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PubMed1992

[Plastic surgery of the trachea after laryngectomy enabling breathing without a tracheotomy tube].

Plastic operations of trachea which enable to breath without the tracheotomy tube post total laryngectomy were presented by authors. Those operations were performed immediately post laryngectomy or also some time post remove larynx operation. In the first case the suitable "modeled" fold of the skin is made, in the second case the metallic half-loops are implanted. Results authors have received so far are encouraged to use of those methods.

Humans↗
PubMedDate not supplied

Voice restoration after total laryngectomy with tracheoesophageal puncture and voice prosthesis.

Removal of the voice box or larynx is the usual treatment for advanced cancer of the larynx. Tracheoesophageal puncture (TEP) has become an accepted method for voice restoration following total laryngectomy. Eleven patients under went total laryngectomy with TEP at San Pablo Hospital Medical Center between March 1989 and October 1995. Seven patients were available for voice analysis. Eighty six percent of the patient was able to talk. This is the first report of TEP being perform in Puerto Rico and with a complete Hispanic population of patients. Results compare favorably with those reported in the medical literature.

Aged↗
PubMed2003

[Tracheoesophageal shunt for voice reconstruction after total laryngectomy to prevent from deglutition disorders].

OBJECTIVE: To observe the effect of tracheoesophageal shunt on voice reconstruction after total laryngectomy. METHODS: Seventy-nine patients with laryngeal cancer of T3 and T4 stages were conducted an operation of tracheoesophageal shunt after total laryngectomy. The vertical voiced slit with a length of 0.8-0.12 cm was made between the posterior wall of trachea and the frontal wall of esophagus, while the cricoid cartilage flap with the length of 2.0 cm and width of 1.2 cm was reserved to form cartilage mucosa flap as an edge to prevent deglutition disorders. Finally, membranous part of trachea was sutured together with the neck skin as an inclination edge. RESULTS: In this series, 71 of 79 patients kept good voice function, and 65 of 71 patients avoided deglutition disorders, but other patients failed to do so. The 3-year survival rate was 66.7% (14/21, for stage T3) and 64.9% (24/37, for stage T4), respectively. The 5-year survival rate was 6/10 (for stage T3) and 50.0% (10/20, for stage T4), respectively. CONCLUSION: The operation of tracheoesophageal shunt is advantageous to prevent deglutition disorders as well as to restore the voice function of larynx.

Adult↗
PubMed2004

Dysphagia after total laryngectomy resulting from hypocalcemia: case report.

Although hypocalcemia is a common postoperative complication of patients who have undergone a total laryngectomy with total thyroidectomy for treatment of laryngeal cancer or cancer of adjacent organs and hypocalcemia can produce the symptom of dysphagia, there has never been a report that hypocalcemia is the cause of dysphagia in these patients. The authors reported two cases who had hypocalcemia after total laryngectomy with total thyroidectomy and presented with sudden and severe dysphagia. However, the symptom of dysphagia was dramatically improved after calcium replacement therapy.

Aged↗
PubMed2004

[First stage speech reconstruction after total laryngectomy with the improved trachea-pharynx anastomosis].

OBJECTIVE: To investigate the improved methods of first stage speech reconstruction after total laryngectomy. METHOD: We improved the method of the first stage speech reconstruction after total laryngectomy with a low level tracheotomy, reconstruction of the glottis with the ahead mucous membrane of esophagus, making stoma at the incision of trachea, lifting and shrinking the cervical trachea and sewing up to the root of tongue. This novel method was adoptioned on 35 patients, the curative effect had been observed. RESULT: Among the 35 patients, 33 patients (94.29%) regained the phonation function to a different extent. Only 2 patients (5.71%) could not speak. Most patients got an articulate and fluent voice. All of the patients could take food by mouth without severe miss deglutition. CONCLUSION: There are many excellences in our operation style. The success rate of the speech is higher, the quality of the speech is better and the rate of the miss deglutition is lower than the classical operation style of the speech reconstruction. It has no use for a factitious speech device and deserves to spread.

Adult↗
PubMed2004

[The observation on the mechanism of speech forming by slit-like trachea-esophagus puncture after total laryngectomy].

OBJECTIVE: To observe the mechanism of the rehabilitated speech using slit-like fistula between trachea and esophagus after total laryngectomy. METHOD: Forty patients after total laryngectomy all come from the fourth central hospital of Tianjin. They all reconstructed voice using slit-like fistula between trachea and esophagus primary or secondary stage. We use teleradiography and laryngotroboscope to observe its mechanism of store gas stage, deliver gas stage and phonation stage. RESULT: While inspiratory, the pulmonary enlarged, and the upper esophagus was closed and circulus invension. After this, the infra-pharyngeal cavity expanded, looks like a downward triangular taper. The upper end of the esophagus opened suddenly. Phonation begin, the superior esophagus was full of air as a ball. The air escape through the segment of trachea-esophagus. The meatus of esophagus opened in coronal position and turn over like lip. It is vibrated together with nearby mucus, mucosa to form voice. After that, thorax shrink, the meatus of esophagus turn in again, the voice behavior is over. CONCLUSION: The power organ of trachea-esophagus voice is lung. It is crucial for the trachea-esophagus fistula unobstructed and smooth to forming voice. When phonation, the mucosa, mucus of infra-pharyngeal and esophageal meatus take part in vibration.

Aged↗
PubMed2004

[Small partial laryngectomy for early-stage glottic carcinoma].

OBJECTIVE: To explore the surgery way for T1, T2 glottic carcinoma. METHOD: Small partial laryngectomy were performed to 112 patients with T1, T2 (T1 N0 M0, T2 N0 M0) glottic carcinoma. The surgery method, effect and treatment advantage was summarized and compared with laser therapy and radiotherapy, the dynamic follow-up of arytaenoidea cartilage movement, glottidis rimae conformation and voice change was analyzed. The preoperative and postoperative voice quality was compared with the software of Dr. speech system for windows. RESULT: All incisions were healed one stage in 6 or 7 days, the mean time in hospital is 9.76 days; all patients took food with mouth after 2 or 3 days, all trachea cannula was removed successfully during in hospital, the mean time with cannula is 7.32 days and the rate of removing cannula 100%. Arytaenoidea cartilago movement of 47 cases 1 week after surgery weakened and gradually improved, glottidis rimae conformation is close to be normal after 2 months. There is no significant difference of Shimmer and NNE between preoperative and postoperative 1 week (P > 0.05), but there is a significant difference between preoperative and postoperative 2 months, half a year, and also is between postoperative 1 week and 2 months, half a year (P < 0.01). All 76 cases survive during 3 years' follow-up, 35 of 36 cases in 5 years' follow-up survive (1 case died without definite cause), and there is 2 cases for recurrence. CONCLUSION: Small partial laryngectomy can provide large operative view, resect the tumor completely, make diet and speech recover in shorter time and improve the voice quality, so the surgery is available.

Adult↗
PubMed2003

[The effects of pharyngeal neurectomy and cricopharyngeal myotomy on postoperative deglutition in patients undergoing horizontal supraglottic laryngectomy].

OBJECTIVES: We compared the effects of pharyngeal neurectomy (PN) and cricopharyngeal myotomy (CPM) on postoperative deglutition in patients undergoing horizontal supraglottic laryngectomy (HSL). PATIENTS AND METHODS: The study included 20 male patients (mean age 53 years; range 39 to 67 years) who underwent HSL for squamous cell carcinoma of the larynx. Tumor stages were T1 in two, T2 in 16 , and T3 in two patients. None had received radiotherapy before surgery. In order to decrease cricopharyngeal muscle spasm following HSL, the patients were randomly chosen for CPM (n=11) and PN (n=9). The two groups were compared with respect to the time to postoperative oral food intake. RESULTS: No significant difference was found with respect to the time to postoperative oral feeding (mean 27 days, range 16 to 45 days in the CPM group; mean 25 days, range 16 to 36 days in the PN group; p>0.05). No significant relationship existed between primary tumor stages and the time to oral feeding (p>0.05). No complications were encountered in the two patient groups. CONCLUSION: In supraglottic partial laryngectomies, PN seems to be as effective as CPM to decrease postoperative cricopharyngeal muscle spasm, with additional advantages of ease and safety.

Adult↗
PubMed2004

[Phonation assessment of voice restoration after laryngectomy].

OBJECTIVE: To take an objective phonation assessment for the patients who have taken the tracheo-esophageal (TE) shunt procedure after total laryngectomy. METHOD: Twenty-four patients after TE shunt procedure were selected as TE group. Esophageal speakers after total laryngectomy and normal subjects were considered as controls. All the subjects of three groups took part in the voice acoustic assessment and MPT measurement. Twenty TE speakers took part in intra-tracheal pressure measurement. TE speakers and esophageal speakers participated in the electronic laryngoscope examination. RESULT: There were no significant differences between TE group and esophageal group in every acoustic parameters, but there were very remarkable differences between TE group and normal subjects in jitter, shimmer, harmonics to noise ratio and normalized noise energy. The pressure of TE speakers for comfortable /a/ is (2.86 +/- 0.69) kPa. The pharyno-esophageal segment vibrated regularly in most alaryngeal speakers and shapes of neo-glottis of most alaryngeal speakers were circular. CONCLUSION: Acoustic parameters of TE speakers were similar to those of esophageal speakers, but the tone of TE speakers was more similar to the normal controls. Speaking of the patients after the TE shunt procedure is laborsaving.

Aged↗
PubMed2004

[Near total laryngectomy with internal vocal shunt by Pearson].

First experience in near total laryngectomy with internal vocal shunt was shown. The applications and surgical technique of this method was described. The function of the vocal shunt in terms of swallowing, deglutition and phonation using endoscopic and radiological examination was presented. Based on previous papers the alternative methods of vocal surgical rehabilitation after laryngectomy was compared. We have emphasized advantage of this operation in selective cases of the laryngeal carcinoma and/or carcinoma of the piriformis sinus as well.

Adult↗
PubMed2005

Correlation of local outcome after partial laryngectomy with cartilage abnormalities on CT.

BACKGROUND AND PURPOSE: The prognostic significance of laryngeal cartilage abnormalities, as seen on CT or MR imaging, in laryngeal or hypopharyngeal cancer, is unclear. The purpose is to determine whether cartilage abnormalities as seen on preoperative CT in laryngeal and pyriform sinus cancer are predictive of local outcome after partial laryngectomy. METHODS: The preoperative CT studies in a consecutive series of 16 patients who underwent extended hemilaryngectomy for squamous cell carcinoma of the glottis (n = 12), supraglottis (n = 1), or pyriform sinus (n = 3) were reviewed retrospectively. Cartilage abnormalities were defined as asymmetric cartilage sclerosis, lysis of ossified cartilage, or tumor visible on both sides of the cartilage. Tumor volume was calculated by using the summation-of-areas technique. Seven patients underwent postoperative radiation therapy. All patients had a follow-up of at least 24 months after treatment or until local recurrence. RESULTS: Eleven patients showed cartilage abnormalities. In six patients, only a single cartilage was abnormal, whereas three patients showed involvement of two cartilages and two patients of three cartilages. The overall average tumor volume was 2.7 mL; the average tumor volume was 1.5 mL in the patients without and 3.3 mL in those with cartilage involvement on CT (P > .05). Two patients suffered a local recurrence. One patient (tumor volume, 1.5 mL) did not show any cartilage abnormalities. The other patient (tumor volume, 1.9 mL) showed abnormalities in all three cartilages and also had evidence of early transcartilaginous tumor spread. CONCLUSION: In patients whose cancer is anatomically suitable for partial laryngectomy, cartilage abnormalities on CT do not preclude speech-preserving surgery.

Aged↗
PubMed1992

The human nasal mucosa after deprivation of airflow: a study of laryngectomy patients.

The effects on the human nasal mucosa of airflow cessation can be studied conveniently in the laryngectomy patient. We studied 39 laryngectomy patients and 50 healthy adults. Mucociliary clearance was measured using the saccharin test, ciliary beat frequency (CBF) analyzed in inferior meatal brushings and transmission electron microscopical observations made in similar nasal brushings. Mucociliary clearance was no faster in laryngectomees (mean 15.4 +/- 7.8 min); however, CBF was higher in the laryngectomees (means 15.0 and 14.1 Hz; p less than 0.05), especially in the first weeks after surgery (mean 16.8 Hz; p less than 0.01). Mucus-producing cells gradually decreased in proportion over the first postoperative year. The changes in the nasal mucosa after airflow cessation are dynamic and require months to equilibrate. This has implications for the timing of postoperative assessment of patients undergoing airway surgery.

Cilia↗
PubMed2001

[Problems in swallowing after partial supraglottic and supracricoid laryngectomy].

The results of above 30 year research of pharyngeal phase of deglutition act in patients after classical and extended supraglottic laryngectomies and supracricoid laryngectomies are presented and compared with physiologic data. Initially roentgenocinematographic method has been used, computerized topokinetic analysis of acquired images was introduced later. With the latter method visualization of the deglutition act was better and the analysis more objective. The main purpose of the study was to find which functions and structures were spared after operations, that were necessary to facilitate pharyngeal phase of deglutition act and make it similar to physiologic act of deglutition.

Deglutition↗
PubMed2004

[Voice after supracricoid partial laryngectomy: comparison of two phonatory mechanisms].

INTRODUCTION: Different laryngeal phonatory mechanisms may be observed at long term after supracricoid laryngectomy. For this study two mechanisms are differentiated. The "dilated" mechanism is the consequence of a forward movement of the neolarynx creating a new resonance cavity. The "contracted" mechanism tallies with the backward contraction of the base of the tongue and the contraction of the posterior pharyngeal wall compressing the neolarynx. OBJECTIVE: The aim of the study is to determine if the voice outcome is different between these two kinds of mechanisms. MATERIAL AND METHOD: The method is based on the selection of a homogeneous group: 12 patients operated by cricoepiglottopexy with a follow up superior to two years and with a stable voice and a full neoglottic closure during phonation. The voice quality and the phonatory mechanism are analysed. Regarding voice assessment, a self evaluation with the vocal handicap index adapted for the study and the GRBAS scale are carried-out. Frequency (usual, minimum, maximum, range) and loudness are used to appreciate the vocal capacities. The phonatory mechanism is studied by videolaryngostroboscopy, performed tongue free, with a normal /e/ and a high-low transition pitch. RESULTS: The outcomes point out a difference between the two mechanisms. The best vocal results are observed in the "dilated" mechanism for the studied parameters and mainly for the frequency parameters. CONCLUSION: The discovery of numerous phonatory mechanisms after supracricoid laryngectomy independent from neoglottic closure lead us to further studies of the impact of this type of surgery on articulatory patterns.

Aged↗
PubMedDate not supplied

[Surgical restoration of the vocal function after laryngectomy].

The restoration of the voice function in patients after total laryngectomy is an important problem, which can be resolved using polymer tracheoesophageal valves. These authors have developed a new tracheoesophageal valve from a biocompatible polymer with an original unilateral lock as well as a procedure of its implantation during laryngectomy. Altogether 9 patients with laryngeal cancer stage III-IV underwent surgery. The high success rate of voice restoration was observed in 6 patients. The procedure is simple in use and will be further modified.

Humans↗
PubMed2005

[The effect of a comprehensive physiotherapy program on the aerobic endurance level of people after total laryngectomy].

After total laryngectomy and follow-up treatment (including radiotherapy) there are many functional disorders in the head and neck. This restricts the movement of the chest and shoulders, and also decreases the ventilation of the lungs. Consequently the level of endurance in people following total laryngectomy is significantly lower. Many patients also view cancer as physically disenabling, so they don't want to do as much physical activity as they could. However it could be seen that intensive physiotherapy with aerobic training and physical exercises led to a decrease in the negative effects of oncological treatment. The influence of physical exercise on aerobic efficiency was examined on a mechanical track during the aerobic test according to a modified version of Bruce's protocol. In conclusion when aerobic training and physical exercises are included in the physiotherapy program for laryngectomised patients an increase in their physical endurance is visible.

Adult↗
PubMed2004

[The evaluation of voice quality after near-total laryngectomy].

OBJECTIVES: It was intended to compare various characteristics of phonation obtained in cases who underwent near-total laryngectomy (NTL) and frontolateral laryngectomy (FLL). STUDY DESIGN: The study included 29 male cases, 9 of whom underwent NTL, 10 of whom underwent FLL and 10 who had normal laryngeal speech. All cases were evaluated and compared statistically according to the fundamental frequency (Fo), intensity and voiceless time measurements, maximal phonation time (MPT), speech rate and speech intelligibility. RESULTS: Fo and Fo range were found significantly high in both patient groups, but MPT and speech rate was meaningfully decreased in these groups relative to the control group. There were not any significant differences between the two patient groups. The speech intelligibilities of the NTL group patients were significantly low relative to other two groups. The voiceless time measurements during phonation were significantly high in two patients groups, but we also found that it was not effective on speech rate and intelligibility. CONCLUSION: The phonation gained after NTL is similar to that of FLL in respect of various features. But owing to differences of the speech intelligibility measurements, we concluded that patients who underwent NTL could be exposed to more problems during communication with their social surroundings.

Adult↗
PubMed2005

[Long-term results of tracheoesophageal puncture for voice restoration after total laryngectomy].

OBJECTIVE: To evaluate the long-term results of tracheoesophageal puncture for Blom-Singer voice restoration after total laryngectomy and summarize our clinical experience of fifteen years. METHOD: From 1986 to 2001, one hundred and thirty four cases with Blom-Singer technique after total laryngectomy for voice restoration were analyzed retrospectively. MDVP of Kay Elemetrics was used to analyze the acoustic parameters of eighteen cases with Blom-Singer indwelling voice prosthesis for 2-14 years. RESULT: For all cases, the follow-up was two to fifteen years. From 1986 to 1989, seven of twelve cases were satisfied with their speech, the success rate was 58.3%. After the year of 1990, the success rate was 93.4% (114/122). The total success rate was 90.3% (121/134). The acoustic parameters of Blom-Singer indwelling voice prosthesis was far away from normal. The common complications included fistula granulations, infection, leakage. CONCLUSION: The procedure of tracheoesophageal puncture for voice restoration is relatively simple and has low complications, high phonation success, good phonation quality, and steady long-term results, which is the best way to make laryngectomeel to speak. Pharyngoesophageal sphincter myotomy can raise the success rate of voice restoration by Blom-Singer indwelling voice prosthesis.

Adult↗