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At least 505 records · Page 28Linked to original sources
PubMed1989

Repair of post-laryngectomy pharyngeal fistulae.

Post-laryngectomy pharyngeal fistulization is an unpleasant occurrence. Presented herein is the author's approach to this problem, along with two cases in which closure was effected by sternocleidomastoid (SCM) myoplasty. SCM myocutaneous flaps have previously been considered for pharyngocutaneous fistulae and then disregarded due to the doubtful nature of the blood supply to the skin. The SCM myoplasty obviates this problem as it relies on muscle rather than skin. SCM myoplasty has been used as a bolster in pharyngeal reconstruction after the pharynx has been closed by pharyngeal mucosal advancement or rotation. The author has extended this idea utilizing the raw muscle of the SCM to directly reconstruct the defect in fistulae deemed too large for primary closure. Anatomical, oncological and technical considerations are discussed, as well as the author's protocol for post-laryngectomy pharyngocutaneous fistulae.

Fistula↗
PubMed1991

Laryngectomy: the patient's view.

The disabilities following laryngectomy are well recognized. The incidence of these disabilities and the acceptability of the surgery to the patients were assessed by a questionnaire method. Sixty-five patients participated in the study. The incidence of disabilities are discussed. Total laryngectomy was felt to be a worthwhile operation by most of the patients in the study despite the disabilities they experienced afterwards.

Activities of Daily Living↗
PubMed1992

Vertical partial laryngectomy: our results after treating 81 cases of T2 and T3 laryngeal carcinomas.

From 1976 to 1989, 81 patients with T2 and T3 laryngeal carcinomas were treated with vertical patrial laryngectomy at the University ENT Department of Thessaloniki, Greece. All patients were male with a median age of 56 years (33-71 years). Four patients had N1 lymph nodes. Ten patients received post-operative radiotherapy. Seventeen patients developed local recurrences or distant metastases. Mean follow-up was more than seven years. Absolute three-year survival was 94.6 per cent for 74 patients and absolute five-year survival was 89.6 per cent for 58 patients. Actuarial five-year survival of the whole group of 81 patients was 91 per cent calculated with the Kaplan-Meier method. Recurrence rate and survival of stage II and III patients are also discussed and compared using the log-rank test. We conclude that vertical partial laryngectomy is a very successful treatment selection for T2 glottic and false vocal cord carcinomas and for some selected T3 glottic lesions.

Adult↗
PubMed1992

The use of pyriform sinus mucosa for reconstruction after vertical partial laryngectomy.

This prospective study included 30 patients with glottic carcinoma of the larynx who were treated primarily by vertical partial laryngectomy. The pyriform sinus mucosa was used to reconstruct the new laryngeal wall and to form a pseudo-vocal fold at the side of resection. Our results showed that 90 per cent of patients were decannulated, 80 per cent were able to eat a normal diet, 70 per cent developed excellent voice quality after surgery and a 97 per cent three-year survival was achieved. The pyriform sinus mucosa proved to be a reliable material for reconstruction after vertical partial laryngectomy.

Adult↗
PubMed1992

Osteomyelitis of the cervical spine following laryngectomy.

Only one case of osteomyelitis of the cervical spine following laryngectomy for carcinoma of the larynx has been reported in the literature to date. We report an unusual case of osteomyelitis of the cervical spine following treatment of laryngeal carcinoma by radiotherapy (RT) and subsequent laryngectomy and discuss the relevant literature.

Carcinoma, Squamous Cell↗
PubMed1993

The treatment of primary recurrence following laryngectomy for laryngeal carcinoma.

Of the 397 patients undergoing total laryngectomy for squamous cell carcinoma by Professor P. M. Stell between 1963 and 1991, 73 are known to have suffered a local recurrence. Of these, 17 were treated by radiotherapy and/or further surgery. Secondary surgery was reserved for selected cases of peristomal and pharyngeal recurrence: of the 35 peristomal recurrences, eight were treated surgically. Previous reports of recurrence after total laryngectomy have focused on the problem of peristomal recurrence. Patients with pharyngeal recurrences can also be treated satisfactorily with microvascular surgical reconstruction techniques. Though rarely curative, secondary total pharyngectomy can be highly palliative and results in little additional morbidity.

Carcinoma, Squamous Cell↗
PubMed1993

Supraglottic laryngectomy: experience with 66 patients over 20 years.

We reviewed the records of 66 consecutive patients with previously untreated supraglottic laryngeal carcinoma who underwent a supraglottic laryngectomy in our department between 1970 and 1989. There were 23 T1, 30 T2 and 13 T3 cases. Eight patients had neck metastases and underwent neck dissection also. Twenty-four (36 per cent) patients received post-operative radiotherapy. Two-year and five-year survival rates were 88.9 per cent and 82.2 per cent respectively. When the survival rates of the patients with T1, T2 and T3 lesions were calculated separately and compared with each other the differences were not statistically significant. Recurrences, post-operative complications, time to progression and indications for supraglottic laryngectomy are discussed.

Adult↗
PubMed1993

Fistulae following laryngectomy in patients treated with irradiation.

The development of fistulae following 197 consecutive laryngectomies performed from 1980 to 1987 have been examined. Fistulae were present in 28 patients (14 per cent). Age, T-classification, daily level of radiation dose and the time lapse between diagnosis and operation did not seem to influence the rate of fistula development. The study indicates that there is a two to three per cent risk of fistula development when a primary laryngectomy is performed. Fistula formation increased to about 10 to 12 per cent following radiotherapy, with an additional increase whenever previous operations on the neck had been done and/or if the disease demanded more extensive surgery. The study also indicates that the risk for fistula development is less when an experienced surgeon performs the operation.

Adult↗
PubMed1996

Reconstruction with composite nasal septal cartilage and auricular cartilage in extended partial laryngectomy.

Several reconstruction techniques have been employed following partial laryngectomy in order to improve laryngeal function. We report 12 cases in which composite nasal septal cartilage and auricular cartilage were used. We decannulated the patients in an average of 19 days. Following the reconstruction we obtained a satisfactory phonatory function and swallowing. Six patients completed a follow-up period of three years without presenting any recurrences or mortality. Our experience with reconstruction using composite nasal septal and auricular cartilage following partial laryngectomy proved effective.

Adult↗
PubMed2006

Electromyography of the cricoarytenoid unit during supracricoid laryngectomy with a cricohyoidoepiglottopexy procedure.

Two patients who received supracricoid laryngectomy with cricohyoidoepiglottopexy to treat laryngeal cancers, underwent intra-operative electromyography analysis. After the lesion was removed and the electrodes were inserted into the remaining intrinsic laryngeal muscles, the depth of anaesthesia was carefully reduced. Gentle tactile stimulations were applied to the pharynx to trigger the reflex movement of the remaining arytenoids. Recordings were made when reflex movement was achieved. Case one: Electromyography (EMG) of the remaining arytenoid demonstrated clear phase differences indicating reciprocal activities between the adductor group (lateral cricoarytenoid muscle, interarytenoid muscle) and the abductor muscle (posterior cricoarytenoid muscle). Case two: EMG of the remaining arytenoid demonstrated reciprocal activities between the interarytenoid muscle and the posterior cricoarytenoid muscle. Activity of the lateral cricoarytenoid muscle was not evident because the muscle was excised during removal of the paraglottic space. Mobility of the arytenoid was attributed to interaction between the interarytenoid muscle and posterior cricoarytenoid muscle. Reciprocal interaction between the interarytenoid muscle and posterior cricoarytenoid muscle alone is also capable of maintaining post-operative laryngeal functions after supracricoid laryngectomy with cricohyoidoepiglottopexy.

Aged↗
PubMedDate not supplied

Does primary tracheoesophageal puncture reduce complications after laryngectomy and improve patient communication?

The charts of 96 patients who had a laryngectomy at the University of Minnesota and affiliated hospitals were reviewed to assess the benefit of primary tracheoesophageal puncture (TEP). Patients were stratified into those with primary TEP and those without. There was no statistical difference in rates of esophageal stenosis, stomal stenosis, or wound breakdown without fistula. No fistulas developed in 33 patients who received primary TEP. 52% Of those with primary TEP, used their prosthesis for speech long-term. Only 5 of 63 patients whose surgery did not include primary TEP, received a secondary TEP, and only 2 retained the prosthesis for speech. There was no increased morbidity or incidence of complications after laryngectomy when performing a primary TEP. Patients will maintain the initial form of speech rehabilitation, even if it is less comprehensible. The early postoperative period is convenienced by using the puncture site as the entrance for nutrition during wound healing.

Communication↗
PubMedDate not supplied

Anterior commissure carcinoma II: the role of salvage supracricoid laryngectomy.

Supracricoid laryngectomy (SCL) was performed for 45 cases of recurrent anterior commissure carcinoma (ACC). The procedure involves excision of the thyroid cartilage with the tumor-bearing mucosa and subsequent anastomosis between the thyroid and cricoid cartilage. It is therefore called cricohyoidopexy, or cricohyoidoepiglottopexy if the epiglottis is also included in the excision. Rate of control of local spread at 2 years was 95.4%. Oncologic and functional results also indicate that SCL is a suitable alternative to total laryngectomy in selected cases of ACC.

Adult↗
PubMedDate not supplied

Staple-assisted laryngectomy for intractable aspiration.

Staple-assisted laryngectomy is a unique method previously reported by Lukyanchenko to prevent wound contamination by using a stapling device for suturing pharyngeal defects in total laryngectomy. We have modified his method and applied it to prevent a postoperative pharyngocutaneous fistula in the treatment of intractable aspiration. In contrast to laryngeal cancer patients, a combined use of an intraluminal light to guide the dissection and laryngofissure to pull the epiglottis can be used to facilitate the use of the stapling device. For most patients with intractable aspiration who have significant malnutrition and drug-resistant bacterial colonization of the pharynx, this method offers certain advantages. This report describes our successful experience with this method in the management of patients with intractable aspiration.

Adult↗
PubMed2005

[Rehabilitation of the olfactory sense after laryngectomy -- the larynx bypass].

BACKGROUND: Patients after laryngectomy lose their previous sense of smell, since air normally circulates via the tracheostoma and active air intake through the nose is no longer possible. The larynx bypass with a throat mask is an aid here. Nasal air circulation is made possible by this connecting piece between the mouth and tracheostoma. MATERIALS AND METHODS: Twenty patients (17 men and 3 women, mean age 60 years) who underwent laryngectomy between November 2003 and February 2004 were examined using Sniffin' Sticks with and without the larynx bypass. Moreover, patients were asked about the practicability of the larynx bypass using a visual analog scale (VAS). In addition to larynx bypass function, we were also interested in the handling for the laryngectomized patients. RESULTS: Overall, patients were able to correctly identify more items with the larynx bypass. The results were significantly better with than without the larynx bypass (p < 0.001). However, the first application of the larynx bypass was considered cumbersome. The median VAS was 5. CONCLUSION: Patients had a better sense of smell with the larynx bypass. However, due to its rather moderate practicability, the larynx bypass does not seem to be suited for daily use in its present form.

Aged↗
PubMed1999

[Comparative voice quality evaluation after laser surgical versus fronto-lateral partial laryngectomy in T1b and T2 vocal cord carcinoma].

BACKGROUND: We conducted a study to compare the voice quality after transoral endolaryngeal laser surgery versus anterolateral partial laryngectomy in terms of ability to communicate effectively. MATERIAL AND METHODS: Two groups each of 8 patients were reexamined at least 6 months after either a laser surgical or a partial anterolateral laryngectomy for a T1b or T2 vocal chord carcinoma was performed by the same surgeon. The following examinations were conducted: video-laryngoscopy, video-stroboscopy, phonetogram when reading a standard text or when speaking and shouting, voice load test, respiratory flow measurement, auditive voice rating following the RBH model, and auditive rating of the voice by the patients according to a questionnaire. RESULTS: A voice disorder with a medium-grade dysphony and an essential limitation of the speaking and shouting voice function and voice quality was detected in both groups of patients. No significant differences were observed in any of the parameters evaluation in both groups of patients. CONCLUSIONS: Both surgical techniques appear to be equivalent in terms of postoperative voice function. However, the tracheotomy was avoided in the patients undergoing laser surgery.

Adult↗
PubMed1998

[Voice rehabilitation after total laryngectomy. Voice prostheses or esophageal replacement voice?].

BACKGROUND: During the last years tracheoesophageal fistula has a well established role and in several units is now the principal means of speech rehabilitation following laryngectomy. The purpose of this study is to present the long term results after using the Provox voice prosthesis and to compare the phonetic results obtained with this means of speech rehabilitation with esophageal speech. PATIENTS, METHODS, AND RESULTS: During the last 7 years, 265 laryngectomy patients were trained in our Department in an effort to develop esophageal speech. One hundred and twelve of them developed comprehensive speech of various quality. In another group consisting of 35 patients, a Provox low-resistance, self-retaining prosthesis was fitted. Twenty-nine of them developed a very good voice. Ten patients of each group were tested in order to estimate the quality of voice of the two methods. Three measurements were obtained from each patient: the maximal intensity, the maximal phonation time, and the number of syllables with one breath. CONCLUSION: All the results confirmed the better quality of the tracheo-esophageal speech. The main two advantages of the prosthesis are the effortless speech due to the low resistance of the valve and the simple maintenance by the patient. The most important disadvantage is the cost and the need to occlude the stoma during phonation. Conclusively each method of speech rehabilitation should be selected individually according to the needs, desire, and abilities of every patient.

Adult↗
PubMed2000

Videostroboscopy of the pharyngoesophageal segment in laryngectomy patients treated with botulinum toxin.

OBJECTIVES: The purpose of this investigation was to use videostroboscopy to study the physiologic and biomechanical effects of botulinum toxin (Botox) injection on the pharyngoesophageal segment (PES) in total laryngectomy patients with poor-quality tracheoesophageal puncture (TEP) voice caused by PES spasm. METHODS: The following was a prospective study. Videostroboscopy of the PES and videotaped recordings of patients performing TEP voice tasks were conducted before and after Botox injection of the PES. Ratings of videostroboscopic and speech samples were performed by 3 blinded judges with extensive experience with this patient population. RESULTS: Perceptually, TEP voice was more fluent and less strained after injection. Videostroboscopically, patients demonstrated improved PES volitional control and mucosal wave characteristics after Botox injection. CONCLUSION: Botox injection in total laryngectomy patients with poor-quality TEP voice caused by PES spasm provides improved physiologic and biomechanical function of the PES, as demonstrated for the first time videostroboscopically. These findings help explain the perceptual ratings of TEP voice improvement noted after Botox injection. Videostroboscopy can be used to provide diagnostic information to help confirm the clinical impression of PES spasm, as well as to document the effects of Botox injection on PES function.

Adult↗
PubMed2000

Pharyngocutaneous fistula as a complication of total laryngectomy: review of the literature and analysis of case records.

Pharyngocutaneous fistula is the most common complication of total laryngectomy. The management of this problem increases hospitalization time and delays initiation of postoperative radiotherapy, where indicated. To identify factors predisposing to the development of pharyngocutaneous fistula, we reviewed the postoperative courses of 293 patients who underwent total laryngectomy at our clinic. General factors taken into account were concurrent diseases such as diabetes, liver diseases, or chronic anemia; local factors included radiotherapy before and after surgery, preoperative tracheostomy, type of cervical lymph node removal, and method of pharyngeal closure. We then compared our data with those reported in the literature by other authors. Last, we applied the Fisher exact test to a correlation we found between the higher incidence of fistula in patients with diabetes, liver diseases, or anemia. The local factor that turned out to be statistically most significant for the development of fistula was preoperative radiotherapy.

Fistula↗