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At least 397 records · Page 22Linked to original sources
PubMed2005

[Application of partial laryngectomy in laryngeal cancer treatment and reconstruction with epiglottic flap and bi-pedicle muscle flap].

OBJECTIVE: To explore and evaluate the surgical method of partial laryngectomy and the laryngeal defects were reconstructed. METHOD: Two hundreds and sixty-five patients with laryngeal cancer were treated by partial laryngectomy and the laryngeal defects were reconstructed by epiglottic flap, bi-pedicle sternohyoid muscle fascia flap and epiglottic flap plus bi-pedicle sternohyoid muscle fascia flap from January 1990 to December 2000. There were 256 males and 9 females,ranging in age from 48 to 75 years old. Neck dissection were performed in 79 patients. RESULT: The total cases began to eat between 10 to 15 days after operation. Two hundreds and eighteen cases were decannulated with a decannulation rate of 82.26%. Wound infection occurred in 12 cases and 2 pharyngocutaneous fistula was found. The three and five years survival rates were 74.72% and 70. 88% respectively. CONCLUSION: After partial laryngectomy in laryngeal cancer epiglottic flap and bi-pedicle muscle fascia flap were performed reconstruction of laryngeal function in a single-stage. These procedures which were relative simplicity, expediency, small injury and high rate of survival present ideal effects and are worthy to be recommended.

Aged↗
PubMed2005

[Self-assessment of the effect of dysphagia on the quality of life in patients after partial laryngectomy for cancer initially located in the supraglottic area].

Dysphagia is frequent in patients after partial laryngectomy for cancer initially located in the supraglottic area. To ensure the best quality of life, establishing how the patient feels after treatment is necessary. Therefore, a self-administered questionnaire was designed to evaluate the dysphagia. 95 patients (75 male and 20 women) who were operated in ENT Department CMUJ between 1998-2004 participated in this study. The MDADI questionnaire in the Polish version was used. The subjective evaluation by the patient of dysphagia is directly related to the size of the tumor and the extent of the partial laryngectomy treatment. Patients, whose tumor was located in supraglottic-glottic area, had subtotal laryngectomy m. Miodoński. Their quality of life was significantly worse due to dysphagia than those with tumors located only in the supraglottic area. Swallowing dysfunctionality was significantly greater after the resection of the hyoid bone. Reconstruction of the base of a tongue by a graft of angiopedunculated submandibular gland diminished the difficulties in swallowing. Moreover, the longer the period after treatment, the higher the quality of life becomes because of the improvement in the swallowing functionality.

Adult↗
PubMed2006

[Evaluation of dysphonia in partial laryngectomy patients].

OBJECTIVES: The purpose of this study was to research and compare the affects of cordectomy, frontolateral laryngectomy or cricohyoidopexy techniques over voice parameters prospectively. PATIENTS AND METHODS: Fifty-six larynx cancer patients (56 males; mean age 59; range 48 to 71 years) whom cordectomy, frontolateral laryngectomy or cricohyoidopexy was applied in S.B. Izmir Training Hospital were included in this study. In the subjective evaluation of the patients voices and RBH scoring, in the aerodynamic evaluation, MPT measurements and in the objective evaluation computerized voice analysis was used. In calculating the dysphonia severity index (DSI), this formula (DSI=0.13xMPT+0.0053xF0 (high)-0.26xI (low)-1.18x jitter (%)+12.4) was used. RESULTS: In the subjective (RBH) evaluation of voices of these three group of patients and their DSI scores, there wasn't any statistically differences among them. When arytenoidectomized patients were evaluated as a separate group, this procedure was found not to have a significant impact over DSI. CONCLUSION: From phoniatric point of view, there wasn't any difference of cordectomy, frontolateral laryngectomy or cricohyoidopexy techniques over voice.

Adult↗
PubMed2006

[Supraglottic horizontal partial laryngectomies in 163 cases].

OBJECTIVE: To evaluate the clinical value of supraglottic horizontal partial laryngectomy. METHODS: One hundred and sixty-three patients with supraglottic laryngeal carcinoma were treated surgically by supraglottic horizontal partial laryngectomy from 1978 to 1998. There were 64 males and 99 females. Five cases were staged I, 95 staged II, 48 staged III and 15 staged IV. The surgical techniques were improved: The hyoid was removed conventionally; The outer perichondrium of thyroid cartilage was turned into the laryngeal cavity and sutured with the mucosa of laryngeal ventricle and the base of tongue was sutured to the reserved thyroid cartilage. Survival was evaluated using the Kaplan-Meier method. The differences between stages were tested by Los-Rank method. RESULTS: The 5-year survival rate were 100.0%, 77.9%, 54.2% and 33.3% for patients staged I to IV respectively, and were statistically significant (P = 0.0006) between different clinical stages. The 5-year survival rate were 73.1% and 45.5% in patients with cN0 and cN + respectively, and were statistically significant (P = 0.0132). The speech and swallowing functions were good after operation. The decannulation rate was 91.4%. The main causes of death were cervical lymph node metastasis in 40% (20/50) and laryngeal recurrence in 18% (9/50). The occult metastasis rate was 23.1% (30/130) and cervical metastasis rates of patients with cN1-3 75.8% (25/33), with a total metastasis rate was 33.7 (55/163). CONCLUSIONS: Supraglottic horizontal partial laryngectomy is very effective in eradicating disease and in preserving laryngeal function on condition that the indications were selected correctly. The selective lateral neck dissection was recommended for supraglottic carcinoma.

Adult↗
PubMed1990

[Voice rehabilitation after total laryngectomy in West Germany. Current state of the art].

In 1987 Lopez published the results of a survey of voice rehabilitation after total laryngectomy as carried out by 400 North American ENT surgeons. In order to obtain the same information on the current state of voice rehabilitation in the German Federal Republic we did a similar survey of 103 ENT clinics. Ninety-five (92%) questionnaires were evaluated. Each year, 2200 laryngectomies are carried out in Germany. Oesophageal speech is the most frequently used form of voice rehabilitation in both countries. In the USA voice prostheses are fitted by 88% of the surgeons questioned to a total of 30% of patients; in Germany only 22% of the clinics in which laryngectomy is carried out fit these devices to a total of 5.6% of patients. External vibrators are used with equal frequency (28%). In contrast to the United States, where intraoral aids are currently used in 15% of patients, we do not employ these at the present time at all. Voice shunt operations (Staffieri, Asai, Amatsu etc.) are still carried out in 7 clinics (6.7%) on 0.7% of all patients (USA: 16% of surgeons on 15% of patients). In the United States 9% of patients are not rehabilitated compared with 6.7% in the Federal Republic.

Germany, West↗
PubMed1989

[Voice restoration after total laryngectomy by tracheoesophageal fistula].

Between December 1985 and December 1988, 34 patients with total laryngectomy had their voice restored by creation of tracheoesophageal fistula. A shunt was created in 13 cases of total laryngectomy. In 21 others, the technique used was tracheosophageal puncture with placement of a Blom-Singer prosthesis. This puncture was carried out either at the time of the laryngectomy or a few weeks later, or when production of esophageal voice failed. Results were assessed on the basis of criteria such as quality of voice, its use and the patient's autonomy. Indications for both procedures, their respective limits and difficulties are exposed. Immediate results following voice recovery were satisfactory in 82% of cases.

Esophagostomy↗
PubMed1987

Alterations in nasal physiology after laryngectomy: the nasal cycle.

Several changes in nasal physiology have been reported following laryngectomy. This paper reviews these changes and investigates the cycle of alternating distribution of nasal airflow in 20 adults. Information about the cyclic activity was obtained from the areas of condensation formed by nasal expiration on the surface of a Gertner-Podoshin plate. Consecutive measurements of these areas were made at 15-minute intervals during a 6-8 hour period. Five control subjects demonstrated a nasal cyclic activity which was absent in five patients 1-3 years post-laryngectomy. Two patients with preoperative cycles showed none three weeks after laryngectomy. Three patients with a temporary surgical diversion of supraglottic airflow showed cessation of the cycle, which resumed after restoration of the natural airway; one of these patients had undergone hemilaryngectomy with section of both superior laryngeal nerves. Five patients showed no alteration after operation involving no diversion of supraglottic airflow (tonsillectomy). These results demonstrate cessation of the cycle following chronic absence of supraglottic airflow, temporary, cessation during acute absence, and independence of the cycle from superior laryngeal innervation.

Adolescent↗
PubMed1986

Primary tracheo-esophageal puncture voice restoration with laryngectomy.

In 1979 Singer and Blom introduced a technique of tracheo-esophageal puncture for restoration of voice in the post-laryngectomy patient. This procedure is usually done as a staged secondary procedure, six months after the primary laryngectomy. This study compares 13 patients who have had a laryngectomy and primary tracheo-esophageal fistula formation with 13 patients in whom the procedure is performed as a delayed operation. A clinical evaluation of the results of tracheo-esophageal puncture is presented. Acceptable results were obtained in 77% of the primary tracheo-esophageal puncture group whereas only 54% of the delayed group attained acceptable results. The advantages of primary tracheo-esophageal puncture include an improved patient morale and acceptance of the procedure, as well as the ability to feed the patient through the Foley catheter. The disadvantages of performing the procedure primarily include an increased rate of postoperative mucocutaneous fistula. The relationship of the tracheo-esophageal puncture to the increased fistulization rate is discussed. Further experience is required before firm conclusions can be drawn about the role this procedure will take in the management of patients for cancer of the larynx.

Aged↗
PubMed1986

[Conservative surgery of cancer of the larynx. Cordectomy, hemilaryngectomy, supraglottic laryngectomy].

Of a total of 219 partial laryngectomies performed, 119 were cordectomies, 30 hemilaryngectomies and 70 supraglottic laryngectomies. Results of each type of operation are presented with emphasis on problems of local recurrences, evidence of validity of procedure selected and of its indications. Analysis of results, with the reservation that indications were sometimes wide but always reasonable, showed an extremely low incidence of recurrences, the quality of the resection (limited or insufficient) having finally little incidence on the latter, except perhaps in the supraglottic laryngectomies. It is suggested, therefore, that no attempt should be made to "recover" a histologically detected insufficient excision by complementary radiotherapy not required in principle. This assists follow up review and allows secondary therapy if an unfavorable course is noted.

Adult↗
PubMed1985

Supraglottic laryngectomy: series report and analysis of results.

Forty-one consecutive patients who underwent supraglottic laryngectomy at UCLA were reviewed. All of the operations were performed by or under the direct supervision of the same surgeon (T.C.). The majority (68%) had advanced squamous cell carcinoma (Stage III-IV). Approximately one half received radiation therapy as part of planned combined therapy. The overall tumor-free survival, with a two-year minimum follow-up period, was 90%. The most common site of tumor recurrence was neck metastasis. There were four laryngeal recurrences, three of which were salvaged with completion laryngectomy. There was only one completion laryngectomy for severe aspiration. The favorable results in this series are attributed to frozen section control of surgical margins, surgical or radiation therapy treatment of cervical lymph nodes at risk for metastatic disease, and the employment of surgical techniques designed to minimize aspiration.

Adult↗
PubMed1979

[Morphological changes in the hypopharynx-esophageal region following laryngectomy. II. Median-sagittal infolding above the ventral aspect of the hypopharynx-esophageal region (author's transl)].

This paper deals with the morphological findings in the hypopharynx-esophageal region of two patients following laryngectomy. In these patients we found a median-sagittal infolding, situated above the ventral aspect of the hypopharynx-esophageal region. This infolding was due to the surgical closure of the ventral wall of the esophagus, following laryngectomy. Histological examination revealed a hernia-like prolapse of the tunica mücosa, m. mucosae and tela submucosa with numerous proliferated macrophages and blood vessels, but no lymphatics. These macrophages are concerned with the removal of an edema, which, however, is only imperfectly removed and finally turns out into a fibrous tissue. The functional meaning of this infolding is not yet clear, but it seems intimately related to the altered function of the hypopharynx-esophageal region following laryngectomy.

Aged↗
PubMed1978

[Surgical rehabilitation of speech after total laryngectomy: the Staffieri techniques (author's transl)].

Surgical speech rehabilitation after total laryngectomy by the three procedures of Prof. Staffieri is based on the principle of establishing a short fistula lined by pharyngeal mucosa between trachea and hypopharynx. It permits voluntary air pressure control for voice production while preventing aspiration during deglutition. In a single-stage procedure the "neoglottis phonatoria" is established on the occasion of the laryngectomy at the top of the trachea. In cases of prevoius laryngectomy a shunt is established between the trachea dorsal wall and the oesophagus, either cranially (direct internal shunt) or more caudally (retrograde internal shunt). The three methods are described, and the one-way function of the different fistulas are demonstrated. The percentage of successful voice restorations that remain free from swallowing difficulties in 700 patients, subjected to these techniques in Europe and Overseas is between 60 and 90%. The main advantage of this operation, which is easy to perform and without risk for the patient, is the wide oncologic spectrum of indications.

Humans↗
PubMed1983

[Partial laryngectomy following combined FAR therapy--evaluation of survival rate and region of recurrence studied by an antomical map].

The clinical records of 75 consecutive patients undergoing partial laryngectomy at Kyushu University Hospital were reviewed. Almost all the patients were treated by combined preoperative FAR therapy (5 FU, vitamin A and irradiation). Among 57 patients, the (estimated) five year survival rate was 76%. The cure rate among 18 patients in whom horizontal laryngectomy was done was high (75%) compared with results presented in other reports. This may be ascribable to the preoperative FAR therapy. Anatomically, critical regions of recurrence were the subglottic region and anterior commissure in vertical partial laryngectomy.

Combined Modality Therapy↗
PubMed1983

Voice rehabilitation after total laryngectomy.

More than 100 years after the first laryngectomy, voice preservation remains a remarkable challenge. A number of surgical techniques have been proposed, yet complications related to aspiration, recurrent disease, or voice failure have been frequent. Representative historical examples are described and their results reviewed. The advent of tracheo-esophageal phonation with a silicone voice prosthesis simplified the approach to this perplexing problem. The principles learned from the secondary application of this method are applied to a primary technique for vocal rehabilitation immediately after laryngectomy. The results are promising without risking alteration of the basic laryngectomy technique and expected cure rates.

Aged↗
PubMed1982

[Reconstructive anterior frontal laryngectomy (author's transl)].

Sliding epiglottoplasty was employed for reconstruction of the glottis after subtotal laryngectomy. Technical aspects are described, and the indications and limitations of this reconstructive partial laryngectomy procedure are discussed from the anatomic and carcinologic points of view. Its advantages include lack of postoperative complications, the very good functional results obtained, and the fact that it can be conducted following radiotherapy and in debilitated patients. It has a limited but definite place among partial laryngectomy procedures.

Adult↗
PubMed1981

[Reconstructive laryngectomy (author's transl)].

The technique, indications, and results of the surgical operation known as reconstructive laryngectomy are described. The intervention involves the performance of a supracricoid subtotal laryngectomy with conservation of an arytenoid, followed by a cricohyoidopexy. This allows re-establishment of the triple function of the aerodigestive junction : phonatory, respiratory, and deglutition; a permanent tracheotomy thus not being necessary. Analysis of results of 103 operations of this type demonstrated that, when conducted under very precise conditions concerning the indications for surgery and the technique employed (conservation of recurrent nerve function of one side), the percentage of permanent tracheotomies following laryngectomy diminished from 72 to 33 p. cent.

Deglutition↗
PubMed1995

[The evaluation of the wound healing failure in patients after total laryngectomy].

The authors presented own results concerning complications in wound healing after total laryngectomies. 59 total laryngectomies and 4 pharyngo-laryngectomies were performed. In 18 cases local and systemic complications were observed. Pharyngo-cutaneous fistulas developed in 15 patients. Therapeutic management was successful in all cases.

Adult↗
PubMed1993

Pharyngo-cutaneous fistulas after total laryngectomy: incidence, etiology and outcome analysis.

A retrospective study of 126 patients who underwent total laryngectomy during a 10-year period was carried out. The incidence of post-laryngectomy pharyngo-cutaneous fistula was 19%. Pre-operative radiotherapy appears to be a risk factor when surgery is performed within three months of completion of radiotherapy. Intra-operative blood transfusion is strongly associated with fistula development. Fistula formation has an important effect on patient morbidity and mortality post-operatively. It remains a relatively frequent complication following total laryngectomy and may be able to be reduced in incidence if surgery is delayed post radiotherapy and blood transfusion is avoided whenever possible.

Adult↗