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PubMed1996

Supracricoid partial laryngectomy after failed laryngeal radiation therapy.

Twelve patients managed with supracricoid partial laryngectomies (SCPLs) after failed laryngeal radiation therapy (RT) were evaluated. None of the recurrent tumors were amenable to vertical or horizontal partial laryngectomy. Results were analyzed for tracheostomy decannulation, oral alimentation, morbidity, local control, and survival. Major complications included perichondritis (2 patients), laryngeal stenosis (2 patients), and pneumonia from aspiration (1 patient). Mucocutaneous fistula and cricoarytenoid joint ankylosis were not encountered. Margins of resection were uninvolved in all cases. The Kaplan-Meier 3-year actuarial survival and local control estimate was 83.3%. Salvage total laryngectomy allowed for an overall 100% local control rate and a 75% laryngeal preservation rate. This preliminary report suggests that, in patients with failed laryngeal RT not amenable to vertical or horizontal partial laryngectomy, the SCPL procedures should be discussed before advocating salvage total laryngectomy. Further series analyzing the role and limitations of the various SCPL procedures after failed laryngeal RT are warranted.

Adult↗
PubMed2000

Supracricoid partial laryngectomy with cricohyoidoepiglottopexy and cricohyoidopexy for glottic and supraglottic carcinomas.

OBJECTIVES: To review the patients operated in our department with supracricoid partial laryngectomy with either cricohyoidoepiglottopexy (CHEP) (59 cases) or cricohyoidopexy (CHP) (10 cases) technique, for primary or recurrent glottosupraglottic squamous cell carcinoma and compare the technique with other surgical or conservative approaches for treatment of laryngeal carcinoma. METHODS: From hospital charts, we retrospectively reviewed 69 patients who had undergone supracricoid partial laryngectomy with the CHEP or CHP technique between 1983 and 1996 for primary or recurrent glottosupraglottic squamous cell carcinoma in our department. Statistical evaluation of oncological and functional results were conducted. Results were compared with other surgical and conservative treatment for glottosupraglottic carcinoma of the larynx that were published previously in the literature. RESULTS: Sixty-nine patients had CHEP or CHP for glottosupraglottic carcinoma of the larynx. Thirteen percent of the patients received adjuvant radiotherapy. Minimum follow-up was 2 years or until death. Five-year actuarial survival (Kaplan-Meier method) was 68%. Global local control was achieved in 84% of cases. Among previously untreated patients (n = 54), local control rate was 94.5%. After 1 year, 92.7% of patients achieved normal swallowing and respiration. Salvage total laryngectomy had to be performed in four patients (5.7%) for persistent aspiration and in five patients (7.2%), who were previously treated with radiotherapy, for local recurrence. No permanent tracheostomy or gastrostomy was required. CONCLUSIONS: Our experience with supracricoid partial laryngectomy with either CHP or CHEP suggests that this technique is a valuable alternative to radiotherapy for T2-T4 glottosupraglottic carcinomas, particularly those with extension and invasion of the anterior commissure. It allows for preservation of a good laryngeal function without altering the long-term survival, keeping total laryngectomy as a salvage procedure.

Adult↗
PubMed2001

Early oral feeding following total laryngectomy.

OBJECTIVES: The time to begin oral feeding after total laryngectomy remains a subject of debate among head and neck surgeons. The prevailing assumption is that early initiation of oral feeding may cause pharyngocutaneous fistula; thus, the common practice of initiating oral feeding after a period of 7 to 10 days. The objective of the study was to demonstrate the feasibility and safety of oral feeding 48 hours after total laryngectomy. STUDY DESIGN: Two-part study includes, first, a sequential study and, second, a prospective analysis of our practice. METHODS: Patients undergoing total laryngectomy without partial pharyngectomy or radiation treatment (except irradiation through small ports for a T1 or T2 glottic carcinoma) were included. In the first, sequential part of the study (part I), a group of 18 patients who were fed 7 to 10 days after total laryngectomy (control group) was compared with a group of 20 patients who received oral feeding within 48 hours. To confirm the results of part I, a prospective analysis of this practice was conducted (part II) in which 35 additional patients who met the above criteria were fed within 48 hours after surgery. RESULTS: In part I, pharyngocutaneous fistula occurred in one patient (5%) in the early feeding group and in two patients (11%) in the control group. In part II, pharyngocutaneous fistula occurred in one patient (2.8%). Overall, fistula occurred in two patients in the combined early feeding group (3.6%). This rate of pharyngocutaneous fistula compares favorably with the fistula rate in the control group of 18 patients. Pharyngeal stricture that required dilation occurred in three of our patients in the study group and two in the control group (5.5% vs. 11%, respectively). The length of hospital stay was significantly shortened from 12 to 7 days. CONCLUSION: Our results indicate that in this patient population initiation of oral feeding 48 hours after total laryngectomy is a safe clinical practice.

Adult↗
PubMedDate not supplied

Differential modes of alaryngeal communication and long-term voice outcomes following pharyngolaryngectomy and laryngectomy.

Patterns of vocal rehabilitation for 37 pharyngolaryngectomy patients and 55 total laryngectomy patients over a 5-year period were compared. An electrolarynx (EL) was introduced as the initial communication mode immediately after surgery for 98% of patients, with 30% of pharyngolaryngectomy and 74% of laryngectomy patients subsequently developing tracheoesophageal speech (TES) as their primary mode of communication. Follow-up with 14 of 37 pharyngolaryngectomy patients and 36 of 55 laryngectomy patients was conducted 1-6 years following surgery and revealed that 90% of the pharyngolaryngectomy patients maintained the use of TES in the long term compared to 69% of the laryngectomy group. Long-term outcomes relating to communication disability and handicap did not differ significantly between the two surgical groups, however the laryngectomy patients had significantly higher levels of wellbeing. Across the whole group of patients, statistical comparison revealed that patients using TES had significantly lower levels of disability, handicap and distress than EL users. Considering that lower levels of disability, handicap and distress are associated with TES, and the data supports that suitably selected patients can maintain functional TES in the long term, increased application of this form of communication rehabilitation should be encouraged where viable for the pharyngolaryngectomy population.

Adult↗
PubMed1996

Speech results and complications of near-total laryngectomy.

Near-total laryngectomy provides a functional alternative to total laryngectomy in selected cases of laryngeal and hypopharyngeal cancer. We report our experience with the first 49 patients treated with near-total laryngectomy over a 3-year period. Successful speech rehabilitation was obtained in 79.5% of the patients in a median time of 40 days. Speech was acquired in 89.6% of the patients with follow-up longer than 6 months. Hands-free conversation was possible in 51.4% of the speaking patients. Five patients had symptomatic aspiration and 23 developed postoperative pharyngocutaneous fistula. Four local recurrences occurred in the laryngeal remnant. These results confirm that near-total laryngectomy provides a relatively safe, simple, and reproducible speech rehabilitation method for patients in whom total laryngectomy otherwise would be required.

Cutaneous Fistula↗
PubMed1981

Subtotal laryngectomy.

A subtotal laryngectomy may meet the requirements of adequate tumor resection in many patients who normally would undergo total laryngectomy. The uninvolved column of innervated endolarynx sacrificed at total laryngectomy to separate the airway and the food way can be preserved to valve a speaking shunt. Such a shunt remains patent and sphincteric without the use of a prosthesis an offers consistent advantages over "post-total" laryngectomy reconstructions. This report describes the principles of subtotal laryngectomy applied in 16 patients with laryngeal or pharyngeal carcinoma. The technique ensures entry into the larynx through tumor-free soft tissues and keeps the tumor margins under direct vision thereafter. During follow-up ranging from 6 months to 6 years, fistula speech has been retained and no local tumor has recurred.

Carcinoma↗
PubMed1990

Efficacy and morbidity of partial laryngectomy and postoperative radiation therapy.

In recent years, we have seen increasing use of partial laryngectomies for larger lesions that were previously treated by total laryngectomy. The resultant closer margins have made postoperative radiation therapy an important adjuvant treatment to conservation laryngeal surgery. We review the University of California, Los Angeles, experience with combination partial laryngectomy and postoperative radiation therapy between 1973 and 1987 for treatment of carcinoma of the larynx. Twenty-four such patients who underwent partial laryngectomies and postoperative radiation therapy are examined. Techniques of treatment, complications, and the functional ability of the remaining larynx are discussed. The locoregional control rate at 5 years was 80%. Risk factors associated with an increased risk of recurrence were positive margins, vascular invasion, and extranodal spread. There were no major problems with postoperative wound healing or airway management during the radiation treatment. Vocal and swallowing function were well preserved in most cases. We conclude that combination partial laryngectomy and radiation therapy permits preservation of laryngeal function without serious complications, and therefore is an effective treatment for selected patients with carcinoma of the larynx.

Adult↗
PubMed2000

[Tracheoesophageal puncture after total laryngectomy: follow-up of healing procedure].

Total laryngectomy due to malignant laryngeal tumors is followed by loss of speaking ability. Voice restoration in laryngectomized patients is the main target in their rehabilitation. Until the late 70's, esophageal speech was considered the most effective rehabilitation method. In 1980 Singer and Blom introduced a prosthesis for tracheoesophageal speech which has been gaining popularity. Tracheoesophageal puncture (TEP) can be performed either at the time of total laryngectomy, or later. 30 of our patients underwent TEP between 1991 and 1999, 15 at the time of total laryngectomy and 15 as a delayed secondary procedure. Mean follow-up was 36 months (range 6 months to 8 years) during which all regained speaking ability. Over the long range, speech rehabilitation with the prosthesis was successful in 24 (80%). In only 1 in the primary TEP group did treatment fail, as the prosthesis had to be removed due to local recurrence of the tumor. Long range failure in 5/15 patients after secondary TEP stemmed from difficulties some patients had in handling the prosthesis and from psychological difficulties in adapting to the new speech device. Complications were mostly minor and occurred mainly in the secondary TEP group. TEP performed at the time of total laryngectomy, or later as a secondary procedure, is effective for speech rehabilitation after laryngectomy.

Aged↗
PubMed2000

[Total laryngectomy: from hands of the general surgeon to the otolaryngologist].

In Europe early attempts at the total laryngectomy were performed in humans in the late 1800s by some Anglo-Saxon general surgeons. In Italy, Enrico Bottini, chief of General Surgery at the Hospital of Novara performed the first total laryngectomy in man in 1875, followed a few years later by Azio Caselli in Reggio Emilia and Francesco Durante in Rome. The latter perceived the need to modify the surgical technique currently being used at that time to remove the larynx. He agreed with the Berlin surgeons Gluck and Sorensen on the need to isolate the respiratory tract as completely as possible from the digestive tract in order to prevent ab ingestis complications and made his own personal modifications to the total laryngectomy techniques proposed by his German colleagues. Professor Francesco Durante proposed, and published in 1904, a new technique for total laryngectomy. In the years to come this technique was adopted by many other general surgeons. Among these, in 1912, his protege Gherardo Ferreri, who later became Director of Otology and Rhinolaryngology at Regia University in Rome, was the first otorhinolaryngologist to perform a total laryngectomy. And thus a new era in laryngology was born, evolving from a purely medical discipline to a topic of surgical interest.

General Surgery↗
PubMed2001

Salvage resection after previous laryngeal surgery: total laryngectomy with en bloc resection of the overlying cervical skin.

OBJECTIVE: To evaluate the effectiveness of extended total laryngectomy for the treatment of recurrences of laryngeal cancer. DESIGN: We conducted a retrospective clinical study of patients who had undergone extended total laryngectomy and were seen over a 15-year period. The follow-up period ranged from 3 to 15 years. SETTING: Academic tertiary referral medical center. PATIENTS: We observed 15 patients who were affected by a recurrence of laryngeal cancer that extended to the overlying soft tissue. All patients were male. The mean age was 61.5 years. Thirteen patients had previously undergone partial laryngeal surgery, and 2 patients had undergone radiation therapy, without success. INTERVENTION: All patients underwent total laryngectomy extending to the soft tissue, including the overlying skin. RESULTS: Five of the 15 patients died of local recurrence, and 1 patient died of massive postoperative hemorrhaging. An actuarial survival rate of 60% was observed at 5 years. CONCLUSION: Total laryngectomy extending to the soft tissues seems to be an effective procedure for treating local recurrences of laryngeal cancer after partial laryngectomy or failure of radiation therapy.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Supracricoid laryngectomy with Cricohyoidopexy--a clinico oncological & functional experience.

Supracricoid laryngectomy with Cricohyoidopexy (CHP) is a procedure that is commonly practiced in France & Canada. Eight such procedures were carried out at Kidwai Memorial Institute of Oncology, Bangalore during the period from 1991 through 1996. Four Glottic, 3 transglottic & one supraglottic cancers were subjected to this procedure. The study comprised of 7 males & 1 female. The average age was 52 years. Two procedures were done as salvage procedures for radiotherapy (RT) failures. The patients have a follow-up ranging from one year to six years, except for one who died soon after discharge from hospital secondary to myocardial infarction. Median follow up was four years. The three year acturial disease free survival was 83%. Six out of 8 (75%) were decannulated, and physiologic deglutition without aspiration was established in all patients. Hospital stay ranged from 11 to 62 days averaging 29 days. The speech was analyzed together with other partial laryngectomies and was found to be qualitatively worse than speech after other partial laryngectomy procedures. In addition speech intensity levels after CHP were lower than in other partial laryngectomy procedures. The speech however allowed normal social interaction. This procedure certainly has distinct oncological advantage in encompassing circumferential horse-shoe lesions with minimal subglottic extension which in the past would have received total laryngectomy and needs to be included in the repertoire of speech restorative surgery in laryngeal cancers.

Adult↗
PubMed2001

[Study of pharyngo-cutaneous fistula after total laryngectomy].

OBJECTIVE: To explore the factors which lead to pharyngo-cutaneous fistula after total laryngectomy. METHOD: A retrospective study of 125 patients who underwent total laryngectomy during a 16-year period was carried out. RESULT: The rate of post-laryngectomy pharyngo-cutaneous fistula is 16.0% (20/125), it appears reduced tendency. With single-factor analysis, the factors effect on the rate of post-laryngectomy pharyngo-cutaneous fistula include clinical tumor stage, tumor types, pre-operative radiotherapy dose, intraoperative blood transfusion, operative duration. With all variable logistic model analysis, the factors effect on the rate of pharyngo-cutaneous fistula are clinical tumor stage and pre-operative radiotherapy dose, but pre-operative radiotherapy is very possible to be a risk factor (P = 0.0566). With logistic model stepwise regression analysis, the factors effect on the rate of pharyngo-cutaneous fistula are clinical tumor stage and operative duration. CONCLUSION: Pharyngo-cutaneous fistula appears easily in patients with T3, T4 tumor, and have pre-operative radiotherapy, especially have large dose preradiotherapy. For these high risk patients, the duration of operation should be as short as possible to reduce the rate of post-laryngectomy pharyngo-cutaneous fistula.

Adult↗
PubMed2003

[Pharyagoesophageal sphinoter myotomy for voice rehabilitation after total laryngectomy].

OBJECTIVE: In those patients received total laryngectomy, Blom-Singer prosthesis speech appears to be the more effective form of rehabilitation. To reduce the effect of pharyngoesophageal sphincter on the Blom-Singer prosthesis voice restoration following total laryngectomy, the pharyagoesphageal sphincter myotomy was designed and carried out. METHODS: After total laryngectomy, the cricopharyngeus muscle stricture or spasm appears to inhibit the air flowing and prevent the speech. The pharyngoesophageal sphincter is now defined as the area including the cricopharyngeus with a portion of inferior constrictor, as well as some of the upper cervical esophagus. The pharyngoesophageal sphincter were incised intra- and post- operation of total laryngectomy, the dissection was approximately 5 cm in vertical length and 1 cm in width. RESULTS: Among the 33 patients who received pharyngoesophageal sphincter myotomy following total laryngectomy, voice restoration was achieved in 32 cases, the success rate was 97%. 25 patients had survived for 3 years, 18 patients survived for 5 years. CONCLUSION: Pharyagoesophageal sphincter myotomy can raise the success rate of rehabilitation of the voice by Blom-Singer prosthesis.

Aged↗
PubMed2002

[A clinical evaluation on supracricoid partial laryngectomy with laryngoplasty].

OBJECTIVE: To evaluate the results of supracricoid partial laryngectomy with laryngoplasty in treating laryngeal cancer and reconstructing its functions. METHODS: One hundred and fifty-nine patients receiving subtotal laryngectomy from 1993 to 1999 were analysed. 4 kinds of operations were performed for them. 46 cases underwent supracricoid partial laryngectomy with the reconstruction of laryngeal function by pedicled flaps. RESULTS: Among the 46 cases receiving supracricoid partiallaryngectomy with laryngoplasty, aspiration did not occur in 40 cases. The decannulation rate was 91.3%, 3, 5 year survival rates were 84.8%, 75%. 41 cases resumed enjoyed satisfactory phonation. CONCLUSION: This form of laryngeal reconstruction in supraericoid partial laryngectomy with laryngoplasty is helpful to restore laryngeal function. It can prevent aspiration and improve the decannulation rate as well as the quality of life in partial laryngectomy patients.

Adult↗
PubMed2000

[Partial laryngectomies at the University Hospital Center of Dakar].

Our experience on partial laryngectomies stretched on a period of 16 years. In an unfavorable medical environment, we issue our indicative criteria throughout this experience. From January 1st 1981 to December, 31st 1996, 14 patients have had a partial laryngectomy in University Hospital Center of Dakar. The average year was 56 and the sex-ratio was 1 woman out of 13 men. There were 13 carcinomas and 1 cas of acute dysplasia. 4 patients have had vertical partial laryngectomy, 5 have had a horizontal partial laryngectomy and 5 a partial laryngectomy on the upper out of the cricoid cartilage with the ganglia. After a 3 years close look, on 10 patients, we noted that 1 died, 1 disappeared, and 8 still were living. Carcinological failures consisted in 3 development by stages and 1 cas of a 2nd localisation. As for as functional results, the removal of the nozzle and the elimination of the nasogastric grohe of supply, were effective for respective average allotted time of 11 and 12 days. This laryngeal partial surgery seem scarce in our practice (12% of the patient who have had it). The improvement of results go to the choice of indications, the information the formation and the acquisition of technical stools more efficient.

Academic Medical Centers↗
PubMed2004

Stomal recurrence post laryngectomy in University College Hospital, Ibadan.

The outcome of laryngeal carcinoma is favourable and cure rate high if detected early. A major complication experienced post surgery for advanced laryngeal carcinoma is recurrence especially at the tracheostome. This study aimed at evaluating the incidence of stomal recurrence post total laryngectomy with respect to the risk factors. This is a retrospective review of eighteen patients (14 males and 4 females) that had total laryngectomy for histologically confirmed laryngeal carcinoma from 1990 - 2002. Seven patients (38.9%) had stomal recurrence. Seven patients (38.9%) had palpable deep cervical nodes at presentation. Fourteen (77.8%) and four (22.2%) patients had emergency and elective tracheostomy procedures respectively. Twelve patients (66.67%) had neck node dissection during surgery. Post-operatively, twelve patients (66.7%) had only radical radiotherapy; four (22.2%) had both radio-/ chemotherapy while two had preoperative and additional postoperative radiotherapy. The mean duration between the preoperative tracheostomy and total laryngectomy was 62.19 +/- 64.56 days while the mean duration between total laryngectomy and development of stomal recurrence was 7.79 +/- 8.57 months. Ten patients (55.6%) died, (seven with and three without stomal recurrence but who died of distant metastases to the lungs and thoracolumbar vertebral bodies). Stomal recurrence post laryngectomy has a grave prognosis. This present study also showed that advanced stage 3 and 4 tumour, transglottic involvement and the presence of preoperative tracheostomy are the likely risk factors that could be associated with recurrence in our environment. There is therefore the need to reevaluate these preventive measures in a prospective study in order to improve the final outcome in our environment.

Adult↗
PubMed2005

[The voice analysis of subtotal laryngectomy by pedicled flaps reconstruction of vocal cord].

OBJECTIVE: To compare the voice quality of patient's after surgery over one year between the reconstruction of laryngeal function in subtotal laryngectomy by pedicled flaps and other laryngeal function in subtotal laryngectomy. METHOD: By using Dr Speech's acoustic analysis software, the noise level of the testing room was controlled under 45 dB. Before testing, patients have pronounced training. The testing voice was selected as[ae]. The evaluation parameters were jitter, shimmer, and NNE. RESULT: All the acoustic parameters of the reconstruction of laryngeal function in subtotal laryngectomy by pedicled flaps were increased distinctly than normal. There were statistical significant differences; compared with those by subtotal laryngectomy, the parameters decreased distinctly, and the voice quality improved distinctly. CONCLUSION: The reconstruction of laryngeal function in subtotal laryngectomy by pedicled flaps improve the voice quality, the acoustic analysis can be a measurable data of the postoperative voice quality evaluation, and administer to its objective evaluation.

Adult↗
PubMedDate not supplied

Outcome after partial frontolateral laryngectomy.

The purpose of this study was to determine the recurrence rate and the long-term survival of patients treated with frontolateral laryngectomy for early glottic cancer. The study is a retrospective analysis of a cohort of patients who underwent frontolateral laryngectomy from 1995 to 2002 with a median follow-up of 48 months. This was a consecutive series of 30 patients with T1bN0 and T2N0 vocal fold carcinoma. Previously treated patients were excluded. Surgical treatment consisted of frontolateral partial vertical laryngectomy and reconstruction with bipedicle sternohyoid muscle flap. Twenty-five patients have been alive with no evidence of the disease. The median follow-up was 48 months (range, 6-85 months). Five patients experienced local recurrence. One of them underwent salvage partial hemilaryngectomy, and 4 underwent wide-field total laryngectomy with adjuvant postoperative radiation therapy. Four of five patients with retreatment were ultimately salvaged, with a median follow-up of 30 months. We had one death caused by the disease. Frontolateral laryngectomy is an efficient treatment for selected cases of early glottic carcinoma.

Female↗