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PubMed2003

Current indications and complications of tracheoesophageal puncture for voice restoration after laryngectomy.

Surgical voice restoration by valved tracheoesophageal fistula is undoubtedly the most successful method of voice restoration for laryngectomy patients, is one of the most important developments in head and neck surgery, and has resulted in a greatly enhanced quality of life for most patients who have undergone this debilitating procedure. In developed countries, it is now unacceptable to perform laryngectomy without giving patients the opportunity to undergo surgical voice restoration. Successful voice acquisition should be achievable in approximately 80% of patients. Success rates will be highest and problems most effectively dealt with under the auspices of a properly organized surgical voice restoration program within a specialist head and neck cancer unit with a well structured specialist multidisciplinary team. This article reviews recent publications addressing indications for surgical voice restoration by tracheoesophageal puncture, expected success rates, and reasons for failure and complications and ways to manage them in the context of the author's own experience.

Female↗
PubMed1976

Functional laryngectomy (cricohyoidopexy).

Two techniques of subtotal functional laryngectomy are described: cricohyoidopexy which is used for supraglottic tumours, and cricohyoidoepiglottopexy for glottic tumours. These operations have been carried out on 61 patients, with tumours too extensive to be managed by the usual partial laryngectomy. The functional results are good, and 94% of the patients have been decannulated.

Epiglottis↗
PubMed1976

Pulmonary complications following supraglottic laryngectomy.

Supraglottic laryngectomy has been generally assumed to protect the patient from aspiration changes in the lungs. This paper details a retrospective survey, the results of which suggest that respiratory infections are common after supraglottic laryngectomy and that pneumonia is a fairly common cause of death. The need for prolonged follow-up after this operation is emphasized.

Bronchitis↗
PubMed1990

Physical and psychosocial consequences of total laryngectomy.

The incidence and severity of respiratory symptoms after total laryngectomy and their influence on daily living were studied in 59 laryngectomized patients. Daily sputum production was the principal complaint of these patients (98%), followed by coughing (64%) and the need for frequent forced expectoration (more than 5 times a day) in order to clear the airway (57%). Frequent stoma cleaning (more than 5 times a day) was required by 37% of the patients. Significant correlation was found between respiratory symptoms, voice rehabilitation and several aspects of daily living, including fatigue, sleep problems, social contacts and psychological distress. These findings indicate that respiratory symptoms after total laryngectomy are both frequent and troublesome. The development of effective methods for minimizing and/or preventing such respiratory problems would contribute significantly to improving the quality of life of laryngectomized patients.

Aged↗
PubMed1991

Oesophageal speech after laryngectomy: a study of possible influencing factors.

52 patients with laryngeal carcinoma were studied before and after laryngectomy with regard to what factors might influence the development of oesophageal speech. The investigations consisted of oesophageal manometry, a follow-up interview and a review of surgical approaches and radiotherapy. 43% of the patients achieved socially acceptable oesophageal speech, 22% were able to speak single words, and 35% had no oesophageal speech at all. 61% had post-operative dysphagia. Age was the only factor which significantly correlated to intelligible speech. The intraoesophageal pressure during oesophageal phonation exceeded in all cases the low PO-HPZ pressure after operation. The extension of surgery and radiation field, severity of dysphagia, alcohol and smoking habits, and mental condition did not differ between the 3 groups of oesophageal speech. It was concluded that the rather complicated process of acquiring oesophageal speech is much more dependent on learning ability which decreases with age than on various kinds of motor dysfunction after laryngectomy.

Adult↗
PubMed1991

The influence of a heat and moisture exchanger (HME) on the respiratory symptoms after total laryngectomy.

The influence of a heat and moisture exchanger (HME) on the respiratory symptoms after total laryngectomy was studied in 42 patients. A significant reduction was found in the mean daily frequency of sputum production, forced expectoration in order to clean the airway and stoma cleaning after use of the HME for 6 weeks. Symptoms of fatigue and malaise decreased significantly, while social contact improved. Patients using oesophageal speech or an electrolarynx benefited more than patients using a voice prosthesis. The findings indicate that respiratory problems after total laryngectomy can be reduced significantly with the use of a device with heat and moisture exchanging properties. In turn, reduction of respiratory symptoms results in an improved quality of life.

Adolescent↗
PubMed1993

Does the location of the laryngectomy stoma influence its ultimate size?

The stoma following laryngectomy may be placed either within the incision or separately. To determine if this variation had a bearing on its ultimate size, measurements of the stoma size were carried out in 61 patients who underwent laryngectomy by one of these methods. It was found that the stoma was nearly twice the size in patients in whom the stoma had been sited within the main wound and that there was a minimal need for the use of a tube or stoma button post-operatively in these patients.

Aged↗
PubMed1995

Long-term pulmonary function after total laryngectomy.

In 58 laryngectomized patients pulmonary function tests were performed during a routine visit to the outpatient clinic. The assessment of pulmonary function with an extratracheal device could easily and reliably be accomplished in all instances. The results show that in long-term follow-up post-laryngectomy expiratory lung function values are significantly lower than predicted. Of the various subjective respiratory complaints, only a higher frequency of coughing was statistically significantly associated with decreased lung function values (P < 0.01). Neither time since surgery (> 1 year vs < 1 year), nor radiation therapy seemed to be correlated with the pulmonary function outcomes. In contrast, the age of the patient did have a significant influence. Although an age-related decline in pulmonary function is a well documented phenomenon, an additional adverse effect was suggested by the present series in the group who was over 65 years of age. Bronchodilator treatment was found to significantly ameliorate several pulmonary function parameters in a sub-group of 18 patients. It may be concluded, that after total laryngectomy significant abnormalities in pulmonary function have to be anticipated. We have found that these disturbances seem to be more pronounced with increasing age.

Age Factors↗
PubMed1996

Extended supraglottic laryngectomy for primary base of tongue carcinomas.

A retrospective review of 56 patients with a primary base of tongue carcinoma was undertaken to determine the value of supraglottic laryngectomy. All the patients had a supraglottic laryngectomy and a total of 77 neck dissections. Forty-three (76.8%) patients received post-operative radiotherapy. The incidence of local recurrence was 23.2%, neck relapse being seen in 16.1% of patients. The 3 year survival was 47%. The overall survival of the whole series and by stage was not improved by combined therapy compared with surgery alone.

Adult↗
PubMed1996

Complications of supraglottic laryngectomy for carcinomas of the supraglottis and the base of the tongue.

The medical records of patients with either a supraglottic carcinoma (n = 193) or a base of tongue carcinoma (n = 56) who underwent a supraglottic laryngectomy were studied. Because of aspiration total laryngectomy was required in 9.8% and 21.4% of patients with supraglottic and base of tongue carcinomas, respectively, being related to locally advanced stage of disease in the base of tongue and to an age older than 65 years in the case of supraglottic carcinomas. The non-decannulation rates were 23.8% and 50% in supraglottic and base of tongue tumours respectively. Post-operative radiotherapy did not influence the decannulation rate, but advanced local disease and age did. Post-operative mortality in the first month after the operation was 2.6% in supraglottic tumours and 3.6% in base of tongue tumours.

Adult↗
PubMed1996

Pharyngocutaneous fistula following total laryngectomy and post-operative vomiting.

The significance of post-operative vomiting as a risk factor in the development of a pharyngocutaneous fistula was examined. The case records of 50 consecutive patients undergoing laryngectomies (39 men, 11 women, average age 64 years) were examined, 17 also underwent a simultaneous radical neck dissection. A fistula developed in eight patients (16%) and the median time to its diagnosis was 11 days (range 3-15 days). Several potential risk factors were examined including age, gender, previous radiotherapy, TNM stage, differentiation of tumour, simultaneous radical neck dissection and also the occurrence of vomiting post-operatively. In this series of patients only vomiting in the early post-operative period appeared to be related to the development of a fistula (regression summary: R2 = 0.6, t-value 5.6, P < 0.0001). An episode of vomiting was recorded in eight patients and of these six (75%) subsequently developed a fistula. The median time of post-operative vomiting was 7.5 days (range 1-10 days) and the diagnosis of a fistula occurred at a mean of 1.2 +/- 0.4 days after the episode of vomiting. In a study of this nature it is not possible to conclude that a causal relationship exists between vomiting and fistula development. However, if this is the case a potential means of decreasing the incidence of fistulae following laryngectomy may be available.

Female↗
PubMed2004

Stomal recurrence after primary total laryngectomy.

Stomal recurrence after total laryngectomy is usually considered to be incurable. A total of 402 patients suffering from squamous cell carcinoma of the larynx treated by total laryngectomy during the period 1982-96 were analysed. In the group of patients studied, the significant risk factors for stomal recurrence were glottic-subglottic tumour localization and regional tumour spread. Postoperative radiotherapy can significantly reduce the risk of stomal recurrence.

Carcinoma, Squamous Cell↗
PubMed2006

Can objective parameters derived from videofluoroscopic assessment of post-laryngectomy valved speech replace current subjective measures? An e-tool-based analysis.

OBJECTIVES: The primary purpose of this study was to assess the pharyngoesophageal segment in total laryngectomy patients using a videofluoroscopy e-tool. STUDY DESIGN: Cross-sectional study. SETTING: Head and Neck Oncology Unit, Tertiary Referral Centre. PATIENTS: Forty-two patients following total laryngectomy. INTERVENTION: Videofluoroscopy using an e-tool (JRuler). MAIN OUTCOME MEASURES: Subjective and objective videofluoroscopy parameters correlated with the GRBAS scale and treatment variables. RESULTS: Of 32 men and 10 women, mean age 63.5 years (10.8) the majority (64.3%) had a reasonable voice (good = 11 and poor = 4 patients). Comparing subjective and objective parameters, significant correlations were only seen with a smaller minimal neoglottic distance at phonation with no regurgitation of barium at phonation (P = 0.05) and a type 1 shape of neoglottis at phonation (P = 0.02). There were also significant correlations between smaller maximum sub-neoglottic distance at phonation and type 1 shape of neoglottis (P = 0.02), smaller maximum sub-neoglottic distance at rest and absence of stasis of barium at phonation (P = 0.05) and the length of neoglottis at phonation and type 1 shape of neoglottis (P = 0.01). For perceptual evaluation, significant correlation was seen only between G1 voice and a smaller minimal neoglottic distance at phonation (P = 0.03) amongst the subjective and objective parameters. There were no correlations between visual parameters and the clinical parameters. CONCLUSIONS: Our observations suggest that this interesting concept has limitations. While objective and quantifiable data can be obtained using videofluoroscopy in laryngectomees, only a few correlate with each other and with voice quality.

Cross-Sectional Studies↗
PubMed1985

Vertical partial laryngectomy for glottic carcinoma.

Vertical partial laryngectomy is recommended as primary treatment for selected T2 glottic cancers. Some irradiation failures are also suitable but the indications are more restricted. A careful assessment of the cancer is mandatory. Of 12 patients undergoing primary surgery, no patient has died from their disease. Five of seven irradiation failures were salvaged by vertical partial laryngectomy.

Carcinoma↗
PubMed1998

Supracricoid laryngectomy: a significant advance in the management of laryngeal cancer.

Supracricoid laryngectomy is a new development in the treatment of laryngeal cancer in Australia. It allows the removal of both vocal cords, vestibular folds, and the entire thyroid cartilage including the paraglottic space without the loss of laryngeal function. This technique may offer a significant advance in the treatment of squamous cell carcinoma of the larynx. This paper reviews the surgical management of laryngeal cancer and discusses this new technique with modifications, indications for its use and the advantages of supracricoid laryngectomy. Case reports of seven patients operated on in our institution are included.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Complications and long-term results after partial laryngectomy for the treatment of idiopathic laryngeal paralysis in 45 dogs.

Forty-five dogs with severe respiratory signs caused by idiopathic, acquired laryngeal paralysis were treated by partial laryngectomy. The predominant postoperative complications were coughing in 28 dogs and pneumonia in 15 dogs. Eight dogs required a second operation to alleviate persistent or recurrent upper airway obstruction. Results of surgery were considered excellent in 11 dogs (25%), good in 18 dogs (40%), fair in 6 dogs (13%), and poor in 10 dogs (22%). Poorer results were obtained by surgical residents than by more experienced surgeons. Death in the immediate postoperative period was related to pneumonia (8 dogs) and laryngeal collapse (1 dog). Nine dogs died later of respiratory disease. Although partial laryngectomy is effective for the treatment of laryngeal paralysis, it is not recommended because of the high incidence of postoperative complications.

Airway Obstruction↗
PubMed1982

Barium examination of the esophagus after total laryngectomy.

Barium examination of the esophagus is often useful for evaluating the cause of dysphagia, a frequent condition in patients who have undergone total laryngectomy. The examination may be difficult to interpret, however, because a variety of anatomic changes may be produced by radiation, infection, fistula, recurrent tumor, or the operation itself. Radiographic and clinical information on 45 total-laryngectomy patients, whose follow-up periods ranged from six months to 17 years, were analyzed. A recurrent tumor was found in 15 patients and was evident radiographically as a mass deviating the neopharynx in 14. Benign strictures in 14 patients appeared either as a long symmetrical narrowing or as a very short, weblike narrowing. Fistulas were demonstrated in 13 patients and presaged the development of recurrent tumors in five. Cricopharyngeal muscular dysfunction accounted for dysphagia in five cases. An understanding of these patterns leads to more accurate interpretation of the postoperative barium examination of the esophagus, and the radiographic findings often indicate the correct diagnosis with a high degree of confidence.

Adult↗
PubMedDate not supplied

Acoustic and aerodynamic measurements of voice production after near-total laryngectomy with epiglottoplasty.

Objective voice analysis based on simultaneous aerodynamic and acoustic measurements is not common and there have been no reports dealing specifically with aerodynamic features of laryngeal performance after partial laryngectomy. The present study describes objective voice analysis after near-total laryngectomy using the Tucker technique (NTLT). We performed and compared acoustic and aerodynamic measurements in patients who underwent NTLT (n = 21) and normal controls (n = 10). Acoustic indexes of instability of frequency and intensity (jitter and shimmer) were always higher in patients. Oral airflow and estimated subglottic pressure (ESPG) were significantly greater in patients than in controls (400 vs. 169 cm(3)/s and 23 vs. 6.2 hPa, respectively). Poor closure of the glottis after surgery leads to a significant increase in glottal leakage in comparison with controls. Higher ESGP values observed in patients are probably related to two factors. The first involves compensation for glottal leakage in order to achieve sufficient air pressure to initiate vibration of the mucosa. The second factor is the poor vibratory quality of the residual mucosa, which may require higher pressure levels than the more compliant normal cord to initiate vibration. Our findings confirm the adverse effects of NTLT on the aerodynamic efficiency of the larynx due to glottal leakage and poor compliance of postoperative mucosa. Aerodynamic measurements could provide the basis for standardized objective evaluation of postoperative voice quality.

Adult↗