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PubMed1977

Construction of a pseudolarynx after laryngectomy and radical neck dissection. A preliminary report.

Voice rehabilitation is a major problem after laryngectomy. A new method to construct a pseudolarynx after total laryngectomy by suturing the trachea to the hyoid bone is described. The surgical technic is relatively simple. Patients are able to speak in the immediate postoperative period without intensive therapy. The quality of speech is good. Aspiration of liquids is a common problem, but in time patients learn to swallow with minimal or no aspiration. This procedure could be utilized in selected cases for good voice rehabilitation after total laryngectomy.

Carcinoma, Squamous Cell↗
PubMed1985

Indications for performing hemithyroidectomy for tumors requiring total laryngectomy.

To determine the necessity of performing a hemithyroidectomy in patients who require a total laryngectomy, the pathologic reports and clinical courses of 261 patients who underwent total laryngectomy were reviewed. Twenty-four percent of the specimens demonstrated transcartilaginous invasion, with the highest incidences occurring in glottic (31 percent) and subglottic (60 percent) tumors. Epidermoid tumor invading the thyroid gland occurred in 5 percent of the specimens. All of these showed invasion by direct extension, were palpable at the time of surgery and were associated with transcartilaginous invasion. Ninety percent of these tumors were primarily glottic or subglottic and 70 percent demonstrated subglottic extension greater than 1.5 cm. Furthermore, the prognosis of patients with tumorous invasion of the thyroid gland was dismal, with local recurrence or distant metastasis occurring within 10 months of curative resection. In patients who had laryngectomies, hypothyroidism was found in 70 percent of those who underwent radiotherapy and hemithyroidectomy, in 38 percent of those who underwent radiotherapy alone, in 23 percent of those who underwent hemithyroidectomy alone, and in 20 percent of those who did not undergo hemithyroidectomy or radiotherapy. Based on these results, we advocate ipsilateral or total thyroidectomy for palpably suspicious thyroid glands seen intraoperatively, subglottic tumors, glottic tumors with more than 1 cm of subglottic extension, T4 endolaryngeal tumors with transcartilaginous invasion, and T4 pyriform sinus tumors.

Combined Modality Therapy↗
PubMed1982

Current practices in the counseling of the laryngectomy patient.

While laryngectomy surgery is increasingly successful, the patient must cope with physical and psychological problems that challenge the individual long after the surgical wounds have healed. To successfully resolve these problems, it is essential that the individual receive accurate and timely counseling by professional workers involved in all phases of the rehabilitative process. Previous studies have found that in many instances the laryngectomy patient is uninformed of consequent physiological changes and, as a result, is unprepared to encounter a physical and psychological reality that has abruptly changed. The present study examines the pre- and postoperative counseling experience of 115 recent laryngectomees. Respondents were from varied locations within the United States. Survey results indicate that, while counseling of laryngectomy patients is usually informative and comprehensive, this vital aspect of the rehabilitative process is often inadequate to meet the needs of the individual. Remedial measures are suggested.

Adult↗
PubMedDate not supplied

Tongue-base-cancer resection with partial supraglottic laryngectomy.

INTRODUCTION: Cancer in the tongue base, which is adjacent to or invading the lingual epiglottis, requires resection of part or all of the larynx to assure adequate surgical margin. Based on whole mount laryngeal sections, a tongue base-partial supraglottic laryngectomy procedure was designed for tumors adjacent to or minimally invading the lingual epiglottis. METHODS: A group of five patients with carcinoma of the tongue base adjacent to or minimally invading the lingual epiglottis was identified. This technique requires excision of the epiglottis, hyoepiglottic ligament, and pre-epiglottic space with the lesion. The structural physiological integrity of the false vocal cords with or without the hyoid bone is preserved. RESULTS: Clear tumor margins were obtained in all five patients. In three patients who required up to 50% resection of the tongue base, decannulation and resumption of a full oral diet was achieved. Two patients with more extensive lesions required 70% resection of the tongue base. Both patients underwent completion laryngectomy months later because of persistent aspiration. CONCLUSION: This preliminary report suggests that partial supraglottic laryngectomy may be used with acceptable functional results in patients with limited tongue base lesions.

Carcinoma, Squamous Cell↗
PubMed2006

Voice rehabilitation with Provox2 voice prosthesis following total laryngectomy for laryngeal and hypopharyngeal carcinoma.

OBJECTIVE: To analyze the effectiveness of the Provox2 voice prosthesis for voice rehabilitation following total laryngectomy. METHODS: From September 2000 to December 2004, the Provox2 voice prosthesis was used for voice rehabilitation in 32 patients following total laryngectomy. The quality of speech with the Provox2 voice prosthesis was analyzed using the HRS rating scale, the maximum phonation time (MPT), incidence of complications and the in situ lifetime. The rate of speech restoration was further analyzed in 129 patients with total laryngectomy from 1996 to 2004. RESULT: Twenty-nine of 32 patients were able to restore speech using the Provox2 voice prosthesis, a speech restoration rate of 90.6%. The maximum phonation time (MPT) was measured in 18 patients using the Provox2 voice prosthesis. The mean MPT was 15.1 s, with a range of 8-28 s. MPT was not influenced by age, concurrent radiotherapy treatment, the location of the primary tumor or use of reconstructive surgery. The average lifetime of the Provox2 in patients with laryngeal carcinoma (12 patients) and hypopharyngeal carcinoma (17 patients) was 27.2 and 16.6 weeks, respectively, which was significantly different (P=0.024, non-parametric Mann-Whitney's U-test). The rate of speech restoration by the use of esophageal speech, and insertion of an artificial larynx was 62.7% for laryngeal carcinoma (59 cases) and 38.6% for hypopharyngeal carcinoma (70 cases), which was also significantly different (P<0.01, chi-square test). CONCLUSION: Provox2 voice prosthesis speech was very useful due to the higher rate of speech restoration, longer phonatory time, and better intelligibility. It was also thought that voice prosthesis speech was useful in conjunction with esophageal speech and an artificial larynx depending on the patient's condition or wishes.

Aged↗
PubMed2004

Optimizing voice after endoscopic partial laryngectomy.

Phonosurgical management of early and midsized glottic cancer has evolved considerably during the past decade. There has been a partial migration from transcervical to transoral partial laryngectomy to diminish perioperative morbidity (ie, tracheotomy) and to facilitate subsequent voice restoration. After an endoscopic partial laryngectomy heals, a medialization of the glottal neocord should be done. An endolaryngeal injection or transcervical medialization is used to reconstruct the glottal valve and the associated aerodynamic competency, which ultimately enhance voice quality. These reconstructive techniques will improve the voice outcome subsequent to almost any endoscopic vertical partial laryngectomy; however,a near-normal conversational level voice can be achieved inpatients in whom there is one remaining normal vocal fold. These favorable results are based on the fact that after effective glottal closure is achieved through the reconstruction, the primary oscillator is the layered microstructure of noncancerous glottal tissue.

Endoscopy↗
PubMed2002

Surgical management of gastroesophageal reflux and outcome after laryngectomy in patients using tracheoesophageal speech.

BACKGROUND: Gastroesophageal reflux disease (GERD) is common in patients with head and neck carcinoma. The impact of laparoscopic fundoplication on laryngectomy patients with tracheoesophageal prostheses for voice restoration is unknown. METHODS: Nine laryngectomy patients who use tracheoesophageal speech underwent laparoscopic fundoplication for documented reflux. Preoperative and postoperative symptoms were recorded. Quality of speech was documented before and after fundoplication. RESULTS: Although 88% of patients had resolution of GERD symptoms, all developed bloating and hyperflatulence. There was no difference in quality of esophageal speech after laparoscopic fundoplication. CONCLUSIONS: Fundoplication in laryngectomy patients that use tracheoesophageal speech eliminates symptoms of gastroesophageal reflux and resolves regurgitation associated prosthesis erosion. Although nearly all patients are satisfied with outcome, there is a high incidence of postfundoplication bloating and hyperflatulence that may be life limiting. Poor quality tracheoesophageal speech should not be used as an indication for antireflux surgery.

Aged↗
PubMed2000

Complications of postoperative radiation therapy after partial laryngectomy in supraglottic cancer: A long-term evaluation.

This retrospective study, based on a series of 90 patients with invasive squamous cell carcinoma of the supraglottis, was designed to document the functional outcome and complications after postoperative radiation therapy following partial laryngeal surgery. The surgical procedure was a standard supraglottic laryngectomy in 62 patients and a supracricoid partial laryngectomy in 28 patients. All of the patients had an unremarkable postoperative course and achieved locoregional control. The average dose delivered to the remaining larynx was 51.2 Gy (range 25-71 Gy). The average dose delivered to the neck was 50.6 Gy (range 22-70 Gy). The patients were treated at 180-cGy per fractions in a continuous course technique with a cobalt 60 beam. In 5 patients (5.5%) complications led to cessation of postoperative radiation therapy, and the total dose delivered to the remaining larynx and neck was less than 40 Gy. All patients were followed up for a minimum of 10 years or until death. The 5-, 10-, and 15-year actuarial survival estimates were 71. 5%, 44.3%, and 36.3%, respectively. The 5-, 10-, and 15-year actuarial severe complication estimates were all 11.2%. Overall, severe complications occurred in 15 patients. Severe complications led to death in 3 patients (3.3%), permanent gastrostomy in 3 (3.3%), and permanent tracheostomy in 1 (1.1%). A severe complication never resulted in completion of total laryngectomy. In univariate analysis, the mean dose delivered to the larynx was the only variable statistically related to the incidence of a severe complication. The mean dose delivered to the larynx was statistically higher (P = 0.014) in patients who had severe complications (60 Gy) than in patients who did not (50 Gy).

Adult↗
PubMed1995

Tracheostomal stenosis after laryngectomy: incidence and predisposing factors.

Laryngectomy for carcinoma of the larynx has been performed since it was first described in 1880. Since that time the complication of tracheostomal stenosis has plagued both surgeons and patients. The reported incidence of tracheostomal stenosis ranges from 4% to 42%. At West Virginia University Hospitals from 1976 to 1994, 106 patients undergoing laryngectomies on the head and neck oncology service were analyzed. The charts of patients treated before 1991 were reviewed retrospectively; a prospective analysis was initiated in 1991. Only patients with a minimum of 6 months of follow-up were included in this study. The male-to-female ratio was 3:1, with an age range of 28 to 86 years (mean, 58 years). The overall rate of stenosis was 28.4%. The incidence of tracheostomal stenosis was higher in women (46.4%) than in men (21.6%) (p < 0.05). Since 1991 a plastic type of closure was used in 25 patients. The stenosis rate was 0% in these patients. Before 1991 a bevel or circle technique was used, with stenosis rates of 33% and 75%, respectively (p < 0.05). Infection at the site of the stoma, fistula, steroid use, neck dissection, pectoralis major myocutaneous flap usage, primary tracheoesophageal puncture, and radiotherapy did not correlate with an increased incidence of stenosis. The most important factor in prevention of stomal stenosis after laryngectomy is attention to detail while forming the stoma. With good technique and a plastic-type closure to break up the suture line, a minimal rate of stenosis should be encountered.

Adult↗
PubMed1996

Glottic carcinoma with a fixed true vocal cord: outcomes after neoadjuvant chemotherapy and supracricoid partial laryngectomy with cricohyoidoepiglottopexy.

Twenty patients with glottic squamous cell carcinoma and a fixed true vocal cord underwent neoadjuvant chemotherapy followed by supracricoid partial laryngectomy with cricohyoidoepiglottopexy. Phonation, respiration, and deglutition were preserved. Local control was better than has been previously reported for either extended vertical partial laryngectomy or radiation therapy. All patients were monitored for at least 3 years or until death. The Kaplan-Meier 3-year survival, local recurrence, nodal recurrence, distant metastasis, and second primary rates were 75%, 10.8%, 5%, 10.8%, and 10.8%, respectively. Overall local control was achieved in all cases, and laryngeal preservation in 90%. Our experience suggested that neoadjuvant chemotherapy with supracricoid partial laryngectomy with cricohyoidoepiglottopexy deserves further consideration in the treatment of glottic tumors with a fixed true vocal cord.

Adult↗
PubMedDate not supplied

Laryngeal long-term morbidity after supraglottic laryngectomy and postoperative radiation therapy.

PURPOSE: This study was performed to investigate factors associated with laryngeal morbidity when postoperative radiation therapy (RT) is added to supraglottic laryngectomy. MATERIALS AND METHODS: From 1980 to 1994, 56 patients affected with T1 to 4 N0 to 2c supraglottic squamous cell carcinoma selected for standard (59%) or extended (41%) supraglottic laryngectomy at 2 different institutions were retrospectively analyzed. Most of the patients (91%) also underwent neck dissection. Approximately 80% of the patients had stage T4 primary lesions or N2 neck disease. Postoperative RT was added for presumed microscopic disease at the primary site (13 patients), regional nodes (23 patients), or both (20 patients). Median delivered doses to the larynx and to the neck were 50 Gy (range, 40 to 64 Gy) and 46 Gy (range, 40 to 64 Gy), respectively. Median follow-up for living patients is 11 years (range, 2.8 to 16.9 years). Laryngeal complication was defined as the appearance of grade 2 or higher toxicity according to the European Organization for Research and Treatment of Cancer (EORTC) and the Radiation Therapy Oncology Group (RTOG) scoring systems. RESULTS: Two- and 5-year actuarial locoregional control rates were 85+/-5% and 83+/-5%, respectively. Thirty patients (54%) developed laryngeal complications. However, just one patient experienced grade 4 laryngeal oedema requiring permanent tracheostomy. Estimated actuarial survival without laryngeal complications were 50+/-7%, 43+/-7%, and 39+/-7% at 2, 5, and 10 years, respectively. At univariate analysis, treated volumes (P = .03) and total dose to the larynx (P = .03) were significantly associated with local toxicity. A trend was observed also for the maximum dose to the neck (P = .06) and dose per fraction (P = .09). A multivariate Cox proportional hazards model showed total dose to the larynx to be the only independent predictor of toxicity (P = .03). The hazard ratio of laryngeal toxicity was 2.2 (95% confidence interval: 1.1/4.6), for a total dose to the larynx greater than 50 Gy. CONCLUSION: After supraglottic laryngectomy, postoperative RT to the neck does not affect local morbidity, but careful RT treatment planning is necessary to avoid delivering a total dose to the larynx greater than 50 Gy.

Actuarial Analysis↗
PubMedDate not supplied

Laryngectomy for chronic aspiration.

Most laryngectomies are performed for neoplastic disease. Recently, the authors have managed four patients with chronic aspiration who ultimately required laryngectomy to control leakage of food and saliva into the tracheobronchial tree. Various surgical procedures have been devised to conserve the larynx and protect the lower airway. Although potentially reversible, these procedures are fraught with complications, and the patients seldom recover sufficiently to justify repair of the larynx. The authors feel that those patients with poor prognoses, associated medical problems, and evidence of impaired wound healing should undergo laryngectomy. This approach removes doubt about the cause of the aspiration and spares the patients additional surgical procedures should a more conservative approach fail.

Adult↗
PubMed1985

The place of partial laryngectomy in the treatment of laryngeal cancer--a view from the U.K.

Attention is drawn to the problems of surgical resection by partial laryngectomy after full therapeutic dosage of Telecobalt irradiation. Material is presented from two treatment centres to indicate trends in surgical treatment and the complications experienced. Results will be given which confirm a reasonable expectation of cure and functional conservation by vertical partial laryngectomy for recurrence of glottic cancer after irradiation. The results of treatment of recurrent supraglottic cancer by horizontal partial laryngectomy gave more cause for concern in terms of complications and survival. In conclusion an attempt is made, based on the quoted experience, to define the position of conservation surgery in two centres for laryngeal cancer in the United Kingdom.

Adult↗
PubMed2004

[Sleep apnea syndrome after total laryngectomy].

INTRODUCTION: Tracheostomy was the treatment of choice for sleep apnoea syndrome before nasal continuous positive airway pressure was developed. The occurrence of sleep apnea syndrome after total laryngectomy is unusual. CASE REPORT: The authors report the case of a 73 year-old man presenting with the symptomatology of sleep apnoea syndrome, several years after a total laryngectomy for cancer. The polysomnographic recording confirmed severe sleep apnoea syndrome with an apnea-hypopnea index of 89. Clinical examination showed a marked reduction in the diameter of the tracheostomy orifice during forced inspiration whilst lying supine. The combination of negative airway pressure and muscle hypotonia during sleep could explain this closure. Use of a silver tracheostomy cannula reversed the symptoms and normalised the apnea-hypopnea index. CONCLUSION: Sleep apnea syndrome is an unusual complication of total laryngectomy, resulting from collapse of the tracheostomy walls during sleep, which can be treated by the insertion of a silver tracheostomy tube.

Aged↗
PubMed2003

Partial laryngectomy imaging.

The treatment of early stage laryngeal cancer is radiation therapy in the majority of cases, with surgery reserved for salvage therapy. Some institutions advocate partial laryngectomy procedures as primary treatment due to improved voice preservation with equivalent local control. The partial laryngectomy includes several variations of laryngeal resection to incorporate differing lesion locations and their patterns of oncologic spread. This serves as a challenge to the evaluating radiologist as post-surgical and post-radiation therapy changes distort the anatomy, and may not reflect recurrent or persistent disease. This article discusses the types of partial laryngectomy, as well as the indications and possible complications of the procedures. Additionally, the appearance of expected changes is outlined in contrast to recurrent or persistent disease.

Humans↗
PubMed2002

Cervical mediastinoscopy after total laryngectomy and radiotherapy: its feasibility.

OBJECTIVE: The feasibility of cervical mediastinoscopy after total laryngectomy and radiotherapy has not been documented. METHODS: We describe our experience with cervical mediastinoscopy in two patients with total laryngectomy and radiotherapy for squamous cell carcinoma and had a Blom-Singer speaking tracheostomy valve in situ. Both patients presented with mediastinal lymphadenopathy and radiographic features suggesting a new pulmonary malignancy. RESULTS: Rigid bronchoscopy and cervical mediastinoscopy were undertaken and paratracheal and subcarinal lymph nodes were biopsied. Both patients made uneventful post operative recovery. Mediastinal lymph node biopsy was definitive in deciding their further care. CONCLUSION: Cervical mediastinoscopy is feasible in patients with total laryngectomy, tracheostomy and radiotherapy.

Aged↗
PubMed1987

A view of partial laryngectomy in the treatment of laryngeal cancer.

Attention is drawn to the problems of surgical resection by partial laryngectomy after full therapeutic dosage of telecobalt irradiation. Material is presented from two treatment centres to indicate trends in surgical treatment and the complications experienced. Results will be given which confirm a reasonable expectation of cure and functional conservation by vertical partial laryngectomy for recurrence of glottic cancer after irradiation. The results of treatment of recurrent supraglottic cancer by horizontal partial laryngectomy gave more cause for concern in terms of complications and survival. In conclusion an attempt is made, based on the quoted experience, to define the position of conservation surgery in two centres for laryngeal cancer in the United Kingdom.

Combined Modality Therapy↗
PubMed1990

Vertical partial laryngectomy on demand.

The author proposes the term 'vertical partial laryngectomy on demand' for all modifications of vertical laryngectomies (frontal, frontolateral, vertical and hemilaryngectomy). This term includes two conditions: the first is complete oncological removal of the tumour (proven by histological examination and with the use of magnification or the operating microscope during the operation); secondly, reconstruction of the laryngeal defect by various procedures. The author uses the sternohyoid fascia in vertical and frontolateral partial laryngectomies. From 120 operated cases, a five-year survival rate of 81 per cent was achieved. The fascia showed resistance to post-operative complications and irradiation.

Combined Modality Therapy↗