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At least 433 records · Page 24Linked to original sources
PubMed2005

Long-term performance of indwelling tracheoesophageal speaking valves in Chinese patients undergoing laryngectomy.

OBJECTIVES: To assess the use of indwelling tracheoesophageal speaking valves in Chinese patients undergoing laryngectomy, to identify the clinicopathologic factors for favorable outcome, and to evaluate the factors that determine prosthesis lifetime. DESIGN: Retrospective review. SETTING: Tertiary care institution. PATIENTS: Sixty consecutive patients with total laryngectomy were included. All had indwelling tracheoesophageal speaking valves for voice restoration. INTERVENTION: Anterograde replacement of voice prosthesis in case of failure of functional speech production or leakage of saliva. MAIN OUTCOME MEASURES: Incidence of successful tracheoesophageal speech rehabilitation for daily communication, influence of different clinicopathologic factors on the outcome, and prosthesis lifetime and its relationship to different clinicopathologic factors. RESULTS: The success rate of speech rehabilitation was 78%. Age younger than 60 years was the only clinicopathologic factor associated with successful speech rehabilitation (P = .04, Fisher exact test). The median device lifetime was 8.2 months. Both age of 60 years or older and the use of subsequent prosthetic valves were identified as risk factors for valve failure on univariate analysis (n = 192; log-rank test; P = .02 and P = .03, respectively), with age of 60 years or older as the only risk factor that reduced the device lifetime in the Cox proportional hazards model (P = .03; relative hazard ratio, 1.5; 95% confidence interval, 1.1-2.4). CONCLUSIONS: Our success rate in using indwelling tracheoesophageal speaking valves was comparable to that reported in the Western literature. The median device lifetime of 8.2 months was satisfactory. Patient age was found to be a significant predictor of successful tracheoesophageal speech rehabilitation, with age of 60 years or more adversely affecting device lifetime.

Adult↗
PubMed2006

Importance of routine evaluation of the thyroid gland prior to open partial laryngectomy.

OBJECTIVES: To determine the incidence and presentation of synchronous thyroid lesions in a patient population undergoing open partial laryngectomy (OPL), and to determine whether routine preoperative evaluation of the thyroid gland prior to OPL is useful to identify synchronous thyroid lesions in order to reduce the need for reoperation in this complex patient population. DESIGN: Retrospective medical chart review. SETTING: Academic institution. PATIENTS: Sixty-seven consecutive patients with laryngeal tumors who had undergone OPL from 1996 to 2005. INTERVENTIONS: Charts of 67 consecutive patients with laryngeal tumors who underwent OPL in 1996 to 2005 have been reviewed for synchronous thyroid lesions. For all patients, reports of (1) complete preoperative examination findings, (2) inpatient course, (3) postoperative follow-up, and (4) postoperative final histopathologic findings were reviewed. For patients with synchronous thyroid lesions, reports of (1) thyroid evaluation and imaging and (2) preoperative (fine-needle aspiration), (3) intraoperative (frozen section), and (4) postoperative (final) histopathologic results for the thyroid lesions were reviewed. MAIN OUTCOME MEASURES: Incidence of synchronous thyroid lesions and laryngeal cancer in patients undergoing OPL. RESULTS: Eight (11.9%) of 67 (95% confidence interval, 5.3%-22.2%) patients with laryngeal tumors who underwent OPL had evidence of synchronous thyroid lesions. All 8 patients had squamous cell carcinoma of the larynx and underwent either supracricoid or supraglottic laryngectomy. In these 8 patients, synchronous thyroid lesions were incidentally detected. Four patients had papillary thyroid carcinoma, 1 had squamous metaplasia, and 3 had follicular thyroid tissue that was negative for malignancy on final pathologic examination. In 2 patients, the thyroid lesions were detected preoperatively (prior to OPL); in another 2 patients, thyroid masses were detected intraoperatively; and in 4 patients, the thyroid disease was identified postoperatively on histopathologic examination of excised cervical lymph nodes. In 2 patients, thyroidectomy was performed as a second operation after the OPL, and 1 of them had transient vocal fold paralysis for 2 months. Thyroid ultrasonography was performed in 4 patients. In 3 patients, the ultrasonography was performed after the OPL final pathologic findings indicated the presence of metastatic thyroid disease in cervical lymph nodes. Ultrasonography revealed intrathyroidal lesions in all 3 patients. CONCLUSIONS: Patients with laryngeal tumors who will be undergoing OPL might have occult synchronous thyroid lesions. Thyroid surgery in patients with previous OPL may have an increased potential for complication owing to postsurgical changes in the central neck region. Routine preoperative evaluation of the thyroid gland, especially with ultrasonography, to screen for occult synchronous thyroid lesions is recommended for all patients with laryngeal tumors who will be undergoing OPL. Eradication of any thyroid cancer detected preoperatively by fine-needle aspiration should be performed at the same time as OPL. Pros and cons of total thyroidectomy for indeterminate thyroid nodules should be discussed with this patient population.

Adult↗
PubMed2006

Functional outcome of supracricoid partial laryngectomy with cricohyoidopexy: radiation failure vs previously untreated cases.

OBJECTIVE: To evaluate the postoperative course and functional outcomes achieved in patients treated with supracricoid partial laryngectomy (SPL) with cricohyoidopexy. DESIGN: Retrospective analysis. SETTING: National Cancer Institute "Regina Elena." PATIENTS: Eighty-two consecutive patients who underwent SPL with cricohyoidopexy between September 1, 1988, and June 30, 2005, were evaluated. The patient cohort was divided into 2 groups: one affected by untreated laryngeal cancer and the other with laryngeal recurrence after radiotherapy. MAIN OUTCOME MEASURES: The postoperative complications and functional outcomes of both patient groups were evaluated and statistically compared. RESULTS: No statistical differences were found between the functional results of the 2 groups of patients analyzed. CONCLUSION: Although a slightly delayed recovery of physiological functions of the larynx could be termed a disadvantage of SCL with cricohyoidopexy after radiotherapy, this operation is a reliable and useful procedure for selected patients with recurrent cancer who would otherwise have been operated on and received a total laryngectomy.

Adult↗
PubMed1981

Contralateral laryngoplasty after supraglottic laryngectomy with vertical extension.

Eight patients with supraglottic carcinoma extending onto an arytenoid or true vocal cord have undergone supraglottic laryngectomy with vertical extension including the resection of an arytenoid. In these patients, the contralateral superior thyroid cornua was used to reconstruct the resulting defect. In this technique, the thyroid cornua is mobilized and green-stick fractured across the posterior commissure, maintaining its blood supply by leaving the inferior and middle pharyngeal constrictor attached. This muscle-cartilage pedicle flap provides bulk for the posterior glottis and can be anchored anteriorly to form the framework for a new vocal cord. Hypopharyngeal and pyriform sinus mucosa is then mobilized to cover the newly reconstructed hemilarynx. This reconstruction has provided a competent glottis with a good vocal baffle in every patient in this series. Preservation of airway, voice, and laryngeal sphincter is comparable with that achieved after routine supraglottic laryngectomy without resection of an arytenoid. Using this technique, the surgeon can rely on a pedicle graft with surprising accessibility, bulk, and reach.

Aged↗
PubMed1983

Multiple laryngeal papillomatosis requiring laryngectomy.

Laryngectomy has been performed on two of the 63 cases of laryngeal papillomatosis treated at the Royal National Throat, Nose, and Ear Hospital, London, over 24 years. Their case histories are reported to illustrate the difficulties in managing extremely diffuse and recurrent forms of the disease. Whole organ laryngeal sections of one case are presented. Both patients experienced an improved life-style and fewer hospitalizations following laryngectomy. Although improved microsurgical methods are now available, the search continues for a treatment that will significantly alter the course of the disease.

Adolescent↗
PubMed1985

Contralateral laryngoplasty. An update on reconstruction of the larynx following supraglottic laryngectomy with vertical extension.

Twenty patients with supraglottic carcinoma extending onto an arytenoid or true vocal cord underwent supraglottic laryngectomy with vertical extension that included the resection of an arytenoid. In these patients, the contralateral superior thyroid cornu was used to reconstruct the resulting defect. In this technique, the thyroid cornu is mobilized and greenstick fractured across the posterior commissure, thus maintaining its blood supply by leaving the inferior and middle pharyngeal constrictor muscles attached. This muscle-cartilage pedicle provides bulk for the posterior glottis and can be anchored anteriorly to form a new hemilarynx. This reconstruction has provided excellent anteroposterior diameter and bulk in the laryngeal remnant, resulting in preservation of airway and voice and prevention of aspiration comparable with that achieved following supraglottic laryngectomy without vertical extension or resection of an arytenoid. It is a reliable technique for reconstructing extended laryngeal defects and is herein presented with long-term follow-up.

Adult↗
PubMed1986

Voice rehabilitation following laryngectomy. Myomucosal tracheoesophageal shunt.

Surgical procedures for speech rehabilitation following laryngectomy lack wide support owing to tumor recurrence, aspiration, stenosis of the fistula, and multiple surgical stages of limited usefulness in irradiated patients. The recent prostheses and their modifications have approximately a 70% success rate but similarly remain limited by the requisite maintenance and soilage. A mucosa-lined tracheoesophageal fistula with a functioning proximal muscle sphincter, created in one stage at laryngectomy, is described. This myomucosal unit can function with or without a prosthesis and potentially eliminates aspiration. Evolution of the flap design in an animal model is delineated and the clinical trial in six patients high-lighted. Five of the six have an excellent vocal quality without an associated air leak on phonation. Three function without a prosthesis.

Adult↗
PubMed1989

Near-total laryngectomy with epiglottic reconstruction. Long-term results.

A previous report reviewed the technique and indications for near-total laryngectomy with epiglottic reconstruction in the management of squamous cell carcinoma of the glottis. This approach permits removal of most of both vocal folds, with immediate reconstruction using the epiglottis without the need for stenting or multistage procedures. Forty-eight patients underwent the procedure and were followed up for at least 2 years or until death. Seventeen underwent the surgery for recurrence after failure of radiation therapy for cure. Complications included one wound infection and one laryngocutaneous fistula. All patients underwent decannulation, with little or no compromise of swallowing. All but 1 now have functional voices. Of 8 patients with recurrence, 6 have been salvaged. Two patients died of disease. The value of near-total laryngectomy with epiglottic reconstruction for management of glottic cancer is reviewed.

Adult↗
PubMed1993

A comparative study of speech after total laryngectomy and total laryngopharyngectomy.

Quality of voice is an important factor in the consideration of treatment for advanced laryngeal cancer. This prospective study compared the speaking proficiency of patients who used the Blom-Singer valve after total laryngectomy and after total laryngopharyngectomy with jejunal graft reconstruction with that of a group of normal subjects. The total laryngectomy group demonstrated excellent communication ability both face-to-face and on the telephone. They exhibited superior scores for objective intelligibility, subjective intelligibility, acceptability, and intonation when compared with the total laryngopharyngectomy group. Both surgical groups produced similar amplitude and frequency parameters during normal conversation but had limited reserve when these functions were stressed. Despite these quantitative variations, patient acceptance was very high in both surgical groups. These results serve as a foundation for the evaluation and improvement of rehabilitation techniques.

Aged↗
PubMed1997

Communication after laryngectomy. An assessment of patient satisfaction.

OBJECTIVES: To determine the satisfaction of patients with their current method of alaryngeal communication. To focus primarily on the patients' perception of their own speech. DESIGN: A retrospective review of patients who underwent total laryngectomy for malignancy identified 4 groups of patients. A survey using a mailed questionnaire was used to compare groups. SETTING: Tertiary care university hospital, University of Texas Medical Branch at Galveston. PATIENTS: Forty-seven patients underwent total laryngectomy for cancer and survived. Thirty-one of the 47 patients responded to the survey. Patients were divided into 4 groups by their current method of communication: (1) tablet writers; (2) esophageal speech; (3) electrolarynx; and (4) tracheoesophageal speech. MAIN OUTCOME MEASURES: Satisfaction with communication, satisfaction with speech quality, ability to communicate over telephone, limitation of interaction with others, and satisfaction with quality of life. RESULTS: Patients in group 4 were significantly more satisfied with their speech (P < .001), perceived their speech to be of better quality (P < .001), had improved ability to communicate over the telephone (P < .001), and had less limitation of their interactions with others (P < .004). Patients in group 4 also rated their overall quality of life higher (P = .23). CONCLUSION: Although many studies in the past have demonstrated the objective superiority of tracheoesophageal speech compared with other methods of alaryngeal communication, most studies have focused on the intelligibility of speech judged by listeners. This study demonstrates that patients who use tracheoesophageal speech rate their own speech significantly higher than patients who use other methods and most likely have an overall superior quality of life.

Adult↗
PubMed1997

Botulinum neurotoxin injection after total laryngectomy.

BACKGROUND: One of several causes of tracheoesophageal puncture (TEP) speech failure after total laryngectomy is disturbance in relaxation of the pharyngoesophageal (PE) segment. We introduce the use of chemical denervation of the PE segment through botulinum neurotoxin (Botox) injection to improve TEP speech. METHODS: An analysis was performed on eight patients who received Botox injections for TEP speech problems after total laryngectomy at the University of Iowa between June 4, 1991 and August 8, 1994. Retrospective chart review identified the evolution of pretreatment evaluation and injection technique which became standardized in April 1992. Prospective evaluation of results was recorded by a single speech pathologist who subjectively identified the response to Botox in all patients and recorded pressure readings at the tracheostoma site during speech in 6 patients. RESULTS: Seven of the eight patients were noted to have improved TEP speech following injection. Five of these seven patients experienced substantially improved speech, three of whom had no ability to produce speech prior to the Botox injection. CONCLUSION: Botox injection is a safe and effective method of improving TEP speech in selected patients with disturbed relaxation of pharyngoesophageal segment.

Adult↗
PubMed1998

Supracricoid partial laryngectomies: oncologic and functional results.

BACKGROUND: The authors present their study on oncologic and functional results of supracricoid partial laryngectomies (SPL) performed on 149 patients between January 1984 and December 1995. METHODS: Cricohyoidopexy (CHP) was carried out on 98 patients and cricohyoidoepiglottopexy (CHEP) on 51 patients. The patients were divided into two groups. The first group included those operated on between January 1984 and December 1992 and who therefore had a minimum follow-up period of 3 years. The second group included those operated on after December 1992 and who therefore had a follow-up period of less than 3 years. The statistical evaluation of this second group was carried out using an actuarial method according to Kaplan-Meier. RESULTS: In the first group, survival rate (regarding disease-related deaths) was 94% (95/101), whereas in the second group, survival rate was 95%. There were 9 recurrences in the 149 patients (6.71%), B of which occurred after CHP (6 for tumor [T] and 2 for node [N]) and 1 (for T) after CHEP. Three of the 6 recurrences for T after CHP occurred in the hypopharynx, 2 in the peristomal area, and 1 in the arytenoid area. The only recurrence for T after CHEP occurred in the paraglottic area. Decannulation was carried out in 85.7% of CHP patients (84/98) and in 98% of CHEP patients (50/51). The nasogastric tube was kept in position for an average of 28 days (range, 15-90 days) in the CHP patients and 15 days (range, 9-90 days) in the CHEP patients. Swallowing was excellent; only a small number of patients (n = 21) were forced to assume a particular posture during meals. Phoniatric controls performed on 104 patients also showed adequate speech recovery. CONCLUSIONS: If the indications are applied scrupulously, CHEP is a valid alternative to partial laryngeal surgery and CHP is a possible alternative to total laryngectomy in the treatment of glottic and supraglottic tumors.

Adult↗
PubMed1999

Modified subtotal laryngectomy with cricohyoidoepiglottopexy--long term results in 81 patients.

BACKGROUND: Standard treatment of early glottic carcinoma is radiotherapy, but involvement of the anterior commissure leads to a reduced cure rate. We investigated retrospectively whether our modified subtotal laryngectomy had improved results for early glottic carcinomas involving the anterior commissure, without causing excessive disability to laryngeal functions. METHODS: Eighty-one patients with T1 or T2 glottic carcinoma involving the anterior commissure were reviewed. Follow-up was at least 3 years. Speech was assessed by subjective evaluation and a computer-assisted voice analysis device. RESULTS: Three-year overall survival rate and 3- and 5-year actuarial survival rates were, respectively, 90.1%, 95%, and 90.8%, with no difference between the different T stages involved (p > 0.46). The local recurrence rate was 7.4%. Speech recovered in all patients and was evaluated as satisfactory in 86% of cases. CONCLUSION: For early glottic carcinomas involving the anterior commissure, subtotal laryngectomies appear to be more effective than radiotherapy, and our modified technique simplifies the procedure.

Adult↗
PubMed1999

Laser treatment of symptomatic anterior pharyngeal pouches after laryngectomy.

UNLABELLED: BACKGROUND. An anterior pharyngeal pouch is a common anatomic variation after total laryngectomy. The exact part the pouch has to play in postlaryngectomy swallowing disorders is unknown but might be bigger than expected. METHODS: Nine patients with a symptomatic pouch were treated with CO2 laser and questioned about pre- and postoperative complaints. RESULTS: Eight out of nine patients noticed an obvious improvement of their swallowing complaints after laser surgery. CONCLUSION: Based on the results, it is concluded that CO2-laser treatment with division of the bar of tissue posterior to the pouch is seen as a safe and simple way to treat patients for symptoms that can be wrongly attributed to a total laryngectomy.

Aged↗
PubMed1988

Tumor clearance at resection margins in total laryngectomy. A clinicopathologic study.

The specimens from total laryngectomy performed in 70 patients were studied using the step-serial whole organ sectioning technique. Transverse histologic sections were taken and examined for minimum tumor clearance. The clinical status of patients for at least 4 years of observation was correlated with microscopic clearance of margins. The actual presence of tumor at the margins of resection was found in 21 (30%) of the specimens. The tumor was found to reach within 1 mm, 2 mm, and more than 2 mm from the margins in nine (13%), four (6%), and 36 (51%) specimens, respectively. The anterolateral margin was most commonly involved (19%), followed by the posterolateral (11%), postcricoid (7%), and upper (1.4%) margins. Local recurrence was found to be related to degree of clearance as 10 of 21 (48%) patients with no clearance and one of nine (11%) with 1 mm clearance had local failure. None of the patients with 2 mm clearance or more developed local recurrence. It is concluded that step-serial whole organ sectioning is an adequate method for thoroughly examining resection margins in laryngectomy specimens.

Carcinoma, Squamous Cell↗
PubMed1989

Patterns of failure after total laryngectomy for glottic carcinoma.

The 136 patients who underwent total laryngectomy as the primary treatment for squamous cell carcinoma of the glottis at the Mayo Clinic in 1970 through 1981 were followed by retrospective record review for at least 4 years or until death, local recurrence, neck recurrence, or delayed neck metastasis. Cancer recurred or progressed in a previously untreated area in 35 patients; for the 29 affected above the clavicles, the median time to manifestation was 9.9 months. A Cox model with four risk factors (P less than 0.05) was found to predict failure above the clavicles: lymph node metastasis in the laryngectomy specimen (Delphian, pretracheal, tracheoesophageal, parathyroid), primary tumor more than 1.5 cm in greatest diameter, subglottic extension, and lymph node metastasis in the neck dissection specimen. A simple risk score computed from the Cox model shows that the more factors present, the higher the risk of disease progression or recurrence.

Adult↗
PubMed1994

A clinical trial of continuous cisplatin-fluorouracil induction chemotherapy and supracricoid partial laryngectomy for glottic carcinoma classified as T2.

BACKGROUND: Vertical partial laryngectomy (VPL) and radiation therapy (RT) are the recommended conventional conservative options for glottic carcinoma classified as T2. In series presenting more than 100 patients with a minimum 3-year follow-up, however, local recurrence rates were reported as 22-43.5%. The authors' experience with a new strategy based on continuous cisplatin-fluorouracil induction chemotherapy (IC) and supracricoid partial laryngectomy with cricohyoepiglottopexy (CHEP) is presented. METHODS: A retrospective analysis of 67 patients who presented with untreated moderately to well differentiated invasive glottic carcinoma classified as T2, managed from 1983 to 1991 with IC and CHEP, was conducted. Statistical analysis of survival, local control, nodal control, distant metastasis, and metachronous second primary tumor incidence was based on the Kaplan-Meier actuarial method. Univariate analysis was performed to analyze the relationships between various factors and survival, local recurrence, and nodal recurrence. Clinical response, histologic response, IC toxicity and postoperative course were reported. RESULTS: The Kaplan-Meier 5-year survival, local recurrence, nodal recurrence, distant metastasis, and metachronous second primary tumor estimate were 92.3%, 5.6%, 1.5%, 1.8%, and 5.6%, respectively. Overall laryngeal preservation was achieved in 65 patients (97%). Ultimate local control was achieved in all patients but one. Nodal recurrence was statistically more likely in patients presenting with a local recurrence. Analysis of the specimens demonstrated complete histologic response to IC in 25 (37.3%) patients. A strong statistical relation (P < 0.0001) was noted between complete clinical response after IC and complete histologic response. CONCLUSIONS: The change from the prevailing treatment modalities of RT and VPL to a new multimodal strategy (IC+CHEP) did not decrease survival and allowed for an increase in laryngeal preservation rate. The high rate (37.3%) of complete histologic response suggests that IC deserves further consideration in the management of patients with glottic carcinoma classified as T2. The favorable results achieved in this series, when compared with historic controls, should stimulate prospective clinical trials comparing the two surgical procedures (CHEP vs. VPL with or without IC) for resection of Stage II glottic carcinoma.

Adult↗
PubMed2005

Laryngeal reconstruction by platysma myofascial flap after vertical partial laryngectomy.

BACKGROUND: Many methods of glottic reconstruction have been described for patients undergoing vertical partial laryngectomy to reestablish the glottic integrity. METHODS: Fifteen patients with T2 squamous cell carcinoma of the glottis were included in this prospective clinical trial. All patients were treated by vertical partial laryngectomy with laryngeal reconstruction by platysma myofascial flap. The surgical procedure and flap design were described. Vocal function was assessed by videolaryngostroboscopy and subjective and objective voice analysis before and after surgery. RESULTS: Complete neoglottic closure and acceptable voice quality were obtained by platysma myofascial flap in all cases. No statistically significant difference was found between the preoperative and postoperative acoustic parameters. CONCLUSIONS: Platysma myofascial flap provides the basic requirements for laryngeal reconstruction with its own favorable characteristics and also allows complete glottic closure without interfering with respiration and deglutition. This technique may be an effective alternative achieving an acceptable quality of voice.

Adult↗