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PubMed2001

[Video-roentgen cinematographic evaluation of pharyngeal phase disorders during swallowing in patients after partial laryngectomy due to localized supraglottic cancer].

Videorentgenocinematographic examinations of swallowing were conducted on 81 patients after partial laryngectomy and on 35 subjects being a control group. Resection of piriform recess, a part of base of the tongue, the hyoid bone or its part is the factor that causes intensified difficulty during swallowing and increase in the frequency of the occurrence of aspiration. The results of videorentgenocinematographic examinations indicate that the shape and mobility of the tongue and the mobility of remaining after the surgery parts of the larynx have the greatest influence on the efficient swallowing in patients who have undergone partial laryngectomy due to cancer initially located in the supraglottic area. The larynx mobility is closely related to the remaining of the hyoid bone. The importance of remaining the possibly non-deformed structure and mobility of the tongue during partial laryngectomy involves the issue of reconstruction of defects occurred during the surgery. Videorentgenocinematographic examinations confirm the effectiveness of the method involving reconstruction of defects in a part of the base of the tongue with a vascular pedicle flap of the submandibular gland.

Aged↗
PubMed1975

Vocational and social adjustment after laryngectomy.

This study examined the vocational and social adjustment of 62 persons with cancer of the larynx. Predisability data were obtained by interview on 14 measures which assessed the vocational, social, and home adjustment prior to cancer. Post-disability data were obtained after laryngectomy by interview on 21 measures of adjustment. Additional measures include severity of laryngeal cancer classified by clinival stages, total or partial laryngectomy, presence of radiation therapy, presence of speech, months since surgery, age, sex, education, and marital status. The best predictors of vocational and social adjustment after laryngectomy were: removation, realism, rehabiltation outlook, previous vocational plans, highest educational grade, educational plans, and acquisition of speech. There were no significant differences in adjustment among patients in different clinical stages.

Adult↗
PubMed2001

[Investigative findings on the reconstruction with tissue materials after partial laryngectomy].

Between 1987 and 1999--1289 patients were treated by surgery in the Department of Otolaryngology and Laryngologic Oncology PAM in Szczecin due to the cancer of the larynx. In this group total, eventual subtotal excision of the larynx was carried out in 801 cases. In 154 cases the phonation way was restored. In this study the remaining group of 502 patients was analysed, which underwent partial aiming at restoration of all basic functions of the larynx. In the mentioned group partial vertical laryngectomy was done in 176 cases, and partial horizontal laryngectomy in 326 cases. Larynx reconstruction with the use of tissue materials was carried out in 59 cases after vertical and in 88 cases after horizontal laryngectomy. Shortcomings and advantages of the method of various tissue application were discussed (cartilage of epiglottis, vasculary based pedicle flap of thyroid gland, submaxillary salivary gland, strap muscles among others were used).

Glottis↗
PubMed1998

[The extended indications of near-total laryngectomy].

OBJECTIVE: To evaluate near-total laryngectomy in treatment of laryngeal cancers. METHODS: Fifty-seven near-total laryngectomies were reviewed, among them 40 were T3 or T4 laryngeal cancers due to tumor invasion to the base of tongue or subglottic region. RESULTS: In these patients, there were 11 cases of T3 pyriform sinus cancers, 5 cervical esophageal cancers, 1 case with adenoid cystic carcinoma involving the base of the tongue and oropharynx. Speech function had been preserved in 93% of cases with normal swallowing. Three year survival rates were 67.5% in laryngeal cancer and 50% in hypopharyngeal cancer. Local recurrence rate was only 3.5%. CONCLUSION: The authors believed that near-total laryngectomy is safe and beneficial to the patients with the above types of cancers. The quality of life may improve if speech function is preserved.

Aged↗
PubMed1975

Limitations of horizontal partial laryngectomy.

The author considers successively: 1--The theoretical justifications for horizontal partial laryngectomy (anatomical considerations, indications as to the modalities of extension of supraglottic tumors, results concerning the cancer itself, functional results). 2--The indications of and contraindications for this type of surgery, with special reference to two types of cancers: median supraglottic carcinomas and antero-lateral epilarynx carcinomas. 3--Some specific problems, namely that of large supraglottic laryngectomy, of combined nodal surgery, and of preoperative radiotherapy. The limits of horizontal partial laryngectomy are specified on the basis of two criteria: its value as far as cancer is concerned (five-year survival rate), the quality of functional results.

Glottis↗
PubMedDate not supplied

[Functional outcomes after supracricoid partial laryngectomy].

OBJECTIVES: We evaluated functional outcomes in patients undergoing supracricoid partial laryngectomy (SCPL). PATIENTS AND METHODS: The study included 20 male patients (mean age 61.5 years; range 43 to 76 years) who underwent SCPL for advanced laryngeal carcinoma. Correlations were sought between variables (age, medical history, reconstruction techniques such as cricohyoidopexy or cricohyoidoepiglottopexy, arytenoid resection) and decannulation time, duration for oral feeding, weight change, and complications. The mean follow-up was 20.9 months (range 7 to 39 months). RESULTS: All patients were decannulated in a mean of 19.9 days. Eighty-five percent of patients achieved normal deglutition without aspiration or weight loss within six months postoperatively. The nasogastric feeding tube was removed in a mean of 39.7 days. Voice quality of patients was sufficient for their social communications. CONCLUSION: Our functional results suggest that SCPL is an alternative technique to total laryngectomy in patients in whom other partial laryngectomy techniques are not considered.

Adult↗
PubMed1975

[100 Years of laryngectomy (author's transl)].

Since the first laryngectomy was performed in 1873 by Billroth in Vienna, this method has been continually further improved. A horizontal laryngectomy with preservation of the air passages was performed in 1957 by Majer and Rieder and named cricohyoidopexy. Cricohyoidopexy consists basically of the removal of the thyroid cartilage and the soft laryngeal tissues prior to pulling the preserved cricoid cartilage upwards and fixing it to the epiglottis and the hyoid bone. This operation ensures that the air passages, the voice, and deglutition are preserved. Serafini and Arsian have extended this technique to a tracheohyoidopexy, which has been successfully performed in many cases. Certain aspects posing problems and creating difficulties during these operative procedures, such as respiration, deglutition and the voice are discussed. These methods of functional laryngectomy, however, have only a limited indication.

Austria↗
PubMed2001

[Objective evaluation of respiratory function of the larynx after partial laryngectomy of various range].

The aim of the study was to identify factors and their effect on the respiratory efficiency of the larynx after partial laryngectomy. The material consisted of 72 patients aged 30 to 71 years (mean 54.3 years) who underwent partial laryngectomy due to cancer, and 10 healthy volunteers aged 22 to 29 years (mean 24.5 years). Airflow was measured under normal conditions and upon application of external resistance. Methods included history taking and physical examination, spirometry, laryngovideoscopy (Lvs), and computed tomography (CT) of the larynx. Some airflow parameters were decreased prior to surgery in comparison to predicted values. In a majority of patients, surgery had a negative effect on all parameters of airflow. Reduction was greater for inspiratory than expiratory parameters. Analysis of the shape of flow-volume loops in patients after surgery showed that the mixed type prevailed. This is characterized by reduction of the inspiratory and expiratory parameters, with greater effect on the inspiratory phase. Morphologically, the mixed type corresponds to narrowing of various extent with flaccid wall stenosis. The flow-volume shape changed dynamically during the healing process of the larynx until normalization was observed. This process was independent of the type of surgery but depended on the size of the laryngeal lumen and wall stiffness. Significant differences were found when laryngeal lumen was measured using CT or Lvs, with Lvs being more accurate. Lung volume parameters remained unchanged, but a statistically significant relationship with lumen size was observed both in experimental and clinical investigations. The most useful parameters for estimating laryngeal airflow were: PIF, FIF50, FIV1, FIV1%/N FEV1 and % Rz/N PEF. Upper and lower values were established for PIF (1.4-2.0 L/s), FIF50 (0.7-1.9 L/s), FIV1 (0.7-1.6 L), FIV1%/N FEV1 (40-60%),% Rz/N PEF (20-40%) on the basis of which the decision to restore respiration through the larynx (decannulation) may be made. It can be concluded from the results that spirometry and Lvs are more accurate than CT for assessment of the respiratory function of the larynx after partial laryngectomy.

Adult↗
PubMed1975

[The problem of tracheal stenosis following laryngectomy (author's transl)].

The striking frequency of tracheal stenoses following laryngectomy gave reason for considerations on the typical causes. In our case-materials 9 tracheal stenoses were observed following 229 laryngectomies during the period from 1952 to 1972. Two of these cases represent typical stenoses produced by pressure. Within a short period of time, from 2 days up to 6 months after operation the 7 remaining cases represented marked tracheal stenoses with the mucosae showing no signes of irritation. These stenoses had been registered since 1965 only, i.e. after the introduction of the general application of insufflation anesthesia in every case of laryngectomy at our clinic. These observations gave reason for supposing that the procedure of anesthesia had to be seen as responsible for the development of tracheal stenoses. Under unfavourable circumstances during operation, even if the tube is inserted for a short period of time the anemising pressure effect of the cuff of the tube might - beside other wellknown factors - produce damages on the tracheal wall.

Aged↗
PubMed2002

[Analysis of vertical partial laryngectomy for carcinoma of the larynx].

OBJECTIVE: To evaluate the effect of vertical partial laryngectomy in the treatment of laryngocarcinoma. METHOD: 50 patients who underwent vertical partial laryngectomy from 1979 to 1997 were retrospectively reviewed. The reconstruction methods for the laryngeal defect were the pedicle muscular flap, skin graft, cervical skin flap, hypopharyngeal mucous membrane flap and outer perichondrium of the thyroid cartilage etc. RESULT: Postoperative decannulation rate was 98.0%. The overall 3-, 5- and 10-year survival rates were 89.6%, 82.9%, 66.7% respectively. Among all the deaths, 4 died of recurrence of laryngocarcinoma, 1 distant metastasis, 1 other carcinoma and 5 intercurrent disease. CONCLUSION: Vertical partial laryngectomy is effective in treating laryngocarcinoma. Anesthesia, resecting limits and the reconstruction methods for the laryngeal defect also affect the curative results.

Adult↗
PubMed2002

[Supracricoid subtotal laryngectomy with laryngeal reconstruction for laryngeal cancers].

OBJECTIVE: To assess the effectiveness of supracricoid subtotal laryngectomy in the treatment of laryngeal cancer and the reconstructed laryngeal functions. METHOD: A retrospective review was made on 411 laryngeal cancer patients in the stage T2 to T4 treated by this surgical procedure form 1985 to 2000. In these cases, 35 were glottic cancers, 6 were supraglottic cancers, 23 patients were performed by supracricoid subtotal Laryngectomy with cricohyoidoepiglottopexy, 18 were performed with cricohyoidopexy. RESULT: Over 3 year and 5 year survival rates were 83.3%(30/36) and 71.4% (20/28). Decannulation rate was 92.7% (38/41). 40 patients resumed normal oral feeding but one was still performed an operation to separate the tracheal from pharynx because of the severe aspiration. All cases were able to speak by the new larynx. CONCLUSION: Supracricoid subtotal laryngectomy with laryngeal reconstruction was not only completely removal of tumors, but also restored the three physiological functions of larynx. It is an effective treatment for laryngeal cancer.

Adult↗
PubMedDate not supplied

[Supracricoid laryngectomy with cricohyoidoepiglotopexy (CHEP). Preliminary report of the National Institute of Cancer].

OBJECTIVE: To present the preliminary results in our institute with supracricoid laryngectomy with cricohyoidoepiglotopexy (CHEP), as well as to evaluate possible short-term complications. METHODS: This study included eight patients with diagnosis of squamous cell carcinoma of the larynx glottic region (three patients were in stage I, two in II and three in III). Histologic grade was well differentiated in three patients, moderately differentiated in four and poorly differentiated in one. RESULTS: Supracricoid laryngectomy with cricohyoidoepiglotopexy were performed in all cases, and bilateral elective functional neck dissection was done in 6 patients. Both cricoarytenoid units were preserved in 6 patients and only one in the other two cases. Mean time of hospitalization was 11 days. Mean time of decanulation was 12 days for the whole group; however, in those patients that preserved both cricoarytenoid units, the mean time of decanulation was 6 days, and in those that preserved one cricoarytenoid unit it was 31 days. Physiologic phonation was achieved in all patients at the moment of decanulation. Mean time for remotion of nasogastric sonde was 25 days, and it was 17 days for those who preserved both cricoarytenoid units and for patients with one cricoarytenoid unit it was 46 days. CONCLUSIONS: Supracricoid laryngectomy with cricohyoidoepiglotopexy allows to preserve the basic functions of the larynx (respiration, degluttion and phonation), as well as the reintegration of affected patients to social life. All patients must be evaluated carefully in order avoid changing the stage or the surgical plan due to substadification of the tumor.

Adult↗
PubMed2003

[Methods of closure for pharyngocutaneous fistula after laryngectomy].

The majority of salivary fistulas after laryngectomy or after laryngo-pharyngectomy close spontaneously within 2-3 weeks, and the remaining require surgical reconstruction. In the years 1987-2000 the pharyngo-cutaneous fistula was closed in 19 patients. The fistula developed after laryngectomy because of larynx cancer T3 and T4. 13 patients were irradiated before. In all the patients laryngectomy was combined with unilateral or bilateral neck dissection. Salivary fistula was closed in one stage operation using pectoralis major myocutaneous flap: 1) skin island of the flap to replace defect of the neck skin and mobilized mucosa from inside, 2) skin island for lining and deltopectoral skin flap from outside, 3) skin island for lining and free split skin flap for external cover, 4) skin island of the flap divided in two paddeles, one for lining and another for external cover. Indications for each method were discussed. Very good result of total fistula closure was obtained in 15 out of 19 patients. The fistula occurred again in 4 patients, in two of them the failure was caused by cancer recurrence.

Adult↗
PubMed2001

[The reconstruction of laryngeal function in subtotal laryngectomy by pedicled flaps].

OBJECTIVE: To explore the possibility of subtotal laryngectomy in the treatment of advanced laryngeal cancer and selection of reconstruction. METHODS: Forty patients were treated surgically by subtotal laryngectomy with preservation of arytenoid cartilage and perichondrium. The pedicled flaps between cricoid cartilage and arytenoid cartilage were sewed up. The new larynx was reconstructed by suturing the cricoid or trachea to the hyoid bone or the tongue base. RESULTS: The 3 and 5 year survival rates were 85.0% and 76.2% respectively. Decannulation rate was 92.5%. CONCLUSION: The reconstruction of laryngeal function in subtotal laryngectomy by pedicled flaps not only is safe and beneficial to the patients with the cancers above the cricoid, but also improves the quality of patient's life.

Adult↗
PubMed2001

[Retrospective analysis of supracricoid partial laryngectomy with epiglottis preserved and reconstruction of laryngeal function].

OBJECTIVE: To retrospectively evaluate the curative and functional consequences of supracricoid partial laryngectomy with epiglottis preserved. METHODS: From 1980 to 1996, 78 patients underwent supracricoid partial laryngectomy with the epiglottis preserved. The survival rate and the functional results were analyzed. RESULTS: Overall three-year survival rate was 87.2%(68/78), overall five-year survival rate was 75.6% (59/78), and ten-year survival rate was 21.1% (8/38). All patients resumed normal oral feeding. 97.4% (76/78) achieved tracheal extubation. Respiratory and speaking functions were good. CONCLUSION: Supracricoid partial laryngectomy with epiglottis preserved and reconstruction of laryngeal function not only improved local cancer control, but also preserves laryngeal physiologic function.

Adult↗
PubMed1999

[The reconstruction of laryngeal function in subtotal laryngectomy with preservation of arytenoid cartilage].

OBJECTIVE: To evaluate subtotal laryngectomy with preservation of arytenoid cartilage to reconstruct laryngeal function in T3 glottic or supraglottic laryngeal cancer. METHODS: Subtotal laryngectomy with preservation of arytenoid cartilage to reconstruct laryngeal function was reviewed in 20 patients with T3 laryngeal cancer(3 cases with glottic cancer and 17 cases with supraglottic cancer). Recurrent laryngeal nerve was preserved during surgery. The mucous membranes between cricoid cartilage and pharynx were sewed up accordingly. RESULTS: All patients had restored phonation and swallowing functions. The 3- and 5-year survival rates were 94.1% and 91.8% respectively. Decannulation rate was 95.0%. CONCLUSION: Subtotal laryngectomy with preservation of arytenoid cartilage is recommended for T3 laryngeal cancer.

Aged↗
PubMed1999

[Supracricoid partial laryngectomy for laryngeal cancer].

OBJECTIVE: To analyze the key points, especially the indications and contraindications of supracricoid partial laryngectomy (SCPL). METHODS: During the years 1995 to 1996, 18 patients with laryngeal cancer underwent supracricoid partial laryngectomy. Ten of them (55.56%) were classified as T1b and T2 glottic cancers, 8 of them (44.44%) as T3 and T4 glottic cancer or transglottic carcinomas. Three types of supracircoid partial laryngectomy (CHP, CHEP and TCHEP) were employed accordingly. RESULTS: Overall three-year survival rate was 94.40%. All patients were decannulated from 14 to 42 days and all resumed normal oral feeding from 14 to 30 days. Speech was good in all patients. CONCLUSION: The SCPL procedure not only increases local control rate, but also maintains physiologic speech and swallowing.

Adult↗
PubMed2000

[Supraglottic horizontal partial laryngectomy].

OBJECTIVE: To evaluate the long-term result of supraglottic horizontal partial laryngectomy. METHODS: Fifty-five patients with supraglottic laryngeal carcinoma were treated surgically by supraglottic horizontal partial laryngectomy from 1986 to 1995. There were 32 males and 23 females with an average age of 56. Eleven cases were staged I, 26 staged II, 11 staged III and 7 staged IV. Closure of the surgical defect begins by covering the thyroid cartilage with mucosa of the medial wall of the pyriform sinus. The outer perichondrium of thyroid cartilage was approximated with the mucosa of laryngeal ventricle. The hyoid cartilage was excised. The base of tongue was sutured to the reserved thyroid cartilage to take the place of epiglottic cartilage. RESULTS: The 3- and 5-year survival rates were 85% (47/55) and 77% (37/48) respectively. The decannulation rate was 96%. Most cases had acquired good speech and swallow function after 8-30 days. Complications included granulation and polyp formation at the base of tongue or at the anterior commissure in 4 cases. CONCLUSIONS: Supraglottic horizontal partial laryngectomy is very effective both in eradicating disease and in preserving laryngeal function.

Adult↗