumor plus cervical metastases, and 7 of cervical metastases alone. Recovery surgery was performed in 9 patients, 5 of whom are still alive and disease free. Functional recovery (respiration, deglutition) took place slightly earlier in C.H.E.P. than in C.H.P. but in both cases this could be shortened, particularly by introducing a rehabilitative protocol during the immediate post-operative period. In no case did it prove necessary to perform a total laryngectomy to avoid "ab ingestis" problems and only one patient has a permanent tracheostomy.

Follow-Up Studies↗
PubMed1995

[The effect of laryngectomy on selected physiologic functions of the nose].

The paper is a continuation of the author's research on pathophysiology of the nose in patients subjected to total laryngectomy due to cancer of the larynx. The aim of the research was to discover how the condition of the nasal mucous and its physiology are affected by the elimination of the nose from the respiratory pathway which is the case in laryngectomy, and also the evaluation of the influence that the nose can exert on the physiology of the respiratory and circulatory systems, despite the elimination of the nose as a first section of the respiratory pathway. The research material was obtained from 110 patients who were subjected to total laryngectomy due to malignancy of the larynx and from a control group number of 30. The research was carried out before the surgery and in different periods after an operation. The condition of the nasal mucous was estimated on the basis of clinical examination including rhinoscopy, measurement of the warmth of the air in the nose and the temperature of the nasal mucous and also on the basis of observation of mucociliary transport. From patients who underwent laryngectomy a cytological material was obtained for examination. In all patients naso-cardiac and naso-pulmonary reflexes were examined. On the basis of the research it was stated that the morphological condition of the nasal mucous does not undergo significant changes despite the elimination of the nose from the respiratory pathway and the nose still maintains its potential ability to perform physiological functions. It can also be said that the elimination of the nose from the first section of the respiratory pathway not only does not remove reflex reactions from the side of the nose, but also often changes their course and character.

Female↗
PubMed1998

[Esophageal morphology with ultrasound imaging after laryngectomy: effect on quality of esophageal speech].

PURPOSE: In patients with aerodigestive cancer, laryngectomy places the esophagus in a superficial position, allowing easy ultrasound examination of this organ. The purpose of the present study was to assess oesophagus morphology after laryngectomy using echotomography and to compare this morphology with voice quality. MATERIAL AND METHODS: In the present study, ultrasonography was performed in 28 patients (delay from surgery: 3 +/- 3 years): 15 were operated using laryngectomy technique (LT) and 13 with pharyngolaryngectomy technique (PLT). On transversal echography, antero-posterior and latero-lateral diameters, esophagus area and dilatation during phonation were systematically measured. These data were compared to the voice quality assessed by two independent observers. RESULTS: A smaller latero-lateral diameter and area were found in the PLT group than in the LT group (p < 0.05) with a flat aspect in group LT. This was associated with faster and better voice acquisition in the PLT group. CONCLUSION: Morphologic study of the esophagus after laryngectomy using ultrasound is in favor of pharyngolaryngectomy technique which allows better conditions for acquiring esophageal voice in better conditions. This could be due to the small area, circle shape and tonicity of the esophagus after this type of surgery.

Esophagus↗
PubMed1998

[Voice function in patients after partial laryngectomy].

103 patients with cancer of the larynx treated with partial laryngectomy were presented. Voice quality before and after surgery was compared. Voice was analysed by subjective and objective-spectrographic methods. Partial laryngectomies consisted of: vertical, horizontal and supraglottic subtotal procedures. The least dysphony was found in horizontal laryngectomy, the biggest--in supraglottic subtotal laryngectomy.

Adult↗
PubMed2000

Functional speech outcomes after laryngectomy and pharyngolaryngectomy.

OBJECTIVE: To compare and contrast functional speech outcomes of patients having undergone total laryngectomy and pharyngolaryngectomy who use tracheoesophageal speech as their primary mode of communication. DESIGN: Group comparison design. SETTING: Adult acute tertiary care hospital. PATIENTS: Thirty patients who underwent total laryngectomy and 13 who underwent pharyngolaryngectomy with free jejunal interposition reconstruction. All patients used tracheoesophageal speech. INTERVENTION: Group comparisons across measures of speech intelligibility, voice quality, tracheoesophageal speech use, voice satisfaction and levels of perceived voice disability, handicap, and well-being/distress. MAIN OUTCOME MEASURE: The existence of any significant differences between the 2 groups on measures of intelligibility, voice quality, tracheoesophageal speech use, and voice satisfaction and levels of voice disability, handicap, and well-being/distress. RESULTS: Statistical comparisons confirmed reduced functional intelligibility (P<.05), reduced vocal quality (P<.01), and higher levels of disability (P<.05) in the pharyngolaryngectomy group. However, no significant difference was observed between the proportion of patients classified as "successful" tracheoesophageal speech users in either group. Low levels of handicap and high levels of patient well-being were recorded in both groups. CONCLUSION: Despite the perceptual differences in voice quality and intelligibility observed between the 2 groups, tracheoesophageal speech that is functional, effective, and perceived by the patients as satisfactory can be achieved after total laryngectomy and pharyngolaryngectomy with free jejunal interposition reconstruction.

Aged↗
PubMed2002

Long-term results of olfaction rehabilitation using the nasal airflow-inducing ("polite yawning") maneuver after total laryngectomy.

OBJECTIVES: To study the long-term results of the nasal airflow-inducing maneuver (NAIM) as an olfaction rehabilitation tool after laryngectomy and to investigate the effectiveness of a new, simpler odor detection test (ODT) called the smell disk test (SDT), or Zürcher Geruchstest. DESIGN: Intervention study. SETTINGS: National cancer center. PATIENTS: Forty-one laryngectomees who received olfaction rehabilitation training with the NAIM 4 months to 2 years earlier. This so-called polite yawning maneuver creates an "underpressure" in the oral cavity, which, in turn, generates a nasal airflow that enables odor molecules to again reach the olfactory epithelium. MAIN OUTCOME MEASURES: Olfaction acuity testing with a standard ODT, along with a questionnaire, providing a subjective olfaction score (present odor perception scale [POPS]), and the SDT, as well as assessment of the patients' correct execution of the NAIM by speech-language pathologists on video recordings made during odor testing and long-term assessment of olfaction acuity. RESULTS: The correlation between the previously used ODT-POPS combination and the SDT was kappa = 0.56 (P<.001). Based on these results, we preferred to use the much simpler SDT instead of the laborious combination of the ODT-POPS. Based on the SDT results, 19 (46%) of the 41 laryngectomees were "smellers" and could be considered normosmic. There was a significant relationship (P =.03) between the patient's correct execution of the NAIM and whether or not the laryngectomee was a smeller according to the SDT. CONCLUSIONS: The effectiveness of the NAIM, or so-called polite yawning technique, for the rehabilitation of olfaction in individuals who have undergone total laryngectomy was reconfirmed. Long-term olfaction rehabilitation was achieved in about 50% of the patients, but more intensified training may be needed to increase the percentage of successfully rehabilitated individuals. The SDT is an effective and simple test for the assessment of olfaction acuity after laryngectomy.

Adult↗
PubMed2002

Acute pain management following laryngectomy.

OBJECTIVES: To evaluate the adequacy of as-needed (prn) dosing of narcotics during the acute postoperative period following laryngectomy and to evaluate the role of nurses' interpretation and implementation of narcotic orders in postoperative pain management. STUDY DESIGN: A retrospective review of the medical records of 37 patients who underwent laryngectomy at the University of Oklahoma. The postoperative care was standardized through a clinical pathway to provide a uniform level of care. METHODS: The parameters reviewed include (1) the type and dose of analgesic prescribed, (2) the quantity and frequency of analgesic administered to each patient, and (3) the adequacy of the initial pain-control prescription. RESULTS: All physician orders for narcotics were at or above the minimum dosing guidelines; 68% met a recommended adequate postoperative prescription for moderate pain. However, none of the patients actually received the intended dose during a 24-hour period while hospitalized. Physicians were contacted about 13 patients (35%) because of inadequate pain relief, but only 8 patients (22%) had their narcotic dose increased appropriately. Patients were dosed below the minimum prescribed dose 19 times (2.8%), and in 24 instances (3.6%) the backup analgesic, designated as "prn breakthrough pain," was given as the primary analgesic. CONCLUSIONS: As-needed dosing of analgesia resulted in suboptimal pain control for at least 35% of patients undergoing laryngectomy. Inadequate prescription and variable implementation of prn orders contributed to this.

Adult↗
PubMed2003

Evaluation of the effects of primary myotomy in total laryngectomy on the neoglottis with the use of quantitative videofluoroscopy.

OBJECTIVE: To evaluate the influence of primary myotomy on characteristics of the neoglottis in patients after laryngectomy. DESIGN: Patient survey. SETTING: University Medical Center St Radboud, Nijmegen, the Netherlands. PATIENTS: Nineteen consecutive patients who underwent laryngectomy (12 with primary lateral myotomy of the upper esophageal sphincter [marked by metal clips]; 7 not requiring myotomy [according to intraoperative palpation]). INTERVENTIONS: Videofluoroscopy. MAIN OUTCOME MEASURES: Visual assessments and quantitative measures of the neoglottis were used to study the relationships between myotomy, and anatomic and morphologic characteristics of the neoglottis. RESULTS: Quantitative measurements showed no difference between the neoglottic characteristics of the patients with (n = 12) and without (n = 7) myotomy, who were all judged to have moderate (n = 4) or good (n = 15) voice quality. Results for the entire patient group during phonation showed only 1 single neoglottic bar, no hypertonicity of the neoglottis, and a significant shortening of the neoglottic bar (P =.007). Results for the myotomy group during phonation showed elevation of the caudal clip (P =.046), shortening of the myotomy (P =.01), and decreased overlap of the cranial clip and the neoglottic bar (P =.007). Furthermore, significant relationships were found between the various quantitative measures of the neoglottis and those of the myotomy. CONCLUSIONS: Quantitative videofluoroscopy enables study of the influence of myotomy on the anatomic and morphologic characteristics of the neoglottis. Our results suggest that a planned myotomy of the upper esophageal sphincter is beneficial when prosthetic voice rehabilitation is applied after total laryngectomy.

Adult↗
PubMed2004

Local control after supracricoid partial laryngectomy for "advanced" endolaryngeal squamous cell carcinoma classified as T3.

OBJECTIVES: To determine the incidence of local control in patients with "advanced" moderately to well-differentiated endolaryngeal invasive squamous cell carcinoma classified as T3, treated with a supracricoid partial laryngectomy; to identify any statistical relationship; and to analyze the consequences of local recurrence. DESIGN: Retrospective nonrandomized case series. SETTING: A tertiary referral care center and university teaching hospital. PATIENTS: An inception cohort of 118 patients. Tumor stage was T3 N0 M0 in 90 patients, T3 N1 M0 in 21 patients, T3 N2 M0 in 5 patients, and T3 N3 M0 in 2 patients. INTERVENTIONS: All patients underwent supracricoid partial laryngectomy. A platin-based induction chemotherapy regimen was used in 100 patients. Postoperative radiotherapy was used for 24 patients. MAIN OUTCOME MEASURES: Local recurrence, nodal recurrence, distant metastasis, and survival; univariate and multivariate analysis of local recurrence. RESULTS: Nine patients developed a local recurrence. The 1-, 3-, and 5-year actuarial local control estimates were 97.3%, 93.5%, and 91.4%, respectively. In a stepwise regression model, the presence of positive margins of resection was the only variable that statistically increased the risk of local recurrence (P =.008). Local recurrence resulted in a significant increase in nodal recurrence (P<.001) and distant metastasis (P<.001) and a significant decrease in survival (P =.03). An overall 89.8% laryngeal preservation rate and 98.3% local control rate were achieved. CONCLUSION: Supracricoid partial laryngectomies should be considered when an organ preservation strategy is discussed in patients with advanced endolaryngeal squamous cell carcinoma classified as T3.

Actuarial Analysis↗
PubMed2005

Supracricoid partial laryngectomy in the treatment of laryngeal cancer: univariate and multivariate analysis of prognostic factors.

OBJECTIVES: To evaluate the oncological results of supracricoid partial laryngectomy as a treatment for selected glottic and supraglottic cancer in a large series of patients who had undergone uniform treatment over a 16-year period and to determine the different prognostic factors that may influence local control and survival. DESIGN: Retrospective clinical study. SETTING: Academic tertiary referral medical center. PATIENTS: The study population comprised 253 consecutive patients (234 men and 19 women) with glottic and supraglottic squamous cell carcinoma. The mean age was 58 years for men and 59.2 years for women. INTERVENTION: Supracricoid partial laryngectomy: 180 patients had undergone cricohyoidopexy and 73 had undergone cricohyoidoepiglottopexy. MAIN OUTCOME MEASURES: Local control and overall survival. Potential prognostic factors for local control and survival were evaluated with univariate and multivariate models. RESULTS: The 3-, 5-, 10-, and 16-year overall survival rates in this group of 253 patients were 85.8%, 79.1%, 57.6%, and 57.6%, respectively. With regard to local control, univariate and multivariate analyses showed that a positive resection margin was the only important predictor of local control and that a dysplastic lesion at the margin of resection is just as aggressive as the presence of invasive carcinoma. When considering the prognostic factors influencing survival, univariate analysis showed that the tumor category, lymph node category, tumor stage, and recurrence all had a significant influence on the survival rate. Multivariate analysis showed that the most important predictor of survival was recurrence. CONCLUSIONS: Supracricoid partial laryngectomy is a valid choice in the treatment of selected glottic and supraglottic cancer while maintaining laryngeal functions and achieving a high rate of local control. T category, N category, tumor stage, positive resection margins, and recurrence are the most important predictors of oncological outcome.

Carcinoma, Squamous Cell↗
PubMed1981

Selective myotomy for voice restoration after total laryngectomy.

Reconstruction of the pharyngoesophagus after total laryngectomy avoids the development of salivary fistulae and restores satisfactory swallowing. Successful techniques for closure include multiple layers of tissue, selected suture materials, the application of postoperative radiation therapy, and modified neck dissection. In addition, vocal rehabilitation has been traditionally associated with the formation of a pharyngoesophageal segment capable of producing sound after air insufflation. A three-year experience with 129 patients after they underwent a total laryngectomy and tracheoesophageal shunt showed that 16 patients (12%) failed to achieve satisfactory speech after tracheoesophageal puncture because of pharyngoesophageal spasm. Response to percutaneous block of the pharyngeal plexus and subsequent myotomy of the cricopharyngeus and pharyngeal constrictor muscles was assessed in 14 patients. Increased pharyngoesophageal tone after total laryngectomy seems to be an important factor in the failure to acquire esophageal voice.

Esophagus↗