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PubMedDate not supplied

Dynamic radiographic imaging following total laryngectomy.

Cinepharyngoesophograms of the pharynx were obtained in 51 patients after total laryngectomy for squamous cell carcinoma. The radiological findings were correlated with operative reports and follow-up findings in 47 patients. Postoperative anatomic changes were well-demonstrated radiographically. A spectrum of radiographic findings were observed and included narrowing at the superior surgical closure site in 52% and pseudodiverticula in 47% of all patients. Cricopharyngeal prominence was observed in 15%, fistulae in 10%, and pharyngeal pouches in 6% of all cases. Increased retropharyngeal soft tissue thickness was not found to be indicative of tumor recurrence. We conclude that cineradiography is a useful method for demonstrating both functional and structural changes following laryngectomy for carcinoma.

Adult↗
PubMedDate not supplied

Laryngectomy alone for T3 glottic cancer.

BACKGROUND: The long-term survival of 81 patients with T3 squamous cell carcinoma of the glottic larynx treated with laryngectomy alone is presented and pathologic predictors for cancer recurrence above the clavicles and cancer death are identified. METHODS: Clinical records, operative notes, and pathologic slides were reviewed. The major end points were failure above the clavicles, cause-specific survival, and overall survival. All patients were followed until death or a minimum of 10.8 years. RESULTS: The main pattern of treatment failure was within an undissected ipsilateral or contralateral neck. Subglottic extension and nodal metastases predicted failure above the clavicles and delayed metastasis within an undissected neck. The 5-year rate of control of disease above the clavicles, cause-specific survival, and overall survival were 74.1%, 73.7%, and 54.3%, respectively. CONCLUSIONS: Patients treated with laryngectomy for T3 glottic cancer who have pathologic evidence of subglottic extension or nodal metastasis are at higher risk for recurrence above the clavicles, particularly within an undissected neck.

Adult↗
PubMedDate not supplied

Thyroid function after radiotherapy and laryngectomy for carcinoma of the larynx.

Total levels of thyroxine (T4) and thyroid-stimulating hormone (TSH) were measured in 37 patients who had previously had carcinoma of the larynx treated by radiotherapy and total laryngectomy with thyroid lobectomy. Ten percent of the patients had clinical features of hypothyroidism and 30% had total T4 levels below the lower limit of normal. A further 40% had results in the low normal range. Forty-four percent of patients had raised TSH levels, 90% of these having low or low normal T4 levels. The histology of the thyroid gland was normal in all 37 patients. Attention should be given to preserving intact the vasculature of the contralateral thyroid lobe whenever it is necessary to remove the ipsilateral thyroid lobe during a laryngectomy. Proper postoperative assessment of thyroid gland function is desirable in all these patients to identify those at risk of hypothyroidism and to avoid unnecessary morbidity.

Humans↗
PubMedDate not supplied

Examination of swallowing after total laryngectomy using manofluorography.

Investigation of postlaryngectomy dysphagia is usually limited to the standard barium swallow. Manofluorography (mano, manometry; fluoro, videofluoroscopy; graphy, picture) is a new technique that permits analysis of simultaneous manometry and videofluoroscopy of deglutition. Manofluorography provides more detailed analysis of the swallowing dynamics during the pharyngeal stage of deglutition than either barium studies or manometry used alone. This study uses manofluorography to examine swallowing in two patient groups, total laryngectomees and total laryngectomees with tongue impairment, to analyze the role of various anatomic components in the swallowing process. Pharyngeal transit times were prolonged in both patient groups studied, with the tongue impairment group exhibiting the longest times. The postlaryngectomy pharynx offered greater resistance to bolus flow. The laryngectomy patients compensated by using increased lingual propulsion, whereas the patients with tongue impairment and total laryngectomy could not. This emphasizes the importance of the tongue in bolus propulsion in the pharynx. Other postoperative changes in swallowing are discussed.

Deglutition Disorders↗
PubMedDate not supplied

Manofluorography of deglutition after supraglottic laryngectomy.

Manofluorography (mano: manometry, fluoro: videofluoroscopy, graphy: picture) provides a simultaneous display of manometry and fluoroscopy on one video screen. This study uses manofluorography to analyze the swallowing patterns of nine patients who had undergone supraglottic laryngectomy. The results show that during swallowing the pharyngeal mechanism for preventing aspiration depends upon three processes: (1) tight lingual-laryngeal contact, (2) coordination of the swallowing reflex, and (3) tongue base and pharyngeal constrictor clearing of the hypopharynx and laryngeal inlet. Anterior suspension of the larynx under the tongue base serves to improve lingual-laryngeal contact. This close contact during deglutition protects the airway from the bolus and also opens the postcricoid region, aiding bolus passage into the esophagus. Impairment of the swallowing reflex, which can cause severe aspiration before the swallowing reflex is triggered, can be rehabilitated by swallowing therapy. Minor aspiration is commonly caused by impaired clearing of the superior hypopharynx after supraglottic laryngectomy.

Deglutition Disorders↗
PubMed1978

Total laryngectomy and reconstruction of a pseudoglottis: problems and complications.

A modified procedure for the reconstruction of a pseudoglottis after total laryngectomy is examined. The history of this technique, including our experience, is reviewed with emphasis on problems and complications. Indications and justifications for surgery are discussed. Though we can only speculate on the basis of a few cases, we believe that a good voice can be obtained when a pseudoglottis is either primarily or secondarily constructed after laryngectomy. We acknowledge that perhaps the risk of liability tempers our approach and restricts our case selection which, no doubt, in part accounts for our modification of the procedure that was initially performed in Europe. We believe that continued careful application of this technique and its variations will improve the results of modern laryngeal surgery.

Glottis↗
PubMed1983

Sternohyoid myofascial flap reconstruction of the larynx for vertical partial laryngectomy.

Reconstruction of the larynx for vertical partial laryngectomy is of paramount importance in eventual voice and deglutition rehabilitation. Many different methods of laryngeal reconstruction have been tried attesting to the challenge of minimizing hoarseness and aspiration after this type of surgery. During the past decade the scope of partial laryngeal surgery has broadened, mandating more extensive reconstructive procedures in order to acceptably rehabilitate upper aerodigestive function. During the past 6 years the author has employed a superiorly-based sternohyoid myofascial flap to reconstruct the larynx after vertical partial laryngectomy in 31 patients. Swallowing was resumed in all patients without significant aspiration. Although decannulation was delayed in 8 patients, all patients were eventually extubated. Voice quality was considered far superior to other reconstructive methods formerly used by the author.

Humans↗
PubMed1994

Clinical experiences with surgical techniques and treatment results in patients undergoing subtotal laryngectomies.

After a period of critical evaluation, subtotal laryngectomies are now considered to be valuable additions to the surgical management of laryngeal neoplasms. It is now possible to obtain good functional and oncological results in treating clinical situations that until a few years ago appeared curable only by radical surgery. We now report our clinical experiences with Labayle and Majer-Piquet types of subtotal laryngectomies and discuss indications and contra-indications to such surgery. Our current preference is to use Labayle technique, since it permits better functional recovery and a shorter clinical course.

Adult↗
PubMed1995

Oral feeding after total laryngectomy for endolaryngeal cancer.

There is still no agreement about the beginning of oral feedings after total laryngectomy. Some authors begin routine feedings on the 3rd postoperative day, while others delay oral feedings until 12-14 days after surgery. The present study was devised as a prospective randomized clinical trial concerning beginning oral feedings on the 7th or 14th postoperative day in 35 patients following total laryngectomy as treatment for endolaryngeal cancer. There were no differences in risk factors present in either group. Only two pharyngocutaneous fistulae occurred in the overall series (5.7%), with both appearing in the 7-day group and developing on the 18th and 20th postoperative days respectively. There were no statistically significant differences in fistula formation between the two groups (P = 0.49). We conclude that it is not necessary to delay oral feedings more than 7 days in patients without suture line tension.

Aged↗
PubMed1983

Tracheostomal recurrences after laryngectomy.

A clinicopathologic study of 681 laryngectomies performed at the Otorhinolaryngology Clinic of the University of Ferrara forms the basis here of a discussion of the etiopathogenesis of the postsurgical tracheostomal recurrence. Special attention is paid to the much debated etiopathogenetic role of preoperative tracheotomy. In all classes of material analyzed, tracheostomal recurrence was more frequent in patients with preoperative tracheotomy, though the percentages varied depending on the class. Morphological analysis of original tumor specimens from preoperatively trachetomized patients who later had tracheostomal recurrence, revealed tumors in 4 out of the 11 usable specimens. Of these, two had submucosal infiltration in a peripheral digitation of the tumor; in the other two cases, no contact was observed between the neoplastic infiltration and the outer border of the original tumor. The authors also reviewed the case histories of patients in whom conservative surgery was followed by total laryngectomy because of endolaryngeal recurrence. The high rate of tracheostomal recurrence in this category of patients suggests that the pathogenetic mechanism may be analogous in the two situations: preoperative tracheotomy/tracheostomal recurrence and inadequate conservative surgery/tracheostomal recurrence.

Humans↗
PubMed1980

Pitfalls after laryngectomy and neoglottis formation.

Intrraluminal manometric investigations in the hypopharynx and sphincter area post laryngectomy revealed pressure recordings of 54 mm Hg and 33 mm Hg, respectively, during the act of swallowing. Aspiration of saliva or food after a laryngectomy with a hypopharyngeal-tracheal shunt can be explained on these grounds.

Deglutition↗
PubMed1978

Infravestibular horizontal partial laryngectomy. A new surgical method.

We have developed a new functional surgical technique for cancers of the larynx specially those situated glottically and subglottically which are considered remedial to a total laryngectomy. Specifically an infravestibular horizontal partial laryngectomy can be performed to remove neoplasms together with the glottis and subglottis. The larynx then may be reconstructed by suturing the bands to the ascended trachea and the conserved upper half of the tyroid cartilage. The results have been encouraging. Swallowing, phonation and respiration by the natural vias has been obtained in 8 of the 12 patients so operated.

Glottis↗
PubMed1989

Myomucosal shunt following total laryngectomy: a report of 31 cases.

An original technique of voice rehabilitation following total laryngectomy based on the concept of a myomuscosal unit was originally described by Strome. Thirty-one cases of myomucosal shunts (MMS) are analyzed in the present report. The 14 initial cases failed because of a lack clinical and surgical experience and insufficient selection of the patients. Among the last 17 cases, 1 was lost to follow-up, 1 had an insufficient follow-up, and 2 patients refused to speak with the MMS instead of a patent shunt; 5 of the remaining patients had voices evaluated as excellent, 7 had voices interpreted as good and only 1 patient had a voice evaluated as poor. Aspiration was not a problem. Eleven patients were found to stenose their shunt, but fistula were recalibrated successfully. The MMs can be used safely in oncological surgery and only 1 of 31 deaths in our total experience was due to a local recurrence. These findings show that the MMS is a reliable procedure for voice restoration following total laryngectomy; a prosthesis is not required and there are currently no oncological limits to the procedure. However, a very close follow-up of the patients is required after surgery.

Adult↗
PubMed2003

[Quality of life for patients after laryngectomy and surgical voice rehabilitation. Experience with the Provox prosthesis].

BACKGROUND: Our study included 52 patients who received follow-up care after laryngectomy; a Provox I prosthesis was used for voice rehabilitation. METHODS: The EORTC Quality of Life Questionnaire was used to assess the postoperative quality of life of these patients with voice prostheses. RESULTS: Of the patients, 36.1% complained of a lack of energy, and 22% experienced sadness suggesting a reactive depression. Of the 55.6% of patients who expressed satisfaction with managing their disease, more than two-thirds were afraid of a potential deterioration of their health. More than 90% of the patients received extensive support from family and friends. As many as 52.8% expressed themselves satisfied with their current life, which is perhaps attributable to the successful rehabilitation of their voice. Eating problems, i.e., varying degrees of dysphagia as a result of treatment, were experienced by 47.3% of the patients. CONCLUSIONS: After the laryngectomy, 11% continue to smoke and 46% regularly consume alcohol. For this reason, rehabilitation measures should place more emphasis on patient education and on programs designed to help patients stop smoking and drinking alcohol.

Adult↗
PubMed2004

[Type I hypersensitivity to a silicone tube after laryngectomy].

While irritation of the tracheal mucosa is a common finding after laryngectomy, specific hypersensitivity to tracheal tubes or their components is extremely rare and has only been documented as a contact allergy. In this case report, we present type I hypersensitivity to tracheal tube components for the first time. The patient regularly used a special silicone tube for swimming after laryngectomy and complained about increasing tracheal irritation during and after the use of this tube. A standard skin prick test with common aeroallergens and a skin patch test with standard, rubber and adhesive allergens as well as with parts of the silicone tube was performed. Different parts of the tracheal tube were also tested with a scratch test. Total IgE as well as specific IgE for latex allergens was measured. Both skin prick and patch tests were negative. No specific IgE for latex allergens was detected. The scratch test generated strongly positive reactions against native tube material. The positive findings in the skin tests demonstrate specific hypersensitivity to the tracheal tube or its components in terms of a type I hypersensitivity. The causative component remains unclear.

Carcinoma, Squamous Cell↗
PubMed2002

Videofluoroscopy of the swallowing act after partial supraglottic laryngectomy by CO(2) laser.

The evaluation of functional deglutition in patients after partial supraglottic laryngectomy by CO(2) laser was performed by videofluoroscopy of the swallowing act. We studied 20 patients in PA and LL projections, and the swallowing act, at 25 frames per s, was captured on videotape. Aspiration was found in six patients, four of whom had manifest clinical symptoms of aspiration. Four patients had post-deglutitive, one intra-deglutitive and one both intra- and post-deglutitive aspiration. Other swallowing disturbances or structural deformities were not detected. Dynamic radiological studies of swallowing, such as videofluoroscopy of the swallowing act, can provide valuable information regarding functional results after surgical procedures in the upper aerodigestive tract. Our encouraging results prove the validity of partial supraglottic laryngectomy by CO(2) laser as a method of treatment for carcinoma of the larynx.

Aged↗
PubMed2004

Reconstruction of the hypopharynx with U-shaped pectoralis major myocutaneous flap after total pharyngo-laryngectomy.

Resection of the whole circumference of the pharynx and esophagus is usually reconstructed with gastric pull-up, jejunum free graft or free forearm flap. The aim of this study was to assess the use of pectoralis major myocutaneous flap for closure of total pharyngeal defect. In 11 patients with hypopharynx and larynx cancer, total pharyngo-laryngectomy and excision of the cervical part of the esophagus and neck dissections were performed; the defects were closed with pectoralis major myocutaneous flaps. The skin island was sutured to prevertebral muscles, forming a letter U shape. Good healing was obtained in six patients, and five patients developed fistula that closed spontaneously within 3-4 weeks. The use of U-shaped pectoralis major myocutaneous flap, suturing it to prevertebral muscles, gives good functional results, and it is a simple and time-saving second choice method of reconstruction of the pharynx after total pharyngo-laryngectomy.

Aged↗
PubMed2005

The physiological rationale of heat and moisture exchangers in post-laryngectomy pulmonary rehabilitation: a review.

Total laryngectomy results in a permanent disconnection of the upper and lower airways and inevitably leads to chronic pulmonary complaints like frequent involuntary coughing, increased sputum production and repeated daily forced expectoration to clean the airway. Heat and moisture exchangers (HMEs), applied in an attempt to compensate for the lost functions of the upper respiratory tract, have been found to diminish these symptoms and improve the quality of life significantly. An HME has three physical properties that might be responsible for these improvements. First, its heat and moisture exchanging capacity improves intra-airway preservation of heat and water. Since the condensation and evaporation of moisture are accompanied by the release and uptake of thermal energy, these parameters are inseparable. Secondly, the HME's resistance may reduce dynamic airway compression, thereby improving ventilation. Thirdly, to some extent, an HME might filter out particles, thereby cleaning inspiratory breathing air. This article summarizes our present knowledge of changes in respiratory physiology after total laryngectomy and the influence of the HME by reviewing the physiological impact of these three physical properties separately for in vitro and in vivo data.

Hot Temperature↗