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PubMed1999

[Supraglottic laryngectomy: 3-year and 5-year results].

A series of 84 patients who underwent horizontal supraglottic laryngectomy between 1980 and 1995 were analyzed. All patients were men, mean age 56 years. Neck metastases were found in 37 patients; 17 patients had stage I disease, 22 stage II, 13 stage III and 32 stage IV. One patient died in the postoperative period. Pharyngocutaneous fistula was the most frequent complication, being present in 10.7% of patients. The 3-year and 5-year survival rates were 78.9 and 74.2%, respectively. Local control was 91.6% at 3-years and 90.4% at 5-years. Local recurrences occurred in 6 patients, all of whom were salvaged by total laryngectomy and radiotherapy. Neck failure occurred in 15 patients, 2 of who were salvaged with further treatment. Second primary tumors appeared in 10 patients, 30% in the head and neck, after a mean interval of 77 months.

Adult↗
PubMed1999

[Reconstructive subtotal laryngectomy: a personal technique in a series of 100 patients operated on between 1990 and 1997].

Described by Majer and Rieder, modified by Piquet, subtotal laryngectomy with cricohyoidoepiglottopexy (CHEP) allowed to treat intralaryngeal carcinoma with preservation of speech and swallowing. Some modifications were proposed to the procedure to simplify it and to improve functional results. Most important one is the one proposed by Guerrier. In the refined procedure we describe, we didn't do any -pexy to conserved as near as possible from normality morphology and physiology of pharyngolaryngeal unit. Dynamics is preserved by keeping jointly the laryngotracheal tract. In addition, we avoid doing a tracheotomy. We present the functional outcome of 100 patients treated between 1990 and 1997: oral feeding was initiated at the 6th day postoperative, delay to achieve proper swallowing was 11.5 days and median hospitalization duration was 18 days (14 days for non tracheotomized group). The comfort of patients without tracheotomy was greatly increased with a low risk of pneumonia. Such a procedure could be applied every time a laryngeal reconstruction had to be done (partial laryngectomy, laryngeal trauma).

Adult↗
PubMed1997

[Voice rehabilitation with double-valve voice prosthesis after laryngectomy].

Between March 1993 and November 1996, 97 laryngectomized patients underwent voice rehabilitation with prostheses designed by ourselves. Of these patients, 84 were males and 13 females. The age ranged from 35 to 78 years. 20 cases had the prosthesis inserted during the laryngectomy operation (first stage), while other 77 cases were inserted after the laryngectomies (second stage). The results showed that all of the patients had clear voice with their own local dialect. 34 of them could even sing songs. 68 cases had been followed-up for 2 years. All could speak during the effective time of the prosthesis and no misswallow occurred.

Adult↗
PubMed2000

[When is laryngectomy indicated in hypopharyngeal carcinoma?].

INTRODUCTION: We studied the histories of 121 patients with hypopharyngeal carcinoma treated at our clinic from 1990-1998. From 1990-1993 all patients with curable hypopharyngeal carcinoma were treated by surgery. Radiotherapy was used for those in whom surgery was impossible or who refused laryngectomy. In 1994 we changed our therapy and only patients in whom the voice could be preserved were treated surgically. All others received radiotherapy as primary treatment. The goal of this study was to ascertain whether and how this shift in therapy was influenced by T and N stage. METHODS: From 1990-1993, 57 patients with hypopharyngeal carcinoma were registered at our clinic. Surgery was performed in 32, 16 received radiotherapy and 9 only palliative treatment. During this time there was no difference in diseased specific survival between the radiotherapy and surgical groups. Therapy was therefore changed in 1994 to preserve voice function. From 1994-1998, 64 patients were diagnosed. Only 10 were treated surgically. 40 received radiotherapy and 14 no curative therapy. Age, N and T stage were comparable in both groups. To show differences we performed Kaplan Meier survival rates for both groups and for the N and T stage of patients undergoing surgery or radiotherapy respectively. RESULTS: 3-year survival was 68% in patients treated from 1990-1993 and 38% from 1994-1998. The difference was statistically significant (p-value 0.02). Survival for nodal stages 0 and 1 was much better in patients undergoing surgery than those receiving radiotherapy. Multivariant analysis was highly significant. T-category showed no tendency for either treatment modality. DISCUSSION: After a switch in the treatment of hypopharyngeal carcinoma in 1994 there was a significant change in survival. For patients with nodal stage 0 and 1 surgery brought much better survival. We conclude that surgery should be the primary treatment for all patients in these small nodal stages, even if total laryngectomy is necessary.

Carcinoma, Squamous Cell↗
PubMed2000

[The course of oropharyngeal stage of deglutition after partial supracricoid laryngectomies. Computerized analysis of radiographic imaging. Preliminary report].

On a pilot basis the performed analysis covered the pharyngeal phase of the deglutition act in five patients, in whom supracricoid laryngectomies were carried out due to carcinoma of the larynx. The rentgenocinematographic (Rtgc) examinations were made half a year after the operations, while in 1 patient the studies were carried out twice, the second being performed two years after the operative procedure thus altogether 6 examinations Rtgc were performed. Computerized topocinetic analysis of images Rtgc was made intended for further considerations and measurements, and concurrently assessing the position of the left-behind anatomical structures, the pathway passed by the studied structures, the velocity, the projection of the encircled kinetic path, as well as the distance of individual structures in respect to each other during a complete cycle of the pharyngeal phase. The provided description highlights the significance of good mobility of the left structures in the food bolus passage trough the lower pharynx and other, than that after supraglottal laryngectomy, mechanism protecting the lower respiratory tracts against food leakage into them.

Carcinoma, Squamous Cell↗
PubMed2000

[Horizontal supraglottic laryngectomy. Study on 41 operated cases between 1989-1996 in La Rioja].

The AA. conduct a retrospective study done with 41 patients operated upon and followed up at the Otolaryngological Department of San Millán y San Pedro Hospital complex, Logroño, between 1989 and 1996. Horizontal supraglottic laryngectomy was the performed surgery, and patients classified in stages I, II, III or IV. The fundamentals of this procedure the oncologic and functional results as well and the survival rate are analysed. Four points are stressed: 1st. The descent of the base of the tongue eases the postoperative swallow. 2nd. The survival shows that recurrences like lymph nodes metastases are the best prognostic factor, with an OR of 2.61. 3rd. More advanced stages have less survival tendency. 4th. The excellence of this technique is evident, having had only one case of local recurrence in our series resolved through totalization of the laryngectomy.

Adult↗
PubMed2000

Vertical extended hemi crico-laryngectomy and reconstruction with a prefabricated tracheal free flap--initial results.

We describe our experiences of treating three patients with recurrent T3 squamous cell carcinoma of the larynx, following initial treatment with radiotherapy; using the technique of partial crico-laryngectomy and autologous pre-fabricated tracheal flap reconstruction as described in 1998 by Delaere (1). We have found the technique to be technically challenging. The patients require extensive speech and swallowing rehabilitation following surgery, but the functional result offers significant advantages over the other surgical salvage procedures of total or near-total laryngectomy. We describe our early results of three patients that we have treated using this technique.

Aged↗
PubMed2000

[Near-total laryngectomy: multicenter experience].

Near-total laryngectomy (NTL) produces good functional and oncological results that are reproducible in different institutions. It is an alternative to total laryngectomy in patients with laryngeal or hypopharyngeal tumors who meet selected criteria. This study analyzed 245 patients treated with NTL in three different institutions. Functional and oncological results were remarkably consistent between the institutions. Local control in previously untreated patients was 98%. A useful voice was obtained in 80% of patients and voice quality was better than that obtained with tracheoesophageal puncture and a voice prosthesis. NTL was not recommended for salvage surgery after radiation failure because recurrences occur in up to 20% of patients.

Humans↗
PubMed2000

[Pharmacological prophylaxis of gastroesophageal reflux. Incidence of pharyngocutaneous fistula after total laryngectomy].

Pharyngocutaneous fistula is a serious complication of total laryngectomy. This problem increases morbidity, prolongs hospitalization, and occasionally causes death. Numerous contributing factors have been implicated in fistula formation (1). We propose that gastroesophageal reflux, which often is subclinical, is an important trigger and should be prevented. We evaluated the effect of associating an antireflux agent like metoclopramide hydrochloride to our usual ranitidine of our protocol after total laryngectomy on reducing the incidence (p<0.05) of pharyngocutaneous fistula.

Cutaneous Fistula↗
PubMed2000

Current status of voice restoration following total laryngectomy.

Total laryngectomy is the surgical procedure traditionally used to treat patients with advanced-stage cancer of the larynx. The impairments resulting from removal of such a small organ are, indeed, profound. They include loss of voice and speech; altered respiration, necessitating a permanent breathing opening in the neck; and diminished sense of smell and taste. When one considers these factors, successful treatment of laryngeal cancer cannot be measured by survival rate alone. Rapid, effective restoration of voice and speech is one of the primary focuses of rehabilitation and is pivotal to the prevention of the potential psychosocial and economic consequences of total laryngectomy. This article focuses on the methods of voice restoration currently being employed to reestablish the ability to speak.

Esophagus↗
PubMed2000

[Disorder types of the larynx airflow in patients after partial laryngectomy: objective examination].

223 spirometric examinations, 144 laryngovideoscopic examinations and 43 CT of the larynx in 70 patients after partial laryngectomies of various extents were analysed. The shape of the flow volume curve was divided in 3 kinds of larynx obturation: fixed, dynamically variable and mixed (with characteristics to both). Factors depending on larynx influence the dimension of the obturation (surface and length of the contraction and also stiffness of the walls) as well as numerous extra laryngeal factors do, independently of the contraction itself. On the base of the parameters and the shape of the flow volume loop the volume flow capacity can be estimated (helpful in estimation of the respiratory sufficiency of the patient), the kind of the obturation (resulted from stiffness of the scar or elasticity of the walls), probable spot of the contraction (obturation of the larynx or bronchial narrowing), changes of the obturation in course of time (specific for the healing process or for developing complications). The results obtained were compared with the laryngovideoscopy, radiological examination and (in several cases) with the interoperative assessment. Great measure of conformability of the spirometric diagnostics with the above mentioned investigations was found. The usefulness of those investigations in the after care of the patients following partial laryngectomies was stressed, as well as in making decision for eventual reoperation and also economic advantages.

Forced Expiratory Volume↗
PubMed1998

[A modified laryngectomy combined with radical neck dissection for late-staged supraglottic carcinoma].

8 cases of supraglottic or transglottic carcinoma with neck lymphatic metastasis received a modified laryngectomy or subtotal laryngectomy combined with radical neck dissection. Laryngeal function was reconstructed in 3 of them. No postoperative complication occurred. All cases survived uneventfully through a five-year following up, except one who died of neck lymphatic and lung metastasis. The indication, procedure and advantage of this operation are discussed in this article.

Aged↗
PubMed2001

An investigation into the quality of life of individuals after laryngectomy.

BACKGROUND: Little longitudinal data are available on the general physical, psychological, and social problems experienced as a result of laryngectomy or on the preoperative status of patients in regard to these aspects. In particular, prospective longitudinal data gathered from the same group of subjects over time and examining a variety of such outcomes is rare. This descriptive study addresses these issues. METHODS: The study investigates the progress of a group of 34 laryngectomees from the preoperative stage up to 6 months after surgery. Medical complications, communication, swallowing, diet, physical, and psychosocial adjustment were measured using both the Short-Form Health Survey (SF-36) and original outcome tools. RESULTS: A large percentage of subjects demonstrated significant and persistent communication and swallowing problems throughout the period studied. Low preoperative and postoperative scores on the SF-36 demonstrate that this group had a poorer state of general health in many respects than those with serious medical conditions previously documented. CONCLUSIONS: The results suggest that communication and swallowing difficulties persist for many laryngectomees up to 6 months after surgery and still require further investigation. Poor preoperative and postoperative general health scores indicate that this group may require more long-term social support than is currently being offered to adjust to the laryngectomy.

Aged↗
PubMed1998

[The use of bi-pedical rotatory door muscle-skin flap reconstruction in extended partial laryngectomy for late (T3 and T4) glottic cancer].

The purpose is to radical treatment for late glottic cancer by surgery, to restore the essential function of the larynx, 62 patients of late (T3 and T4) glottic cancer were treated by extended vertical partial and subtotal laryngectomy. At the same time, an appropriate method of reconstruction of laryngeal function by bi-pedical rotatory door muscle-skin flap was presented. The decannulation rate was 87.1% and 85.0% cases enjoyed satisfactory voice. All cases resumed normal mouth-food-taking. The conclusion is that selective treated with extended partial laryngectomy is effective for T3 and T4 glottic cancer.

Adult↗
PubMed1975

[Reconstructive laryngectomy].

Following a brief historical review of the sporadic attempts to improve the total laryngectomy, the author presents a technique for reconstructive laryngectomy. This technique should be restricted to one part of the cricoid and, according to certain modifications, to the free part of the epiglottis. Using these modifications, this technique allows the neck to be closed completely, thus avoiding a permanent tracheostomy. Relearning phonation and swallowing is spontaneous. Four cases are presented -- two successful. In the two failures, it was noted that one death was due to a hepatic deficiency and one to failure in relearning to swallow, which was attributable to senility.

Aged↗
PubMed2001

[Laryngomucoceles and subtotal C.H.E.P. reconstructive laryngectomy. Report of 6 cases].

UNLABELLED: We conducted a retrospective analysis of 131 patients who underwent subtotal CHEP laryngectomy for a tumor of the larynx between 1990 and 1999 in order to determine the incidence of laryngomucocele after surgery. RESULTS: Five patients developed laryngomucocele late after surgery. A sixth patient underwent surgery in another unit. Laryngomucocele developed progressively or was disclosed by acute episodes of dyspnea, requiring tracheotomy again in two cases. One patient developed bilateral mucocele. Three patients had cervicotomy, and three others were treated by CO(2) laser endoscopic marsupialization. DISCUSSION: We discuss the pathophysiology of late laryngomucocele after subtotal laryngectomy and various techniques that can be used to avoid this complication. CONCLUSION: Although exceptional, laryngomucocele generally requires surgical removal by cervicotomy or CO(2) laser endoscopic marsupialization to prevent acute respiratory failure.

Adult↗
PubMedDate not supplied

Evaluation of dynamic compliance of lungs and disturbances of breathing mechanics in patients following laryngectomy for carcinoma of the larynx.

The purpose of study was to observe changes which may develop in the mechanics of breathing following laryngectomy in patients with carcinoma of the larynx as compared with the pre-operative conditions. The studies were carried out on a group of 29 patients, performing the measurements twice, i.e. before operation and after laryngectomy and tracheostomy. The measurements were done using a Godart Compliance-Test type 121 apparatus. The value of the coefficient of dynamic compliance of the lungs was determined together with the magnitude and type of work necessary to overcome respiratory resistance. It was found that after the operation the coefficient of dynamic compliance of the lungs increased by 63.7% while the total work of breathing decreased by 38.7% and the work necessary to overcome the elastic resistance of the lungs fell by 33.7% and that for overcoming the non-elastic resistance fell by 49.3%. The most significant changes in breathing mechanics observed after the operation concerned the ratio or breathing work necessary to overcome the non-elastic resistance to the total breathing work. This ratio was 43.35% pre-operatively and 34.11% post-operatively. The obtained results suggest that impairment of laryngeal patency caused by the tumour raises the breathing work and reduces the coefficient of dynamic compliance of the lungs due mainly to an increased non-elastic breathing resistance.

Airway Resistance↗
PubMed2001

[Glottic-hypoglottic laryngectomy in the treatment of laryngeal tumors].

Subglottic cancers and glottic cancers with subglottic extension are considered extremely serious because they are not easily detected and are normally quite advanced when diagnosed. Furthermore these cancers spread rapidly beyond the larynx to the lymph nodes (cervical and recurrential chains). Total laryngectomy is elective surgery in the treatment of subglottic cancer. However, in selected cases, small tumors may also be treated successfully with partial glottic-subglottic laryngectomy. The aim of this paper is to present a personal experience with partial surgery in the treatment of subglottic cancer. The surgical operation consists of the resection of both vocal cords, the subglottic region and the cricoid cartilage with the proximal tracheal rings. The larynx is reconstructed through a tracheal-thyroid approach. The surgical technique is illustrated and the authors' experience discussed.

Aged↗