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[Subtotal reconstructive laryngectomy: author's experience].

The authors conclude 18 year's experience with reconstructive laryngectomy by adopting two surgical techniques for intrinsic laryngeal tumors. The first, where one or both of the arytenoids are conserved, can be applied in cases of supraglottic neoplasms extending to the glottis as well as in glottic cancers where a simple cordectomy is not feasible. In both cases this technique is indicated when at least one arytenoid is respected. The second technique involves removal of both arytenoids and is used in cases of intrinsic supraglottic or glottic tumors extended to both arytenoids. The anatomic-pathological criteria supporting these techniques are: 1) the presence of a fibrous ligament anterior to the arytenoid vocal process. This makes possible proper exeresis within healthy tissue (as can be done in supraglottic surgery due to the anatomic characteristics at the anterior commissure level); 2) neoplastic infiltration of the cricoid cartilage takes place exceptionally in supraglottic and glottic neoplasms; in such cases neoplastic manifestation can be radiographically identified. Generally removal of the soft tissues and of the perichondrium within the cricoid area grants conservative surgery the same oncological radicality as that of total laryngectomy. Insights into restoration of laryngeal function when employing the arytenoid-preserving technique are as follows: 1) conservation of the recurrent nerve(s) 2) pulling the base of the tongue back and downward; close to the crico-arytenoid structure can be achieved by crico-hyoid-pexy. In the technique involving removal of the arytenoid: 1) reconstruction of two pseudo-arytenoids 2) the base of the tongue has to be brought close to the edge of the cricoid cartilage possibly by crico-hyoid-pexy. A total of 21 patients have undergone surgery with these techniques since 1984 and to date no neoplastic recurrences have been observed. Those who underwent surgery where the arytenoids were preserved (16 cases) showed laryngeal functional recovery times similar to those for supraglottic surgery. The recovery times were longer for those undergoing bilateral arytenoidectomy (5) and this was especially so for swallowing.

Adult↗
PubMed1988

Analysis of prognostic variables and results after supraglottic partial laryngectomy.

A consecutive series of 78 patients who underwent conservation surgery for squamous cell carcinoma of the supraglottic larynx is analyzed. The majority of the patients were middle-aged men who had early-stage disease, with only 18 patients in stage III and 6 in stage IV. The epiglottis was the most frequent site, followed by the aryepiglottic fold and other sites in the supraglottic larynx. There was no operative mortality and the complication rate was low. Univariate analysis showed no influence of tumor stage, tumor differentiation, or involved surgical margins on survival. Determinate survival rates of 85 percent at 3 years and 72 percent at 5 years were observed. Local recurrences took place in 12 patients, 4 of whom were salvaged by total laryngectomy; neck failure occurred in 13 patients, 7 of whom were salvaged after further treatment; and 1 of the 2 patients with distant metastasis was salvaged after further treatment. We believe that every patient with a favorable lesion of the supraglottic larynx should be considered for conservation surgery, specifically, supraglottic partial laryngectomy, adhering to the criteria mentioned. Initial surgical treatment offers excellent local control and 5 year survival. Adjuvant postoperative radiotherapy may be considered in those patients with bulky primary tumors, positive surgical margins, and histologically confirmed cervical lymph node metastases.

Adolescent↗
PubMed1988

[Partial supracricoid laryngectomies: techniques, indications and results].

The authors present results of a retrospective study on 99 patients who underwent a partial supracricoid laryngectomy. Indications included carcinomas developed on the laryngeal vestibule, in the ventricle or at the glottic level. This represents an alternative to total laryngectomy. Surgical techniques and functional results are discussed. Ninety-eight percent of patients could be decanulated and a regular diet was possible in 94%. The survival rates are 76% after three years and 68% after five years. Local recurrences occurred in 3% of cases and cervical metastases were not controlled in 13%. The authors comment on indications for surgery according to the site of involvement. Contra-indications are massive invasion of the pre-epiglottic space, extension away from the superior aspect of the cricoid and arytenoid fixation.

Cricoid Cartilage↗
PubMed1987

[Results of operations of salvage laryngectomy].

The surgery of the larynx in an irradiated neck changed since 30 years by an evolution of the radiotherapeutic technics and the surgical procedures. At the Curie Institute, from 1960 to 1986, 230 patients were operated with laryngectomy for failure of the first treatment (average doses: 70 Gy). 29 had partial laryngectomy. The feeding tube was removed before 6 weeks in 78% of the patients. 19 patients (8%) died in the 3 months after surgery (8 carotid blow-up). The crude survival rates are 70% at 1 yr, 42% at 3 tr, 37% at 5 yr. These rates are identical in patients with persistent disease two months after irradiation (90), in patients with recurrence (110) and for those with second primary in the larynx (21). 54% of T1 and T2 patients are NED at 3 yr and 47% at 5 yr. For T3 and T4 rates are only 22% and 17%. Best results are in glottic cancers (74% at 3 yr); poorest in advanced supra-glottic (17%). Salvage procedure is effective in larynx and neck in 62% of the patients. Early detection of a failure after irradiation is a major condition for the application of a protocol of definitive radiotherapy in laryngeal cancer.

Female↗
PubMed1987

[Mechanisms of adaptation of breathing and swallowing coordination following partial laryngectomy].

Integrated study of respiration and deglutition includes 48 healthy examinees and 30 patients after partial laryngectomy. Every act of swallowing is accompanied by a respiratory pause (swallow apnoea) which in healthy subjects lasts for approximately 0.7438 sec. In the patients after partial laryngectomy swallow apnoeas are significantly prolonged and last for approximately 1.2482 sec. Swallow apnoea is usually followed by expiration. This is observed in the majority of subjects, its function being the protection of the lower respiratory pathways. Besides the interaction between breathing and swallowing, synergism is also present, functioning as adaptive mechanism of the upper respiratory and gastrointestinal system.

Adolescent↗
PubMed1987

[Cancer of the valleculal and laryngeal vestibule treated by supraglottic horizontal laryngectomy. Apropos of 173 surgically treated cases at the Institut Gustave-Roussy].

The authors make a report on a series of 173 supraglottal horizontal laryngectomies carried out from 1970 to 1984 at the Gustave-Roussy Institute of Villejuif. After recalling of operability conditions and tackling characteristics of this series are quoted variants required from tumours localisations diversity and importance of extension. Then are treated clinical and anatomo-pathological classification as briefly surgeries results. This work is specially concerning in survival by analysing different topographical clinical and histological criteria. Survival of 173 patients, having gone through an supra-glottal laryngectomy is 45.5% at 3 years and 31.3% at 5 years. At least, reasons of failure are analysed. This kind of partial surgery caring of voice, should be proposed to patients affected by vallecula or epiglottis carcinomas as regards of good functional and improved carcinological results.

Adult↗
PubMed1987

[Reconstructive laryngectomies. Technical and functional aspects].

Technical aspects are described of the reconstructive laryngectomy used between 1982 and 1986 to treat 59 patients with endolaryngeal epidermoid carcinoma. Both "conservative" techniques (Tücker's laryngectomy, total endolaryngeal functional evidement) and "non-conservative" techniques (cricohyoidopexy, cricohyoidoepiglottopexy, cricobasiglossopexy) as well as their functional outcome are described. Results of surgical review of endolaryngeal spaces (paraglottic space, hyothyroepiglottic space) are analyzed for each method, and a schema for their use proposed.

Adult↗
PubMed1987

[Cartilage-mucous membrane transplant from the nasal septum in laryngeal reconstruction following extended frontolateral laryngectomy].

The authors present in detail the method of reconstructing the larynx after extended fronto-lateral laryngectomy using a mucochondrial nasoseptal graft. The method has been used in 61 cases of laryngeal cancer arising not only from the glottis but also from the laryngeal ventricle, the vestibular fold and part of the epiglottis. After describing other reconstruction techniques after vertical laryngectomy the authors point out the advantages of mucochondrial nasoseptal graft.

Cartilage↗
PubMed1986

Lung function and within-breath changes in resistance in patients who have had a laryngectomy.

We describe the construction of a simple device which may be used to connect a patient with a tracheostomy to standard lung function testing equipment. We compared the lung function of nine patients after laryngectomy with nine patients matched for similar degrees of airflow obstruction, and found that peak flow rate (as per cent predicted) was significantly lower than predicted FEV1 in the patients with tracheostomy. This suggests that the larynx may normally affect production of peak flow. We then compared the change in resistance over the normal tidal volume in the two groups, finding no significant difference, and obtained similar results from paired studies in two patients before and after laryngectomy. We conclude that, while the laryngeal aperture varies during tidal breathing, it plays no major part in the overall resistance changes which occur during a normal breath.

Adult↗
PubMed1986

[Voice rehabilitation after total laryngectomy].

Several methods for the restoration of voice after total laryngectomy were discussed. The technique of esophageal voice can restore clear and fluent speech, but often requires the long period of training. Alternate methods include artificial devices, such as the electrolarynx and air bypass devices, and some surgical techniques like the tracheoesophageal fistula formation after the Blom-Singer procedure. Surgical procedures of glottoplasty have also been improved, decreasing the severe complications like aspiration. However no methods relieve patients from the great inconvenience of "closing the tracheostoma with the fingers". Exploration of the better surgical techniques and the more efficient artificial devices is necessary, as well as the effort to decrease the number of total laryngectomy by the early diagnosis.

Humans↗
PubMed1985

[Finger-free speech following total laryngectomy. Instrumentation and technic of surgical voice rehabilitation].

Surgical voice restoration during and after total laryngectomy using Blom-Singer puncture and the glottoplasty techniques provide good results. There is no doubt that the proportion of patients with a good voice is higher after surgical voice restoration than with the use of the esophageal speech or electronic speaking aids. Nevertheless there are problems due to the shunt or the necessary daily changing of the prosthesis with its risks, and failures due to the tracheostomy, the prosthesis and the pharynx. In order to reduce these surgical problems we developed new instruments, a personal surgical procedure for restoration during and after laryngectomy using this set of instruments, a new type of prosthesis and a tracheostoma valve. This technique allows the patient to speak fluently without using his hands, to breathe and to swallow without aspirating.

Humans↗
PubMed1985

[Total glossectomy without laryngectomy for recurrence after initial irradiation (2 year follow-up)].

In our experience of 171 glossectomies for recurrence, salvage partial glossectomy yields 50% of local control. Myo-cutaneous flap allows wide total glossectomy without total laryngectomy. This procedure may improve the local control. Of 25 patients treated by this technique, 2 deceased before the 45th post-operative day, 15 swallow correctly and 11 have a good speech. The survival rate is 10/21 at 6 months, 7/16 at 12 and 6/13 at 18. A local failure was observed in 7 and 6 have a second primary in the upper respiratory and digestive tract. Total glossectomy without total laryngectomy is only indicated for patients with bulky tumor, without spread of the vallecula and with no palpable cervical node.

Adult↗
PubMed1979

Current attitudes of laryngectomy patients.

Improved surgical techniques and adjunctive therapeutic measures are producing more long-term survivors of laryngeal carcinoma and facilitating voice preservation through the methods of conservation surgery; however, when surgery includes total laryngectomy, prolonged rehabilitation involving many disciplines may help patients to adjust to many new aspects of their daily lives and to avoid the severe depression which may attend this procedure. In order to evaluate the program currently in use at our institution and to provide suggestions for developing and improving rehabilitative programs, we have used interviews and questionnaires to study 60 laryngectomy patients. The study focused on the patients' attitudes and their impressions of the adequacy of the preoperative and postoperative visits by physicians, speech pathologists, nurses, social workers, and other members of the therapy team.

Aged↗
PubMed1972

Vocal rehabilitation after partial or total laryngectomy.

One of the paramount concerns of a patient who must undergo surgical intervention for laryngeal cancer is the effect on his speech. The type of operation is based on the anatomic extent of the cancer, but each procedure presents inherent problems in vocal rehabilitation. Glottic incompetence is the primary deficit to be overcome following hemilaryngectomy, whereas the aspirate voice is the principal problem with supraglottic laryngectomy. When the larynx must be sacrificed by total laryngectomy, the patient attempts to learn esophageal speech. If this fails, a vibrating sound source for speech can be acquired, either by the construction of a trachealpharyngeal communication or by use of a manual electric vibrator.

Humans↗
PubMed1983

[Comparative study of pre and post-operative dynamic respiratory indices in subjects undergoing total laryngectomy].

A spirometric measurement was carried out on patients with cancer of the laryn before and after surgery for total laryngectomy at the Istituto Policattedra of the University of Parma ENT Clinic. Postoperative spirometry was performed by means of a Vitalograph apparatus with the mouthpiece positioned right over the tracheal opening. The parameters considered were the dynamic respiratory indices (CV/MEVS - MEVS/CV). Forty patients was mostly based on the fact that, prior to laringectomy, all of them had been subjected to a spirometric measurement for aneasthesiologic purposes. According to the results obtained, the patients can be divided into three groups. The first group consists of 10 subjects in whom no improvement was observed in their MEVS value, which in some instances had actually worsened. The second group is composed of 20 patients in whom the spirometric values remained more or less steady. The third group comprises 20 patients who showed a marked improvement of their respiratory indices. In some of the latter patients the values obtained were even better than those in the normal range. However, the overall average results are not statistically significant, except for an average 9% improvement of MEVS due, as expected, to a reduction of the dead space following total laryngectomy and a corresponding, though very slight, 4% improvement of the Tiffenau ratio.

Aged↗
PubMed1983

[Comparative cytologic studies of human nasal secretions (differential smears of secretions in patients following laryngectomy and patients with rhinitis sicca in comparison with healthy subjects)].

Using a new method, exfoliative cytologic examinations were performed in patients after laryngectomy and in patients with rhinitis sicca in comparison to normal nasal mucosa. In patients after laryngectomy an increased rate of nasal secretion can be seen. In the nasal smear the main fraction of cells are ciliated epithelial cells. Contrariwise, in patients with rhinitis sicca many squamous epithelial cells can be found. The new method enables the preparation of quantitative cytograms.

Adult↗
PubMed1984

Voice rehabilitation after laryngectomy with the Groningen prosthesis.

The Groningen voice prosthesis is a recently developed silicone device for surgical rehabilitation of the voice following total laryngectomy. The prosthesis is placed in the tracheo-esophageal wall as a primary procedure during laryngectomy or as a secondary procedure some time after surgery. The insertion is a one stage surgical technique. The prosthesis is self-retaining and remains in situ, on average for three months. Its replacement is a simple outpatient procedure. Successful speech was achieved in 80% of the patients rehabilitated as a primary procedure. Aspiration of liquids or food was not observed. The Groningen prosthesis has several advantages over other currently available devices.

Adult↗
PubMed1980

Current trends in post-laryngectomy speech rehabilitation.

In recent years there has been considerable interest in exploration of surgical speech rehabilitation (SSR) for the laryngectomee as an alternative to conventional management. The history of the evolution of present pneumatic and electronic methods is traced. The details of the various methods are analyzed including the phonatory neoglottis method reported by Staffieri. Algorithms are offered for the patient who is about to undergo laryngectomy, for the patient who has had laryngectomy in the past, and for the patient facing total pharyngolaryngectomy. The prospects for future developments in the field of SSR are analyzed, acknowledging that none of the present methods provides an ideal solution to the problem of laryngeal aphonia.

Humans↗