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PubMedDate not supplied

["Near-total" laryngectomy: functional results].

"Near total" laryngectomy is an alternative to total laryngectomy in some advanced laryngeal tumors. A prospective study was made of the results obtained in 40 patients treated with near total laryngectomy. Speech was achieved in 74.3% of patients within a mean time interval of 63 days. Of the subjects who had more than 5 months of follow-up, 84.6% could speak. Half of the patients who achieved speech used the Barton-Mayo button and did not need to use their hand for phonation. Major swallowing problems were found in 13.9%. The most common complication was pharyngo-cutaneous fistula (58.9%).

Adult↗
PubMed1996

[Diagnosis and therapy of dysphagia after partial horizontal laryngectomy].

Due to an increase in the numbers of function-preserving laryngectomies and the utilization of laser techniques in cancer surgery, more patients after supraglottic partial laryngectomies are experiencing dysphagia of different intensities. We therefore developed a functional therapy program that we use for patients after supraglottic partial laryngectomies following a special diagnostic evaluation including video-laryngoscopy and, if necessary, high-speed cine-radiography. This therapeutic treatment was developed from conventional treatment for patients with dysphagia caused by neurological disorders and includes body posture, altered mouth movements, food consistency and swallowing technique. In so doing, exercises are used to achieve closure of the vocal folds, aids for swallowing liquids and general directions. This method for evaluation and treatment is presented in 12 patients as examples. We now report our positive long-term results and demonstrate the possibilities and limits of therapy. Additional procedures for isolated cases are discussed critically with regard to their indications and treatment.

Aged↗
PubMed1995

Laryngectomy: a quality of life assessment.

Cosmetic disfigurement and loss of voice following a total laryngectomy can cause major psychosocial problems. Fifty patients who had undergone a total laryngectomy and completed more than six months following surgery, were randomly selected during a routine follow-up, and asked to answer a questionnaire, to asses their degree of disability and extent of rehabilitation. The questionnaire have five main components viz. general information, functional evaluation, vocal rehabilitation, social assessment and economic sequelae. Results revealed that these patients suffered from a significant decrease in social acceptance (70%), social activity (82%), sexual activity (62%), ability to communicate vocally (58%), and severe financial repercussions (78%). A large number of patients (40%) were dissatisfied with the present level of rehabilitation offered. Inspite of these problems the majority (80%) were willing to accept a total laryngectomy as treatment of their cancer. This emphasizes the need for greater interaction between the treating surgeon, speech therapist, occupational therapist, and psychotherapist to rehabilitate these patients adequately.

Aged↗
PubMed1996

[The use of hyoid osteomuscular flap in extended partial laryngectomy].

The surgical defect after conventional partial laryngectomy practically needs no special technique to repair. On conservation surgery for late (T3 and T4) cases a large part of the larynx is to be resected so that the margin of surgical clearance is ample and, at the same time, an appropriate method of reconstruction is mandatory to restore the essential functions of the larynx. For this purpose we developed a technique of osteomuscular flap to repair the defect left behind after a three-fourths laryngectomy (for supraglottic case) or an extended vertical partial laryngectomy (for glottic case). In both cases the arytenoid cartilage or the cricoarytenoid joint was resected to ensure the safety margin of resection. The mylohyoid muscle was severed at the upper border of the body of the hyoid bone. A small piece of the hyoid bone (about 5 mm) and its attached strap muscles were used. The muscles were made a 90 degree bent toward the laryngeal cavity. The hyoid bone was used to substitute the removed arytenoid and the muscles to bridge over the laryngeal lumen. The postericoid mucosa was advanced to cover the transplanted hyoid bone. Then the cut edge of the thyroid cartilage was lifted up and sutured with the base of the tongue to close the wound. 108 cases were treated within a period of 12 years (1979-1990). The three year survival rates for stage II and stage IV of supraglottic type (66 cases) were 78.6% and 66.7% respectively, and for stage II of glottic type (42 cases), 79.3%. The decannulation rate was 75%-85%, and 80% of the patients enjoyed a socially acceptable voice. All cases resumed normal mouth-food-taking.

Adult↗
PubMed1995

[The effect of laryngectomy on the fibrinolysis process in the blood of patients with laryngeal neoplasms].

Some data in the literature indicate on the influence of different kind of surgery on the fibrinolytic process. Tissue plasminogen activator (t-PA) and plasminogen activator inhibitor type 1 (PAI-1)--play important role in regulation of fibrinolysis. The aim of our work was to evaluate the influence of laryngectomy on fibrinolytic potential in the blood of operated patients with larynx carcinoma. Study group consisted of 20 men aged 42-75 years old with larynx carcinoma subjected to total laryngectomy. In the blood of patients we measured the concentration of t-PA:Ag, fibrinogen and FDP levels, PAI-1 activity, and ELT. The increase of t-PA and FDP concentrations, decrease of PAI-1 activity and fibrinogen level with simultaneous ELT shortening indicate on the fibrinolysis activation during the laryngectomy.

Adult↗
PubMedDate not supplied

[Complications of total laryngectomy in relation to the previous radiotherapy].

Different factors, particularly prior radiotherapy, are associated with the occurrence of postoperative complications after total laryngectomy. We compared the postoperative complications of 50 patients who underwent total laryngectomy without prior radiotherapy and those of 50 patients who underwent total laryngectomy for tumor recurrence or persistence after radiotherapy. Twenty-four percent of the patients without previous irradiation suffered cervical complications compared with 26% of the patients with previous irradiation. The most frequent cervical complication was pharyngo-cutaneous fistula, which occurred in 12% of the non-irradiated patients and in 18% of the irradiated patients. There were no significant differences in the frequency of complications or in the occurrence of fistulas in relation to prior radiotherapy. In the group of irradiated patients, the proportion of major fistulas was greater. The occurrence of cervical complications, particularly pharyngo-cutaneous fistulas, significantly prolonged the hospital stay.

Carcinoma, Squamous Cell↗
PubMed1998

Functional outcomes following treatment for advanced laryngeal cancer. Part I--Voice preservation in advanced laryngeal cancer. Part II--Laryngectomy rehabilitation: the state of the art in the VA System. Research Speech-Language Pathologists. Department of Veterans Affairs Laryngeal Cancer Study Group.

This two-part investigation assessed functional outcomes related to communication (including amount of speech therapy), swallowing and eating, and employment status for patients who received one of the two treatment modalities for advanced laryngeal cancer (stage III or IV laryngeal squamous cell carcinoma) in Veterans Administration Cooperative Study #268. One hundred sixty-six patients were randomized to primary surgery (laryngectomy) and radiotherapy (RT), and 166 to induction chemotherapy (CT) and RT. The first investigation dealt with examining and comparing functional outcomes for patients in the two treatment arms of the main study. Results showed clearly that patients with advanced laryngeal cancer are better off from the standpoint of speech communication if they can be treated for this disease without removal of the larynx. In contrast, there were few significant differences between patient groups for other non-speech-related measures. The second investigation focused on communication-related outcomes associated with the rehabilitation of total laryngectomy patients. Results revealed that only relatively small percentages of total laryngectomy patients (6%) developed usable esophageal speech or remained nonvocal (8%), and that a majority of patients ended up as users of artificial electrolarynx (55%) or tracheoesophageal (31%) speech. The results from both investigations are discussed with respect to factors that can influence the rehabilitation process and long-term outcome status of patients who are treated for advanced laryngeal cancer with these two strategies.

Adult↗
PubMed1996

[Extended vertical partial laryngectomy for treatment of the glottic cancer with T3 category].

From June 1981 to December 1992, 32 patients of glottic cancer with T3 category were treated by extended vertical partial laryngectomy, i.e. vertical laryngectomy plus the resection of the arytenoid and part of the cricoid plate. The laryngeal defect was reconstructed by an osteomuscular flap. The 3- and 5-year survival rates were 78.1% and 73.9% respectively. The decannulation rate was 81.3%. The voice was satisfactory in 84.3%. All patients resumed mouth-food-taking. The authors conclude that selective glottic cancer of T3 category treated with extended vertical partial laryngectomy, which preserves the functions of the larynx and improves the quality of the life, is feasible and acceptable.

Adult↗
PubMed1996

[Speech restoration via a tracheo-esophageal tegmental valve fistula following total laryngectomy].

In order to restore the patients' speech function after total laryngectomy, the speech restoration operation has been done successfully in 12 patients with laryngocarcinomas by making tegmental valve fistula from esophageal flap and tracheal tissue after total laryngectomy. First, the trachea and the esophagus were separated, and a tissue flap 20mm in length from posttracheal wall was made. Its upper end was 10mm in width, lower end 8 mm, laterally 5 mm x 6 mm, the tracheal mucosa and cartilage were sewn up to from a tegmental valve, then, a tissue flap 20 mm in length from the preesophageal wall was done with its upper end 15 mm in width, lower end 10 mm. Then a tegmental valve fistula (speech-tube) was made by sewing up two flaps crisscross and a 12F catheter was inserted into the tegmental valve fistula as a supporter for 10 days. Finally, a tracheostomy was performed by sewing up the trachea to the neck skin. All patients could speak fluently and clearly after surgery and kept their sex and dialect characteristics whereas without misswallowing. The operation is a perfect way for total laryngectomy with speech restoration in patients with upper glottal or glottal laryngocarcinomas.

Adult↗
PubMed1998

[Vertical partial laryngectomy with false vocal cord flap reconstruction: carcinologic and functional results].

Glottic reconstruction with false vocal cord flap was carried out to improve vocal function after vertical partial laryngectomy. This retrospective study reports carcinologic and functional results of 77 patients operated by vertical partial laryngectomy with or without glottic reconstruction. Five years actuarial survival rate and tumoral control rate were 79% and 90% respectively, without significant differences between patients with or without glottic reconstruction. Vocal study found that supraglottic structures were involved in neoglottic closure in 47% of the patients. Anterior commissure web was statistically reduced in patients with glottic reconstruction. The carcinologic results of this study allow for glottic reconstruction at the time of vertical partial laryngectomy. Neoglottic closure and postoperative anterior commissure web are factors which could influence final vocal results.

Aged↗
PubMed1998

[Horizontal laryngectomy in treatment of laryngeal cancer--oncologic and function results].

The purpose of this paper was the retrospective evaluation of the results after horizontal partial larynx resection of different dimension. The material comprised 468 patients treated according to the described techniques in ENT Clinic Pom. Med. Acad. between 1970-1991. The series of patients subjected to analysis consisted of 35% of all cases treated by surgery and 70% of all conservative operations performed for cancer of the larynx in the above-mentioned period of time. Particulars were obtained from: a) case history, b) control examination, c) correspondence, d) data from USC. The results of the treatment in particular groups were submitted for detailed analysis. The assessment of applied technique from oncologic point of view was done on the basis of local recurrences and percentage of 3 and 5 years survival rate. Functional results were evaluated according to protective, respiratory and phonatory functions of the residual larynx. Results of the investigations were submitted for statistic valuation. In all types of operations satisfactory oncologic results were achieved. They were represented by high percentage of survival rate and low percentage of local recurrences. The longest survival 3- and 5-years respectively (73.90%) and 63.45%) and the lowest index of local failure (4.2%) were seen after classic, supraglottic resection. After horizontal glottic larynx resection 8/10 of patients operated on survived 3 years, 4/6 survived 5 years. Local recurrence was observed in 1/12 patients (Tab. 2). The lowest rate of survival (54.76% and 42.86%) and the highest number of local failures (11.3%) were revented after supracricoid laryngectomy with cricohyoidoepiglottopexy (CHEP)--in this group carcinomas staged T3 were predominant. After enlarged supraglottic laryngectomy and supracricoid resection with cricohyoidopexy (CHP) oncologic results were very close (Fig. 1). No substantial statistical difference was recorded in survival percentage after enlarged supraglottic larynx resection (70.51% and 61.66%) and supracricoid one with CHP (68.54% and 58.43%), nor in percentage of local recurrences (4.4% and 5.7%). The efficiency of the residual larynx was dependent on the extent of the resection. From the discussed types of operations the best functional results were achieved after classic supraglottic and glottic larynx resections. This was distinct in the best quality of speech, efficient respiratory tract protection and high percentage of decannulated cases (93%). In the glottic resection the respiratory tract protection was satisfactory in 9/11 patients and in 7/8 satisfactory speech quality was noticed. Following the extended laryngeal structures resection (extended supraglotic and supracricoid laryngectomies) worse protection of respiratory tract, higher percentage of not decannulated cases and worse quality of speech were observed than in operation previously discussed. It was proved that the one-stage reconstruction of the laryngeal structures (arytenoid cartilage and/or vocal cord) or base of the tongue improves the result considerably, in particular the deglutition and phonation. The oncologic and functional results after the discussed types of operation should stimulate their more frequent application in larynx cancer treatment.

Adolescent↗
PubMed1998

[Labayle's supracricoid partial laryngectomy in the treatment of laryngeal cancer: personal experience and long term follow up].

The present study was carried out to assess the indications and to evaluate the functional and oncological results of the supracricoid laryngectomy with crico-hyoid-pexy proposed by J. Labayle. This technique consists of a sub-total laryngectomy where the cricoid cartilage, the hyoid bone and at least one of the arytenoids are spared. These structures can then be reassembled into a "neo-larynx", thus preserving respiration and phonation. The present paper deals with 23 laryngeal carcinomas: 13 glottic (2 T1bN0, 6 T2N0, 1 T2N1, 1 T2N1, 3 T3N0) and 10 supraglottic (4 T2N0, 3 T2N1, 3 T2N2). The follow-up shows a 5-year overall actuarial survival rate of 80.65%. The authors agree that when performed under very precise indications the crico-hyoid-pexy is a useful alternative to both radiotherapy and the extended-partial or total laryngectomy in the treatment of laryngeal carcinoma. It also appears useful in treating selected cases of post-surgical or post-radiotherapy recurrences.

Adult↗
PubMed1999

Development and implementation of a clinical pathway for patients undergoing total laryngectomy: impact on cost and quality of care.

BACKGROUND: The current health care climate demands the provision of quality patient care in a cost-effective manner. Clinical pathways define the essential components of care that are provided to patients with a specific diagnosis to achieve a desired outcome within a predetermined period. Development and implementation of clinical pathways streamline the provision of quality care in the most cost-effective manner. OBJECTIVES: To develop a clinical pathway for patients undergoing total laryngectomy and to evaluate its impact on the cost and quality of care provided to these patients. SETTING: A tertiary care academic medical center. PATIENTS AND METHODS: A total of 45 patients were included in the study. The clinical pathway was implemented for 15 patients, while the other 30 patients were treated without the implementation of the pathway guidelines. MAIN OUTCOME MEASURES: Length of hospital stay, readmission rate, and hospital variable costs. RESULTS: The clinical pathway affected all cost outcome measures. Length of stay decreased by 2.4 days (29%; P=.001), and the average hospital variable cost decreased from $3992 to $3419 per case. This represents a 14.4% reduction in cost associated with pathway implementation (P=.02). The standardization of care eliminated unnecessary variation and repetition in resource usage, resulting in overall cost reduction. Pathway implementation resulted in a lower readmission rate (7% [1/15]) than that of patients treated prior to protocol implementation (23% [7/30]). CONCLUSION: Implementing a carefully developed clinical pathway may reduce cost without compromising the quality of care for patients undergoing total laryngectomy.

Cost Control↗
PubMed2000

Rehabilitation of olfaction after laryngectomy by means of a nasal airflow-inducing maneuver: the "polite yawning" technique.

OBJECTIVE: To develop a nasal airflow-inducing maneuver and apply it in the olfactory rehabilitation of patients who have undergone laryngectomy. DESIGN: Intervention study; before-and-after trial. SETTING: National cancer center. PATIENTS: Forty-four patients who underwent laryngectomy; 34 men and 10 women; mean age, 64 years (range, 42-80 years); mean time since surgery, 6 years (range, 8 months to 18 years). INTERVENTION: In a prospective clinical intervention study, we assessed the effectiveness of a nasal airflow-inducing maneuver ("polite yawning," ie, yawning with closed lips). Speech therapists trained the patients in the maneuver, and its effectiveness in inducing nasal airflow was checked with digital and water manometers. MAIN OUTCOME MEASURES: Olfactory acuity was assessed before and after the intervention by means of an odor detection test and a structured questionnaire concerning olfaction, taste, and appetite. Patients were categorized as "smellers" and "nonsmellers" on the basis of the results of the odor detection test and the present odor perception scale derived from the questionnaire. RESULTS: The nasal airflow-inducing maneuver could be taught to all patients, mostly in only one 30-minute therapy session. Fifteen of the 33 patients in the pretreatment nonsmeller category converted to smellers, for a success rate of 46% (P<.001). CONCLUSION: The nasal airflow-inducing maneuver (the "polite yawning" technique) allowed almost half of the patients to recover their sense of smell.

Adult↗
PubMed2002

Downsizing of voice prosthesis diameter in patients with laryngectomy: an in vitro study.

In patients with laryngectomy, voice prostheses inserted into a tracheoesophageal fistula (TEF) are widely used for vocal rehabilitation. Gradual dilation of the TEF may cause bothersome leakage around voice prostheses. Prosthesis-related weight and mechanical trauma possibly exacerbate TEF dilation. If prosthesis size were to be decreased, with a concomitant decrease in prosthesis weight and diameter, dilation of the TEF would probably lessen. We performed in vitro tests to study the effects on aerodynamic prosthesis function when the prosthesis size-in particular, the inner diameter-was decreased. The effects on airflow and pressure were specifically studied in the airflow range of patients with laryngectomy. A 1-mm decrease of the regular inner prosthesis diameter from 5 mm to 4 mm showed no significant aerodynamic consequences at the average laryngectomized airflow point. Also, such a 1-mm decrease in diameter involved a prosthesis weight reduction of 18%. In view of these findings, downsizing the standard prosthetic diameter should be considered in future voice prosthesis development.

Dilatation, Pathologic↗
PubMed2003

Outcome of salvage total laryngectomy following organ preservation therapy: the Radiation Therapy Oncology Group trial 91-11.

OBJECTIVE: To evaluate the incidence of morbidity, mortality, and disease control for patients requiring salvage total laryngectomy (TL) following organ preservation therapy. DESIGN: Patients entered into a 3-arm randomized prospective multi-institutional trial for laryngeal preservation who required TL following initial treatment. SETTING: The Radiation Therapy Oncology Group 91-11 trial for laryngeal preservation. PATIENTS: From 1992 to 2000, 517 evaluable patients were randomized to receive chemotherapy followed by radiation therapy (arm 1), concomitant chemotherapy and radiation therapy (arm 2), or radiation therapy alone (arm 3). RESULTS: Overall, TL was required in 129 patients. The incidence was 28%, 16%, and 31% in arms 1, 2, and 3, respectively (P =.002). Of these, 7 patients (5%) required TL for aspiration or necrosis. Following TL, the incidence of major and minor complications ranged from 52% to 59% and did not differ significantly among the 3 arms. Pharyngocutaneous fistula was lowest in arm 3 (15%) and highest in arm 2 (30%) (P>.05). There was 1 perioperative death. Local-regional control following salvage TL was 74% for arms 1 and 2 and 90% for arm 3. At 24 months, the overall survival was 69% (arm 1), 71% (arm 2), and 76% (arm 3) (P>.73). CONCLUSIONS: Laryngectomy following organ preservation treatment is associated with acceptable morbidity. Perioperative mortality is low but up to one third of patients will develop a pharyngocutaneous fistula. Local-regional control is excellent for this group of patients. Survival following salvage TL was not influenced by the initial organ preservation treatment.

Carcinoma, Squamous Cell↗
PubMed2003

Partial laryngectomy with imbrication laryngoplasty for glottic carcinoma.

BACKGROUND: Treatment options for unilateral glottic carcinoma include radiation therapy, partial laryngectomy, and endoscopic cordectomy. We used partial laryngectomy with imbrication laryngoplasty (PLIL) for definitive treatment with curative intent in a select group of patients. STUDY DESIGN: Retrospective multicenter review of 24 patients treated with PLIL. Data collection included demographics, tumor characteristics, time to decannulation, time to oral food intake, local control, survival, voice result as judged by the physician, voice result as judged by the patient, and patient satisfaction. SETTING: Five academic medical centers. METHODS: PLIL includes a composite resection of the entire vocal fold, with its ligament, muscle, adjacent paraglottic tissues, and the adjacent block of thyroid cartilage. A neocord is reconstructed by imbricating the remaining thyroid cartilage strips and covering them with a false vocal fold flap. RESULTS: A total of 24 patients (T1, n = 13; T2, n = 10; and T3, n = 1) underwent PLIL. Median time to decannulation was 4 days, and median time to oral food intake was 5 days. Clear margins were achieved in 23 patients (96%). Follow-up ranged from 1 to 11 years (median duration of follow-up, 5.5 years). In the patients who had clear margins at the initial surgery, the rate of overall disease control was 100%. Voice quality was judged by the physician as good or excellent in 100% of the patients who underwent PLIL, and as better than typical hemilaryngectomy in 23 patients (96%). Twenty-three patients (96%) were satisfied with their voice quality. CONCLUSIONS: PLIL provides us with a single modality curative approach to unilateral glottic carcinoma. It also provides rapid recovery of oral and/or nasal airway and swallowing, excellent voice quality, and a disease-control rate similar to or better than other treatment modalities.

Adult↗
PubMed2005

Quantitative detection of substitute voice generator during phonation in patients undergoing laryngectomy.

OBJECTIVE: To evaluate the vibration pattern of the substitute voice generator of patients who have undergone laryngectomy. For automatic quantification of the oscillations of the pharyngoesophageal (PE) segments, image processing of digital high-speed video sequences is applied. DESIGN: Physiologic analysis. SETTING: An acute care hospital. PATIENTS: Endoscopic recordings were taken of 10 men who underwent laryngectomy (mean +/- SD age, 61.5 +/- 5.2 years) during sustained phonation of a vowel using a 90 degree endoscope coupled to a high-speed camera. MAIN OUTCOME MEASURES: An image-processing algorithm was developed to automatically define the pseudoglottis in each recording and track its movements. RESULTS: The clinical assessment of the high-speed technique for the endoscopic examination of the substitute voice generator yields the following results. The forms and oscillation characteristics of the pseudoglottides varied considerably: 3 pseudoglottides were circular, 6 were split shaped, and 1 was triangle shaped. A quasi-periodic opening and closing were observed and automatically detected by the described algorithm in each recording independently from quality of the recording and from morphologic and oscillation characteristics of the PE segment. The frequencies of the extracted oscillations of the pseudoglottides correspond to the structure of the acoustic signals. CONCLUSIONS: Automatic image processing of PE segments derived from high-speed endoscopic recordings enables the detection and quantification of the substitute voice generator's oscillations in high temporal resolution. These data directly prove that the detected pseudoglottis is the source of the substitute voice. Close relations between substitute voice and functional properties of the PE segment exist. In the future, these data will be interpreted by applying biomechanical models of the PE segment. Presumably, results may help to optimize surgical and adaptive procedures for specific substitute voice restoration.

Aged↗