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At least 469 records · Page 26Linked to original sources
PubMed2006

CO(2) laser treatment of laryngeal stenoses after reconstructive laryngectomies with cricohyoidopexy, cricohyoidoepiglottopexy or tracheohyoidoepiglottopexy.

Supracricoid laryngectomy with cricohyoidopexy (CHP) or cricohyoidoepiglottopexy (CHEP) is a conservative laryngeal surgery tailored to T1b-T2-T3 glottic-supraglottic carcinomas. Tracheohyoidopexy (THP) and tracheohyoidoepiglottopexy (THEP) allow a chance of conservative surgery also for selected transglottic carcinomas. These techniques are comprehensively named reconstructive laryngectomies (RLs). Post RL laryngeal stenosis not due to carcinoma persistence or recurrence is an unusual occurrence. The aim of the present study has been to analyse retrospectively and describe the treatment of the cases of laryngeal stenosis after RL, which occurred in Vittorio Veneto Otolaryngological Department in a 6 year period. In the period between 1999 and 2004, 225 patients underwent RL in our Department. In 18 of them (8%) a laryngeal stenosis after RL was diagnosed. The same evidence was shown in 2 patients who underwent RL in other Institutions. All patients underwent CO(2) laser surgical treatment of the laryngeal stenosis. The 14 patients who underwent RL-CHEP, the 5 patients who underwent THEP and the patient who underwent CHP were treated on average with CO(2) laser 1.2 (range 1-2), 4.2 (range 2-7), and 2 times, respectively. Decannulation was possible in all patients but one after CO(2) laser treatment of the stenosis in a mean period of 3.4 months. Laryngeal stenoses after RLs can be successfully treated with CO(2) laser excision with a very limited morbility. The only reasonable contra-indication to CO(2) laser excision could be a cranio-caudal length of the laryngeal stenotic tract longer than 1 cm: in this occurrence diagnosed after THP or THEP, an external surgical approach could be preferred.

Carbon Dioxide↗
PubMed2000

Obstructive sleep apnea syndrome after reconstructive laryngectomy for glottic carcinoma.

Obstructive sleep apnea syndrome (OSAS) is characterized by repetitive episodes of partial or complete obstruction of the upper airway during sleep. The obstruction predominantly occurs along the pharyngeal airway but other sites of obstruction have occasionally been described. We report our experience with three patients suffering from OSAS suspected to be of laryngeal origin. OSAS developed after reconstructive laryngectomy for glottic carcinoma and upper airway obstruction seemed to be located in the reconstructed laryngeal area. The three patients were given nCPAP (nasal-continuous positive airway pressure) treatment associated with peroral endoscopic CO2 laser vaporization of the laryngeal edema. After CO2 laser treatment, one patient was able to stop nCPAP treatment. The other two have remained on nCPAP therapy. OSAS may arise in the post-operative period of reconstructive laryngectomy for glottic carcinoma and can be managed by CO2 laser vaporization (laryngeal edema in the reconstructed area) in association with nCPAP treatment.

Aged↗
PubMed1999

The Gregorio Marañón Hospital experience with vertical partial laryngectomies.

We present a retrospective study of 551 patients treated with conservative surgery for glottic carcinoma at the Gregorio Marañón Hospital between 1962 and 1996. In all, 12% of cases were locally advanced carcinomas. In early-stage carcinomas there were no statistical differences in 5-year survival between those treated by endoscopic laser resection, vertical hemilaryngectomy and radiotherapy. However, tumor recurrence after primary radiotherapy was higher (27%) than with conservative surgery (12%), while the voice preservation rate was significantly higher with surgery (83%) than with radiotherapy (72%). With locally advanced cancer, irradiated patients (to 60 Gy) had a 50% probability of recurrence with a very low chance for salvage by total laryngectomy (5-year survival rate, 38.5%). In contrast, partial laryngectomy could be performed on carefully selected patients, and the results for these patients were comparable to those for smaller lesions (with a 5-year survival rate of 81%).

Actuarial Analysis↗
PubMed2001

Investigating quality of life and coping resources after laryngectomy.

Surgical procedures and in particular laryngectomy can become a life-saving treatment for patients with laryngeal or hypopharyngeal cancer, but can result in permanent damage. Clinical observation suggests that patients vary considerably in their ways of dealing with this new situation and in their ability to cope. The aim of our interdisciplinary group was to investigate the quality of life of laryngectomy patients and learn about their perceptions, situation and coping mechanisms. The development of an appropriate study design and a measurement strategy is presented. We investigated 29 laryngectomized patients who had joined the local self-help group. The patients were free from tumour disease and were mostly married with children, retired from work and had not graduated from high school. Assessment of the quality of life was performed with the European Organization for Research on Treatment of Cancer questionnaires QLQ-C30 and H+N35 and additional open questions. Analysis of the acquired data showed that family support was judged most important for overcoming the problems of disease and treatment. Deficits in this area were highly correlated with a low overall quality of life. Financial problems resulted because of the high percentage of retirement before or after therapy. We suggest that perioperative support taking these facts into consideration can result in an improved coping process. Further prospective studies are needed to reveal the effect of such measures.

Adaptation, Physiological↗
PubMed2003

Functional outcome following colon interposition in total pharyngoesophagectomy with or without laryngectomy.

Our study compares deglutition between a group who had undergone total esophagopharyngolaryngectomy and a group who had esophagectomy and partial pharyngectomy with preserved larynx, after reconstruction of the upper digestive tract with pedicled colon interposition. In four patients the laryngeal structures could be preserved (three caustic burns and one proximal esophageal tumor). Six patients underwent a total laryngopharyngectomy for large pharyngeal tumors. Swallowing was assessed by a questionnaire, clinical examination, and videofluoroscopy. All patients had normal intake of semisolid foods and fluids. All patients but three experienced some feeling of "narrowing" of the tract: four at the level of the hypopharynx, two at the oropharyngeal level, one at the oral level. In the laryngectomy group, solid food caused some degree of delayed swallowing in three patients. Dumping occurred in one case out of the nonlaryngectomy group. On clinical examination a tense motility in all laryngectomy patients appeared, food remnants in five and repeated swallowing movements in four. The videofluoroscopy confirmed repeated swallowing movements and presence of residual food in the oral cavity. Temporal stagnation occurred at the anastomosis site in all patients and in two patients at a place of colon redundancy. Colon interposition is a reliable reconstruction and gives the possibility of a good functional outcome. Although preservation of the larynx facilitates swallowing even in this reconstructive procedure, it may be better to perform a total laryngopharyngectomy and colon interposition in oncological cases where the pharyngeal remnant is borderline for primary closure.

Adult↗
PubMed2003

New surgical technique for primary and secondary voice restoration using a free ileocecal patch graft after total laryngectomy.

PURPOSE: We devised a new surgical technique to restore the voice after laryngectomy. This procedure is designed to repair the hypopharyngeal defect by using a free ileocecal patch for voice rehabilitation. METHODS: We performed this procedure in seven patients; for primary voice restoration in six and for secondary voice restoration in one. The technique involved resecting an ileocecal segment containing the ileocecal valve and cutting a patch from the cecum, the size of which was equalized with the hypopharyngeal defect. After patch repair of the defect, the tracheopharyngeal shunt was completed by an anastomosis between the ileum and trachea. RESULTS: One patient died from sudden rupture of the carotid artery, but all six survivors were able to speak and swallow without aspiration, achieving fair to good articulation. CONCLUSIONS: The advantages of our method are as follows. (1) The operative procedure is simple and does not require complicated remodeling of the intestinal graft for voice production. (2) The ileocecal valve can prevent aspiration. (3) The patch expands the pharynx and prevents narrowing. (4) Using this procedure, it is possible to achieve voice restoration even in patients who have undergone total laryngectomy in the past.

Adult↗
PubMed1976

Alteration in esophageal motility after laryngectomy.

Ten laryngectomees underwent esophageal motility studies to assess the effect of laryngectomy on esophageal function. When these patients are compared with controls, marked derangements in esophageal motility were noted in the upper esophageal sphincter (UES) and in the body of the esophagus. Lower esophageal sphincter (LES) function did not differ significantly from the controls. Dysphagia developed postoperatively in five of the ten laryngectomees. This preliminary analysis suggests that esophageal motility disturbances may be relatively frequent after laryngectomy and that these disturbances may be clinically significant. The theoretical basic for the motility abnormalities and areas of future research are discussed.

Aged↗
PubMed1990

Fabrication of a custom recessed tracheostoma valve retainer for the total laryngectomy patient.

Total laryngectomy patients who depend on a prosthesis for the production of alaryngeal speech often have irregular peristomal anatomy. The standard tracheostoma (speech) valve retainer cannot be intimately adapted to uneven and highly mobile tissue. Fabrication of a custom speech valve retainer is indicated under such circumstances but may be complicated by restricted access to the surgically created stoma. This article describes the clinical and laboratory techniques for the fabrication of a custom tracheostoma valve retainer that displaces the peristomal soft tissues and musculature. This technique permits access for placement of the speech valve and valve retainer in close proximity to the speech button prosthesis. Enclosure of the custom retainer in the recess underlying the peristomal musculature also provides a plug that enhances retention and increases patient confidence during alaryngeal speech. The coordinated efforts of the speech specialist and the prosthodontist in the fabrication of this prosthesis enhances the quality of life for the total laryngectomy patient.

Humans↗
PubMedDate not supplied

Partial vertical laryngectomy--indications and surgical technique.

Partial vertical laryngectomy is a treatment option for certain T1 glottic cancers. Selection criteria and surgical technique are reviewed. Partial vertical laryngectomy for early vocal cord cancer is considered by some to be an obsolete procedure. However, as outlined in this paper, we believe it is a realistic treatment option for T1 glottic cancers that cannot be removed endoscopically.

Carcinoma, Squamous Cell↗
PubMed1991

A model for quality of life after laryngectomy.

In this paper we propose a theoretical model for quality of life after laryngectomy. By combining findings from literature, relevant factors for determining quality of life are presented. The importance of these factors is exemplified by interviews with laryngectomies. The practical purpose is to embed this model in a patient's choice process between surgery and radiotherapy, the two main treatments of laryngeal cancer. It is argued that such a decision is at best made by a cooperation of patient, physician and social worker or psychologist.

Aged↗
PubMedDate not supplied

Total laryngectomy and postoperative radiotherapy for T4 laryngeal cancer: a 14-year review.

OBJECTIVE: The most appropriate treatment of locally advanced carcinoma of the larynx remains to be ascertained. Management of T4 laryngeal cancer patients with postoperative radiotherapy after total laryngectomy is generally advocated and not often debated. However, the effects of this combined treatment approach are poorly documented. We reviewed the oncologic outcome and long-term survival of individuals treated by total laryngectomy and postoperative radiotherapy (TLPR) for T4 carcinoma of the larynx. METHODS: Twenty-eight patients with a pathologic diagnosis of T4 laryngeal cancer treated by TLPR during a 14-year period were studied retrospectively. Median follow-up from treatment until the end of observation was 36 months (range 6 to 123 months). RESULTS: The overall actuarial and disease-free survival rates at 7 years were 43% and 30%, respectively. Local recurrence, regional relapse, and distant metastasis developed in 4%, 4%, and 7% of the cases, respectively. Later esophageal stricture, dental caries, or carotid artery disease in 3 patients (11%) was successfully managed. Multivariate analysis showed patient age, bilateral true vocal cord-anterior commissure involvement by laryngeal cancer (horse-shoe lesion), and any type of treatment failure to be the most predictive variables affecting prognosis. CONCLUSION: Long-term disease control and survival is achievable by TLPR with minimal late toxicity in patients with T4 carcinoma of the larynx.

Adult↗
PubMedDate not supplied

Supracricoid laryngectomy: is it time to define guidelines to evaluate functional results? a review.

PURPOSE: Supracricoid laryngectomy (SCL) permits local control and 5-year survival rates similar to total laryngectomy in selected cases of advanced-stage laryngeal carcinoma. Although most of the reports regarding the surgical technique and oncological results have been proposed by European groups, increased interest in SCL has also been shown in recent years by American surgeons. There is still a lack of comprehensive studies about functional outcomes (respiration, deglutition, phonation) after SCL. Materials and methods This report briefly evaluates the functional outcomes of SCL recorded by the Department of Otolaryngology Head and Neck Surgery of Padua University since 1998 and critically reviews recent English-language literature describing SCL functional results. RESULTS: The present review confirms that the available data on functional results were collected using heterogeneous methods, parameters, and evaluation scales. CONCLUSIONS: Every effort has to be made to uniform the format for presenting outcome data, particularly on swallowing and voice parameters. Defining guidelines to evaluate the functional results of SCL may facilitate interstudy comparability.

Aged↗
PubMedDate not supplied

Elective neck dissection during salvage laryngectomy.

PURPOSE: To evaluate the rate of occult metastases detected with elective neck dissection during salvage laryngectomy for radiation failures. METHODS AND MATERIALS: Retrospective review of 63 patients failing radiation therapy treated with salvage surgery between 1970 and 1999. Charts were reviewed for tumor stage, neck treatment, complications, surgical time, and survival. Median follow-up for patients with glottic and supraglottic cancers was 7.8 and 4.5 years, respectively. RESULTS: Thirty-one of 41 glottic cancer patients received elective neck dissections. Three (10%) of 31 had occult metastases. Recurrent staged rT3 and greater tumors showed a 20% rate of occult metastases. No survival advantage was noted between patients treated with elective neck dissection and those followed expectantly (P = .87). Cartilage invasion and perineural invasion in the larynx were associated with a higher risk of occult metastases (P < .05). Ten of 22 supraglottic cancer patients received elective neck dissections. Two (20%) of 10 had occult metastases, and a statistically significant survival advantage was not noted (P = .49). CONCLUSIONS: We recommend bilateral neck dissection at the time of laryngectomy for recurrent staged rT3/4 tumors and all patients with recurrent supraglottic cancers because of the higher rate of occult metastases.

Adult↗
PubMed2004

A nine-year institutional experience with near-total laryngectomy.

BACKGROUND: Pearson's near-total laryngectomy (NTL) is an alternative procedure to total laryngectomy in selected patients with advanced laryngeal cancer. Based on our experience with NTL for >9 years, we present here the functional results, complications, and survival rates. METHODS: A retrospective study was carried out from January 1993 to May 2002. We studied 15 patients with advanced laryngeal, oropharyngeal, and hypopharyngeal cancer who underwent NTL. Survival rates were calculated using the Kaplan-Meier method. RESULTS: The most common complication was fistula (8 of 15) followed by minor aspiration (4 of 15 patients). Eleven patients (73.5%) attained a good voice; 3 patients (19.9%) obtained a bad voice; and 1 did not achieved vocal ability. Three patients (19.9%) had local recurrence; no patients had neck recurrence; and 2 patients (13.3%) had distant metastasis. Six patients (40%) died from their disease, and 2 (13.3%) patients died from other causes. The 3-year actuarial survival rate was 81.6%. CONCLUSIONS: NTL is useful in the treatment of selected patients with advanced laryngeal, oropharyngeal, and hypopharyngeal cancer and results in good control and survival rates. Satisfactory functional results can be attained in the majority of patients. When the surgical margins are positive or close, TL must be carried out.

Adult↗
PubMed2004

Extended sigmoid-shaped free jejunal patch for reconstruction of the oral base and pharynx after total glossectomy with laryngectomy.

The procedure for reconstruction of the extensive defect after total glossectomy with total laryngectomy has not been standardised so far. We have devised a new method in which a free jejunal patch is extended to a sigmoid-shaped form specifically optimised for reconstruction of the defect that consists of the entire floor of the mouth and the antero-lateral walls of the pharyngoesophageal tract. After a jejunal segment of about 40 cm has been longitudinally opened in full length, the proximal quarter is folded parallel to the second quarter, which is then folded parallel to the third quarter in the opposite direction, to be laid out in a S-shaped form. Side-by-side sutures are then placed along each of the folded borders and corrective trimming is done to fit the defect. This widely extended patch replaces the whole oral base, whereas the remaining distal quarter of the patch replaces the antero-lateral walls of the hypopharynx and cervical esophagus. Because of the encouraging functional results with satisfactory restoration of oral alimentation, this procedure is considered to be ideal for the reconstruction of the defect which follows total glossectomy with total laryngectomy.

Adult↗
PubMed2006

Voice reconstruction using the free ileocolon flap versus the pneumatic artificial larynx: a comparison of patients' preference and experience following laryngectomy.

This study compares the psychological adjustment and voice function of patients undergoing voice rehabilitation using the free ileocolon flap for creation of a voice tube shunt and patients undergoing voice rehabilitation using the pneumatic artificial larynx. Twelve laryngectomy patients were included; six underwent free ileocolon transfer following a period of pneumatic artificial larynx use. Mean duration after laryngectomy was 5.2 years. Mean follow-up was 210 days. A chart review, questionnaires and a prospective evaluation were performed. Voice tube shunt patients had better speech function and higher self-esteem. People's discrimination and appearance when speaking were important in the patients' choice of method for rehabilitation. There was a high preference for choosing the voice tube shunt and a higher motivation and willingness to use that voice mechanism in the voice tube shunt group. Patients who undergo free flap reconstruction of voice have better speech function and self-esteem than patients who continue to use the external pneumatic device. Psychological assessments are important for surgical patients in order to evaluate a critical aspect of our perceived success - the patients' perception.

Adaptation, Psychological↗
PubMed2004

Voice rehabilitation after near-total laryngectomy.

Near-total laryngectomy provides oncologic control of hypopharyngeal and laryngeal cancers that are not amenable to conservation procedures. The resulting myomucosal shunt provides a prosthesis-free method of voice rehabilitation. This review presents indications, technique, and speech rehabilitation for a near-total laryngectomy.

Cricoid Cartilage↗
PubMed2004

Predictors of wound complications after laryngectomy: A study of over 2000 patients.

OBJECTIVES: To identify risk factors for and the rate of wound complications after laryngectomy in a large, prospectively collected national dataset, and to generate a predictive model. Study design We used the National Surgical Quality Improvement Program (NSQIP) registry created by the Department of Veterans Affairs (VA) to identify patients undergoing total laryngectomy from 1989 to 1999 (n = 2063). We linked these data to inpatient and outpatient VA administrative records to capture data for prior radiation. Over 20 preoperative and intraoperative risk factors were analyzed using bivariate techniques. Those significant at the P < 0.01 level were analyzed with logistic regression and conjunctive consolidation to identify independent predictors of wound complications. RESULTS: The overall wound complication rate was 10.0%. In adjusted analyses, prolonged operative time (>10 hours, odds ratio = 2.10, 95% confidence interval: 1.32-3.36), exposure to prior radiation therapy (OR =1.63, 1.07-2.46), presence of diabetes (OR =1.78, 1.04-3.04), preoperative hypoalbuminemia (OR =1.90, 1.32-2.74), anemia (OR =1.59, 1.07-2.36), and thrombocytosis (OR =1.48, 1.04-2.10) were independently associated with postoperative wound complications. A prognostic model using three variables-prior radiation therapy, diabetes, and hypoalbuminemia-provided excellent risk stratification into three tiers (6.3%, 13.7%, 21.7%). CONCLUSIONS: Preoperative radiation, prolonged operative time, low albumin, and diabetes were independently associated with postoperative wound infections. These results will help to identify patients at risk for wound complications, thus allowing for heightened surveillance and preventive measures where possible.

Diabetes Complications↗