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Tzelnick S, de Almeida JR, Gilbert R, Goldstein D. Vertical Partial Laryngectomy With Temporoparietal Free-Flap Reconstruction for Recurrent Laryngeal Cancer: Long-Term Study. OTO Open 2024; 8:e179. [PMID: 39157740 PMCID: PMC11330586 DOI: 10.1002/oto2.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 07/06/2024] [Indexed: 08/20/2024] Open
Abstract
Objective Treatment options for recurrent early glottic carcinoma's include conservative and radical surgical options. These options offer similar survival benefits with different impacts of patient's quality of life. We previously present our experience with vertical partial laryngectomy (VPL) and showed high locoregional control rates with high-quality voice results and normal swallowing. Study Design A long-term retrospective review. Setting Tertiary Care Center. Methods We analyzed all patients underwent VPL between the years 1995 to 2018. Long-term oncologic and functional outcomes were collected. Results A total of 40 patients were included. The majority of whom were male (n = 38, 95%) with a mean age of 64.9 years (SD ± 9.5). With a median follow up time of 12 years (range 0-24), 9 patients (22.5%) had disease recurrence; the majority of whom (8 patients), had local recurrence and all were salvaged with total laryngectomy. Eight patients (20%) developed second primaries in the head and neck region with a median time to diagnosis of 77 months (range 8-227 months). Ten-years overall survival, disease specific survival, and local disease-free survival were 80%, 90%, and 80%, respectively. Five patients had postoperative laryngeal dysfunction with a total 10-years laryngectomy free survival of 70%. Conclusion VPL has a sustainable oncologic outcome with a high long-term laryngectomy free survival rate. This entity is an acceptable conservative salvage option for selected postradiated recurrent laryngeal squamous cell carcinoma patients.
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Affiliation(s)
- Sharon Tzelnick
- Department of Otolaryngology–Head and Neck Surgery, Princess Margaret Cancer CentreUniversity Health NetworkTorontoOntarioCanada
- Department of Surgical Oncology, Princess Margaret Cancer CentreUniversity Health NetworkTorontoOntarioCanada
| | - John R. de Almeida
- Department of Otolaryngology–Head and Neck Surgery, Princess Margaret Cancer CentreUniversity Health NetworkTorontoOntarioCanada
- Department of Surgical Oncology, Princess Margaret Cancer CentreUniversity Health NetworkTorontoOntarioCanada
| | - Ralph Gilbert
- Department of Otolaryngology–Head and Neck Surgery, Princess Margaret Cancer CentreUniversity Health NetworkTorontoOntarioCanada
- Department of Surgical Oncology, Princess Margaret Cancer CentreUniversity Health NetworkTorontoOntarioCanada
| | - David Goldstein
- Department of Otolaryngology–Head and Neck Surgery, Princess Margaret Cancer CentreUniversity Health NetworkTorontoOntarioCanada
- Department of Surgical Oncology, Princess Margaret Cancer CentreUniversity Health NetworkTorontoOntarioCanada
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Mukoyama N, Nishio N, Kimura H, Tokura T, Kishi S, Ogasawara K, Tsuzuki H, Yokoi S, Wada A, Shigeyama M, Ozaki N, Fujimoto Y, Sone M. Anxiety, depression and quality of life in patients with head and neck cancer undergoing laryngectomy: A long-term prospective evaluation. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024. [PMID: 38647077 DOI: 10.1111/1460-6984.13036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 04/09/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND This study aimed to assess anxiety, depression and quality of life (QoL) in patients with head and neck cancer undergoing laryngectomy using comprehensive self-reported questionnaires for a period of up to 5 years. METHODS This prospective observational study enrolled 150 consecutive patients with locally advanced head and neck cancer who underwent laryngectomy at Nagoya University Hospital between 2007 and 2020. Anxiety, depression and QoL were assessed at baseline (preoperative) and at 3, 6, 12, 24, 36, 48 and 60 months after surgery using two brief self-reported questionnaires, such as the eight-item Short Form Health Survey (SF-8) and the Hospital Anxiety and Depression Scale (HADS). RESULTS The surgical procedures were total laryngectomy, pharyngo-laryngectomy and pharyngo-laryngo-oesophagectomy in 97 (65%), 41 (27%) and 12 (8%) patients, respectively. All eight items of the SF-8 were significantly worse than those of the normal population at baseline and at 3 months after surgery. However, general health, vitality, mental health and bodily pain improved to normal levels within 1 year after surgery and were maintained for 5 years. In this study, 35% of patients were categorised as potential cases of depression, and 35% were potential cases of anxiety. During the follow-up period, the proportion of patients with anxiety gradually decreased after surgery. Further analysis revealed that the SF-8 and HADS scores and trends in 89 patients without tumour recurrence were similar to those in the total enrolled 150 patients. CONCLUSION Anxiety, depression and QoL in laryngectomised patients improved at 1 year after surgery and were maintained for up to 5 years. WHAT THIS PAPER ADDS What is already known on the subject Laryngectomy is associated with prolonged functional and psychological effects and has a major impact on patient quality of life (QoL). Several prospective studies evaluating the QoL in laryngectomised patients have been reported, in which significant deterioration in social functioning was found even 1 year after surgery. What this paper adds to existing knowledge One year is not a sufficient period for laryngectomised patients to return to normal life and spend their time in a social community. A recent review showed that most studies on QoL in laryngectomised patients were conducted under 1 year after the procedure, and there were not enough studies of sufficient quality. This is the first long-term prospective observational study of Japanese patients with head and neck cancer who underwent laryngectomy up to 5 years after surgery. What are the potential or actual clinical implications of this work? Our long-term observational study showed that the scores for anxiety, depression and QoL in laryngectomised patients improved at 1 year after surgery and were maintained for up to 5 years. Clinicians should recognize the importance of psychosocial risk factors in their QoL and multidisciplinary management, including social and psychological support, is essential for long-term laryngectomised survivors.
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Affiliation(s)
- Nobuaki Mukoyama
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Nishio
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroyuki Kimura
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tatsuya Tokura
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinichi Kishi
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuyoshi Ogasawara
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Center for Postgraduate Clinical Training and Career Development, Nagoya University Hospital, Nagoya, Japan
| | - Hidenori Tsuzuki
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sayaka Yokoi
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihisa Wada
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mayu Shigeyama
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Norio Ozaki
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Institute for Glyco-core Research (iGCORE), Nagoya University, Nagoya, Japan
| | - Yasushi Fujimoto
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Otorhinolaryngology, Head and Neck Surgery, Aichi Medical University, Aichi, Japan
| | - Michihiko Sone
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Kouka M, Beckmann L, Bitter T, Kaftan H, Böger D, Büntzel J, Müller A, Hoffmann K, Podzimek J, Pietschmann K, Ernst T, Guntinas-Lichius O. Oncological and functional outcome after laryngectomy for laryngeal and hypopharyngeal cancer: a population-based analysis in Germany from 2001 to 2020. Sci Rep 2024; 14:7761. [PMID: 38565603 PMCID: PMC10987613 DOI: 10.1038/s41598-024-58423-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 03/28/2024] [Indexed: 04/04/2024] Open
Abstract
Prognostic factors for overall survival (OS), percutaneous endoscopic gastrostomy (PEG) dependency, and long-term speech rehabilitation via voice prosthesis (VP) after laryngectomy for laryngeal or hypopharyngeal cancer were investigated in a retrospective population-based study in Thuringia, Germany. A total of 617 patients (68.7% larynx; hypopharynx; 31.3%; 93.7% men; median age 62 years; 66.0% stage IV) from 2001 to 2020 were included. Kaplan-Meier and Cox multivariable regression analyses were performed. 23.7% of patients received a PEG. 74.7% received a VP. Median OS was 131 months. Independent factors for lower OS were stage IV (compared to stage II; hazard ratio [HR] = 3.455; confidence interval [CI] 1.395-8.556) and laryngectomy for a recurrent disease (HR = 1.550; CI 1.078-2.228). Median time to PEG removal was 7 months. Prior partial surgery before laryngectomy showed a tendency for independent association for later PEG removal (HR = 1.959; CI 0.921-4.167). Postoperative aspiration needing treatment was an independent risk factor (HR = 2.679; CI 1.001-7.167) for later definitive VP removal. Laryngectomy continuously plays an important role in a curative daily routine treatment setting of advanced laryngeal or hypopharyngeal cancer in Germany. Long-term dependency on nutrition via PEG is an important issue, whereas use of VP is a stable long-term measure for voice rehabilitation.
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Affiliation(s)
- Mussab Kouka
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Louise Beckmann
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Thomas Bitter
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Holger Kaftan
- Department of Otorhinolaryngology, Helios-Klinikum Erfurt, Erfurt, Germany
| | - Daniel Böger
- Department of Otorhinolaryngology, SRH Zentralklinikum Suhl, Suhl, Germany
| | - Jens Büntzel
- Department of Otorhinolaryngology, Suedharzklinikum Nordhausen, Nordhausen, Germany
| | - Andreas Müller
- Department of Otorhinolaryngology, SRH Wald-Klinikum Gera, Gera, Germany
| | - Kerstin Hoffmann
- Department of Otorhinolaryngology, Sophien-Hufeland-Klinikum, Weimar, Germany
| | - Jiri Podzimek
- Department of Otorhinolaryngology, Klinikum Bad Salzungen, Bad Salzungen, Germany
| | - Klaus Pietschmann
- Department of Radiation Oncology, Jena University Hospital, Jena, Germany
| | - Thomas Ernst
- University Tumor Center, Jena University Hospital, Jena, Germany
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
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Bandi F, Chu F, Zurlo V, Di Natale V, Zorzi S, Pietrobon G, De Berardinis R, Tagliabue M, Ansarin M. Unlocking tracheoesophageal speech from pharyngoesophageal spasm: preliminary results of a videofluoroscopic-guided botulinum toxin A injection technique. Eur Arch Otorhinolaryngol 2024; 281:1885-1893. [PMID: 38278866 DOI: 10.1007/s00405-024-08448-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/29/2023] [Indexed: 01/28/2024]
Abstract
PURPOSE The tracheoesophageal puncture for the voice prosthesis (VP) placement is the recognized gold standard in post-laryngectomy voice rehabilitation. Despite the development of specific intraoperative techniques, a subset of patients will suffer from poor functional outcomes due to pharyngoesophageal spasms (PES). This paper evaluates the functional outcomes after transcutaneous botulinum toxin type A (BTX-A) infiltration for PES with a videofluoroscopy-guided technique. METHODS Since 2022, eight consecutive patients with VP and affected by PES were treated with BTX-A injection by a standard videofluoroscopic guided technique at the European Institute of Oncology, IRCCS (IEO) in Milan. A lidocaine test was performed pre-operatively to evaluate the potential effect of chemical neurectomy. All patients with positive lidocaine tests were injected with 50 IU of BTX-A (Allergan, Irvine, CA) according to the sites marked during the videofluoroscopy. Reported symptoms (VHI, SECEL), perceptual (INFVo), aerodynamic (MPT) and manometric parameters were collected before and after treatment. RESULTS In all cases, BTX-A was performed as an outpatient procedure without complications. For seven patients, only one BTX-A injection was needed, while one patient required a re-injection. Subjective and perceptive improvement after BTX-A was significant for VHI, SECEL and INFVo. MPT showed significant improvement after a chemical neurectomy. After a mean follow-up of 6 months, all patients maintained a good TES quality. CONCLUSION The videofluoroscopic guided BTX-A injection of the pharyngoesophageal tract showed to be a feasible and reproducible technique in all cases. The pharyngoesophageal videofluoroscopy allows defining of patients' anatomical landmarks that help the surgeon to perform a homogeneous injection, empowered by post-injection massage.
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Affiliation(s)
- Francesco Bandi
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Francesco Chu
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Valeria Zurlo
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Valentina Di Natale
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Stefano Zorzi
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Giacomo Pietrobon
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Rita De Berardinis
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Marta Tagliabue
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.
- Department of Biomedical Sciences, University of Sassari, 07100, Sassari, Italy.
| | - Mohssen Ansarin
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
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Grošelj A, Tancer I, Jerman A, Paučič J, Pušnik L. Pharyngeal reconstruction after total laryngectomy with sliding epiglottis: technical aspects with retrospective review. Front Oncol 2024; 13:1284266. [PMID: 38260857 PMCID: PMC10801030 DOI: 10.3389/fonc.2023.1284266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Several techniques have been employed for defect reconstruction after total laryngectomy, among others sliding epiglottoplasty. As there is a paucity of data on sliding epiglottoplasty after total laryngectomy, this study aimed to present this reconstruction technique in detail with the retrospective analysis of the patients. Methods We retrospectively reviewed single-center medical records of patients who underwent pharyngeal reconstruction after total laryngectomy between 2007-2013, with a follow-up to 2020. The study included patients who had total laryngectomy performed followed by a primary closure or sliding epiglottoplasty. The patients were divided according to the pharyngeal reconstruction technique: sliding epiglottis (n = 38) and primary closure (n = 120). Results The baseline characteristics of patients, TNM stages, and previous treatment strategies did not differ significantly between the sliding epiglottis and primary closure group. The postoperative complication rates, including the pharyngocutaneous fistulae formation and strictures were comparable between the analyzed groups; however, a slightly higher incidence of pharyngocutaneus fistulae was noted within the patients after sliding epiglottoplasty. Overall 3-year survival of patients who underwent the epiglottoplasty and primary closure group were 73.7% vs. 57.5%, respectively. Conclusions Sliding epiglottoplasty is considered a safe reconstruction technique. Although slightly better outcomes were noted within the epiglottoplasty group, it is still considered inferior to the primary closure. This technique ought to be considered in meticulously selected patients in whom primary closure is not feasible, epiglottis with nearby structures is spared from disease, and when the distal flaps are less appropriate or contraindicated.
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Affiliation(s)
- Aleš Grošelj
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Center Ljubljana, Ljubljana, Slovenia
- Department of Otorhinolaryngology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Anže Jerman
- Department of Maxillofacial and Oral Surgery, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Jošt Paučič
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Luka Pušnik
- Institute of Anatomy, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Cortina LE, Wu MP, Meyer CD, Feng AL, Varvares MA, Richmon JD, Deschler DG, Lin DT. Predictors of multiple dilations and functional outcomes after total laryngectomy and laryngopharyngectomy. Head Neck 2024; 46:138-144. [PMID: 37908173 DOI: 10.1002/hed.27545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/20/2023] [Accepted: 10/01/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Following total laryngectomy (TL) or laryngopharyngectomy (TLP), patients may develop strictures that require multiple dilations to treat. However, the risk factors associated with dysphagia refractory to a single dilation are unknown. METHODS Single-institution retrospective review of patients who underwent at least one stricture dilation after TL/TLP between March 2013 and March 2022. RESULTS A total of 49 patients underwent stricture dilation after TL/TLP. Thirty-five (71%) underwent multiple dilations. Pharyngocutaneous fistula, primary chemoradiation therapy, and a shorter time interval from TL/TLP to first dilation were independently associated with dysphagia requiring multiple dilations. Patients in the multiple dilations group had a higher rate of limited diet and G-tube dependence compared to patients in the single dilation group. CONCLUSIONS Shorter time interval to stricture formation is a prognostic indicator of the need for multiple dilations following TL/TLP. Patients requiring multiple dilations are at increased risk of persistent dysphagia long-term.
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Affiliation(s)
- Luis E Cortina
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Michael P Wu
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Charles D Meyer
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Allen L Feng
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Mark A Varvares
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Jeremy D Richmon
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Daniel G Deschler
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Derrick T Lin
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
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7
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Bramati C, Galli A, Salerno E, Giordano L. Challenging management of an enlarged tracheoesophageal fistula in an irradiated patient. BMJ Case Rep 2023; 16:e255770. [PMID: 37977831 PMCID: PMC10661048 DOI: 10.1136/bcr-2023-255770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
Speech restoration after total laryngectomy may be achieved in different ways, the gold standard being tracheoesophageal puncture (TPE) with the positioning of a speech prosthesis. TPE is not immune to complications, the most common of which being leakage through or around the prosthesis. When dealing with an enlarged tracheoesophageal fistula, the management can be either conservative or surgical. In the following case report, we present a particularly challenging case, in which every conservative strategies failed and a major surgery was required to close the fistula.
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Affiliation(s)
- Chiara Bramati
- Otorhinolaryngology - Head& Neck Surgery Department, IRCCS Ospedale San Raffaele, Milano, Lombardia, Italy
| | - Andrea Galli
- Otorhinolaryngology - Head& Neck Surgery Department, IRCCS Ospedale San Raffaele, Milano, Lombardia, Italy
| | - Emilio Salerno
- Otorhinolaryngology - Head& Neck Surgery Department, IRCCS Ospedale San Raffaele, Milano, Lombardia, Italy
| | - Leone Giordano
- Otorhinolaryngology - Head& Neck Surgery Department, IRCCS Ospedale San Raffaele, Milano, Lombardia, Italy
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Jabbour N, Rodriggs T, O'Dea M, Mur T, Vitale K, L Faden D. Protocolized awake secondary tracheoesophageal puncture with immediate voicing. Head Neck 2023; 45:2735-2740. [PMID: 37671696 DOI: 10.1002/hed.27506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/25/2023] [Accepted: 08/20/2023] [Indexed: 09/07/2023] Open
Abstract
Tracheoesophageal (TE) puncture with voice prosthesis placement is a common method for vocal rehabilitation in patients who have undergone total laryngectomy. Tracheoesophageal voice prosthesis (TEP) placement after laryngectomy, known as secondary TE puncture, is traditionally done in the operating room, using rigid esophagoscopy. Traditional secondary TEP placement carries a number of downsides including risks associated with general anesthesia, high cost, and technical challenges associated with anatomical variables. As a result, in-office secondary TE puncture has become an increasingly utilized procedure with many advantages but currently lacks standardization. Here, we describe a kit-based, awake, in-office secondary TE puncture with primary TEP placement technique. This technique calls for an endoscopic snare in the event there is difficulty passing the guidewire in the cranial trajectory. No surgical technique videos demonstrating in-office secondary TE puncture currently exist. Here, we present a video tutorial of our technique, breaking down the procedure into 10 steps from analgesia to voicing.
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Affiliation(s)
- Nicolette Jabbour
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Timothy Rodriggs
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Meredith O'Dea
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Avedisian School of Medicine, Boston University Chobanian, Boston, Massachusetts, USA
- MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Taha Mur
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kailey Vitale
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Avedisian School of Medicine, Boston University Chobanian, Boston, Massachusetts, USA
| | - Daniel L Faden
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Avedisian School of Medicine, Boston University Chobanian, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
- Massachusetts Eye and Ear, Boston, Massachusetts, USA
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9
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Eita A, Mohamed N, Rybkin A, Kang JJ, Fiasconaro M, Zhigang Z, Zakeri K, Yu Y, Sadaka E, Sherman E, Dunn L, Cracchiolo J, Wong RJ, Cohen M, Lee NY. Outcomes for Organ Preservation with Chemoradiation Therapy for T4 Larynx and Hypopharynx Cancer. Laryngoscope 2023; 133:1138-1145. [PMID: 35801573 PMCID: PMC10547133 DOI: 10.1002/lary.30279] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 05/27/2022] [Accepted: 06/09/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Limited data is available to guide non-surgical management of Stage T4 larynx and hypopharynx cancer patients who have inoperable disease or refuse surgery. We aim to review the nonoperative management of T4 laryngeal and hypopharyngeal cancer and report the long-term therapeutic and functional outcomes. METHODS We reviewed the nonoperative management of T4 laryngeal (n = 44) and hypopharyngeal (n = 53) cancer from 1997 to 2015 and performed a univariate analysis (UVA). RESULTS The 2-/5-year OS rates were 73%/38% for larynx patients and 52%/29% for hypopharynx patients. Locoregional failure (LRF) occurred in 25% and 19% of larynx and hypopharynx patients, respectively. On UVA of the larynx subset, N3 nodal status and non-intensity-modulated radiation therapy were negatively associated with OS; treatment with radiation therapy alone impacted disease-free survival; and age >70 was associated with LRF. On UVA of the hypopharynx subset, only T4b status significantly impacted OS. In the larynx and hypopharynx groups, 68% and 85% received a percutaneous endoscopic gastrostomy (PEG) tube and 32% and 40% received a tracheostomy tube, respectively. At the last follow-up visit, 66% of our larynx cohort had neither tracheostomy or PEG placed and 40% of our hypopharynx cohort had neither. CONCLUSION We report better than previously noted outcomes among T4 larynx and hypopharynx patients who have unresectable disease or refuse surgery. LEVEL OF EVIDENCE 4 Laryngoscope, 133:1138-1145, 2023.
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Affiliation(s)
- Amgad Eita
- Department of Radiation Oncology, Memorial Sloan Kettering, New York, USA
| | - Nader Mohamed
- Department of Radiation Oncology, Memorial Sloan Kettering, New York, USA
| | - Alisa Rybkin
- Department of Radiation Oncology, Memorial Sloan Kettering, New York, USA
| | - Jung Julie Kang
- Department of Radiation Oncology, Memorial Sloan Kettering, New York, USA
| | - Megan Fiasconaro
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering, New York, USA
| | - Zhang Zhigang
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering, New York, USA
| | - Kaveh Zakeri
- Department of Radiation Oncology, Memorial Sloan Kettering, New York, USA
| | - Yao Yu
- Department of Radiation Oncology, Memorial Sloan Kettering, New York, USA
| | - Emad Sadaka
- Department of Clinical Oncology, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Eric Sherman
- Department of Medicine, Memorial Sloan Kettering, New York, USA
| | - Lara Dunn
- Department of Medicine, Memorial Sloan Kettering, New York, USA
| | | | - Richard J. Wong
- Department of Surgery, Memorial Sloan Kettering, New York, USA
| | - Marc Cohen
- Department of Surgery, Memorial Sloan Kettering, New York, USA
| | - Nancy Y. Lee
- Department of Radiation Oncology, Memorial Sloan Kettering, New York, USA
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Brisson-McKenna M, Jefferson GD, Siddiqui SH, Adams S, Afanasieva Sonia S, Chérid A, Burns J, Di Gironimo C, Mady LJ. Swallowing Function After Treatment of Laryngeal Cancer. Otolaryngol Clin North Am 2023; 56:371-388. [PMID: 37030949 DOI: 10.1016/j.otc.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Dysphagia is a common functional outcome following treatment of laryngeal cancer. Despite curative advances in both nonsurgical and surgical approaches, preserving and optimizing swallowing function is critical. Understanding the nature and severity of dysphagia depending on initial tumor staging and treatment modality and intensity is crucial. This chapter explores current evidence on the acute and chronic impacts of treatments for laryngeal cancer on swallow function, as well as the medical and nonmedical management of dysphagia in this population.
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Affiliation(s)
- Maude Brisson-McKenna
- Department of Speech-Language Pathology, McGill University Health Centre, Glen site, D04.7510-1001 boul. Décarie, Montréal, QC, H4A 3J1, Canada.
| | - Gina D Jefferson
- Department of Otolaryngology-Head and Neck Surgery, University of Mississippi Medical Center, 2500 N. State St.Jackson, MS 39216-4505, USA
| | - Sana H Siddiqui
- Head & Neck Surgery, Thomas Jefferson University Hospitals, 925 Chestnut Street, 6th Floor, Philadelphia, PA 19107, USA
| | - Sarah Adams
- Voice and Swallowing Center, Thomas Jefferson University Hospitals, 925 Chestnut Street, 6th Floor, Philadelphia, PA 19107, USA
| | - Sofia Afanasieva Sonia
- Department of Speech-Language Pathology, McGill University Health Centre, Glen site, D04.7510-1001 boul. Décarie, Montréal, QC, H4A 3J1, Canada
| | - Aïda Chérid
- Department of Speech-Language Pathology, McGill University Health Centre, Glen site, D04.7510-1001 boul. Décarie, Montréal, QC, H4A 3J1, Canada
| | - Jesse Burns
- Department of Speech-Language Pathology, McGill University Health Centre, Glen site, D04.7510-1001 boul. Décarie, Montréal, QC, H4A 3J1, Canada
| | - Carla Di Gironimo
- Department of Speech-Language Pathology, McGill University Health Centre, Glen site, D04.7510-1001 boul. Décarie, Montréal, QC, H4A 3J1, Canada
| | - Leila J Mady
- Head & Neck Surgery, Thomas Jefferson University Hospitals, 925 Chestnut Street, 6th Floor, Philadelphia, PA 19107, USA; Cancer Risk and Control Program of Excellence, Sidney Kimmel Cancer Center, 233 S 10th Street, Philadelphia, PA 19107, USA
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11
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Tang JA, McCarroll L, Schmalbach CE. Voice Restoration and Quality of Life in Larynx Cancer. Otolaryngol Clin North Am 2023; 56:361-370. [PMID: 37030948 DOI: 10.1016/j.otc.2022.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2023]
Abstract
Voice restoration following laryngectomy has a significant influence on quality of life (QOL). Three main techniques exist to provide voice: esophageal speech (ES), artificial larynx (electrolarynx [EL]), and tracheoesophageal puncture (TEP). Although the EL was historically the most used technique, TEP has quickly become the gold standard. ES remains the least frequently used technique in developed countries. Technique selection must be made on an individual basis, considering the patient's cancer history and comorbidities. Ultimately, the choice in voice-restoration technique requires joint decision making with the surgeon, speech pathologist, and patient.
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Affiliation(s)
- Jessica A Tang
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins Hospital, 601 N. Caroline Street, Baltimore, MD 21287, USA
| | - Liane McCarroll
- Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA
| | - Cecelia E Schmalbach
- Department of Otolaryngology-HNS, Lewis Katz School of Medicine at Temple University, Temple Head & Neck Institute, Fox Chase Cancer Center, 3440 North Broad Street, Kresge West 309, Philadelphia, PA 19140, USA.
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12
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Hanubal KS, Chheda NN, Dziegielewski PT. Neopharyngeal Stricture following Laryngectomy. Semin Plast Surg 2023; 37:31-38. [PMID: 36776807 PMCID: PMC9911225 DOI: 10.1055/s-0042-1759796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Stricture formation is a serious complication following pharyngeal reconstruction. These strictures can be life-threatening and can severely impact quality of life. In this article, the existing literature on surgical risk factors linked to neopharyngeal stricture formation is reviewed. Intraoperative preventative measures reconstructive surgeons should consider are also discussed. Finally, this article will describe the evaluation and management of pharyngoesophageal strictures, including the challenges and options when dealing with refractory strictures.
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Affiliation(s)
| | - Neil N. Chheda
- Department of Otolaryngology, University of Florida, Gainesville, Florida
| | - Peter T. Dziegielewski
- Department of Otolaryngology, University of Florida, Gainesville, Florida
- University of Florida Health Cancer Center, Gainesville, Florida
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13
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Doyle PC, Damrose EJ. Has Esophageal Speech Returned as an Increasingly Viable Postlaryngectomy Voice and Speech Rehabilitation Option? JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:4714-4723. [PMID: 36450150 DOI: 10.1044/2022_jslhr-22-00356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE The literature on postlaryngectomy voice and speech rehabilitation is long-standing. Although multiple rehabilitation options have existed over the years, the acquisition and use of esophageal speech (ES) has decreased significantly over the past 40 years. This reduction coincides with the increased application of tracheoesophageal puncture (TEP) voice restoration. The literature suggests that voice acquisition failures observed secondary to TEP may represent a similar phenomenon that led to ES acquisition failures. METHOD A comprehensive review of the literature on ES and TEP voice/speech was conducted. Specific attention was directed toward information on ES and TEP speech failures. Information on pharyngoesophageal segment (PES) spasm in the context of ES and TEP voicing failures was of specific importance. RESULTS Similarities between voicing failures with both ES and TEP were identified. In order to resolve spasm in TEP speech, proactive efforts to eliminate it were undertaken, and regardless of the method used, voicing improvements were observed. These data suggest that both ES and TEP speech acquisition failures may be related to the same control mechanisms influencing the PES. CONCLUSIONS The elimination of PES spasm provides evidence that justifies the reconsideration of ES. Consequently, ES may return as an increasingly viable postlaryngectomy voice and speech rehabilitation option.
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Affiliation(s)
- Philip C Doyle
- Division of Laryngology, Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford University, CA
| | - Edward J Damrose
- Division of Laryngology, Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford University, CA
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14
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Zhang J, Li Q, Wu HY, Yang Y. A Systematic Review of Swallowing Training Measures for Postoperative Oral Cancer Patients. Dysphagia 2022; 37:1839-1850. [PMID: 35435477 DOI: 10.1007/s00455-022-10445-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/28/2022] [Indexed: 12/24/2022]
Abstract
Swallowing disorder is one of the most common postoperative complications for oral cancer patients and seriously influences quality of life. Limited attention has been paid to evaluating swallowing training measures in postoperative oral cancer patients. This study systematically reviewed swallowing training measures for these patients. A comprehensive search strategy was undertaken across various databases for studies published between database inception and 15 June 2021. Raters independently judged titles, abstracts and full articles for selection according to inclusion and exclusion criteria. The included literature was evaluated for quality and data were extracted. Meta-analyses were conducted using RevMan 5.3. Ten intervention studies (four randomized controlled trials and six quasi-experimental studies) involving 588 patients were identified. Across the studies, most started in the early postoperative stage; however, there were differences in starting time, training time and duration, and type of training. We summarized four training methods: oral exercise, oral sensory stimulation, compensatory strategies and protective airway manoeuvres. The meta-analysis indicated that swallowing training could improve patients' swallowing function and quality of life in the short term, but the long-term effects were not obvious. Swallowing training mostly occurred in the early postoperative period and training measures were often used in combination. The timing, frequency and content of interventions varied between studies, and the effectiveness of any single measure was unclear. High-quality randomized controlled trials are necessary to study the efficacy and clinical applicability of various training measures, to provide a theoretical basis for their optimal selection and to develop a standardized training programme for postoperative oral cancer patients.
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Affiliation(s)
- Jing Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology, Beijing, 100081, China
| | - Quan Li
- Tianjin Medical University Eye Hospital, Tianjin, 300384, China
| | - Hong-Yun Wu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology, Beijing, 100081, China
| | - Yue Yang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology, Beijing, 100081, China.
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15
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Rahayu Rarasati R, Herawati Juniati S, Yusuf M. Conformity between modified Swallowing Outcome After Laryngectomy questionnaire and Flexible Endoscopic Evaluation of Swallowing in laryngeal carcinoma patients after total laryngectomy. J Public Health Res 2022; 11:22799036221127624. [PMID: 36310823 PMCID: PMC9597034 DOI: 10.1177/22799036221127624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/01/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND One of the impacts in anatomic laryngeal and phariyngeal changes after total laryngectomy (TL) is oropharyngeal dysphagia (OPD). The detection of neopharyngeal residue as a sign of OPD can be performed by videofluoroscopy (VFS) and flexible endoscopic evaluation of swallowing (FEES). The availability of these tools in rural areas is still limited, thus the treatment of OPD is not maximal. There is a need for a more practical tool, including the modified swallowing outcomes after laryngectomy (SOAL) questionnaire. METHODS This was an analytic observational diagnostic study with a cross-sectional approach. Samples were obtained in Otorhinolaryngology Oncology Clinic and Outpatient Clinic of Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, who filled SOAL modified questionnaire followed by FEES. Samples were obtained within 3 months from 10 May to 10 August 2021. The number of samples obtained through simple random sampling was 16 post-TL patients from a total population of 17 patients who met the inclusion and exclusion criteria. The conformity test between modified SOAL questionnaire and FEES was analyzed using McNemar comparison test and Kappa association test. RESULTS McNemar test showed no significant difference between both assessment tools (p > 0.05), and the Kappa test showed an association between both tools (p < 0.05). The results of this study stated that there was conformity between modified SOAL questionnaire and FEES in patients after TL in all types of food bolus had Kappa score of >0.81, showing a reliable association between these tools. Kappa test also showed that out of all three types of boluses, the soft bolus had the highest conformity with a Kappa score of 0.875, followed by thick bolus with 0.839, and watery bolus with 0.818. CONCLUSION There was a conformity between the results of the modified SOAL questionnaire and FEES in head and neck surgery patients after TL.
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Affiliation(s)
| | - Sri Herawati Juniati
- Sri Herawati Juniati, Department of
Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universitas
Airlangga- Dr. Soetomo General Academic Hospital Center, Surabaya, East Java,
Indonesia. Emails: ;
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16
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赵 小, 马 志, 李 碧, 冯 勇, 余 晓, 樊 建, 何 刚, 李 彬. [The one-stage technology of epiglottis function and voice reconstruction after total laryngectomy with the sternohyoid myocutaneous flap]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2022; 36:753-757. [PMID: 36217653 PMCID: PMC10128554 DOI: 10.13201/j.issn.2096-7993.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Indexed: 06/16/2023]
Abstract
Objective:To investigate the clinical effect of one-stage sternohyoid musculocutaneous flap after total laryngectomy for reconstruction of epiglottis function and vocalization. Methods:A retrospective analysis of 8 patients who underwent total laryngectomy from November 2019 to September 2020. The sternohyoid myocutaneous flap was designed after total laryngectomy. The lower edge of the flap was sewed with the posterior upper edge of the tracheostomy opening, and the lateral and medial edges of the flap were anastomosed to create a vocal tube. The lateral edge of the upper end of tube was sutured with the anterolateral wall of the hypopharynx, then made full use of residual epiglottis and tongue root tissue to reconstruct epiglottis function. Results:None of the 8 patients had serious complications after total laryngectomies. Fifteen months after operation,the vocal tube flaps survived and had intact structure under fiberoptic laryngoscope. All patients could speak clearly and forcefully, and the swallowing function was intact. Conclusion:The use of adjacent myocutaneous flap to construct the vocal canal and reconstruct the epiglottis function is a simple and effective technique that can be completed in one stage and improve the voicing of patients undergoing total laryngectomy.
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Affiliation(s)
- 小龙 赵
- />四川省人民医院 电子科技大学附属医院耳鼻咽喉头颈外科(成都,610000)Department of Otolaryngology Head and Neck Surgery, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology, Chengdu, 610000, China
| | - 志跃 马
- />四川省人民医院 电子科技大学附属医院耳鼻咽喉头颈外科(成都,610000)Department of Otolaryngology Head and Neck Surgery, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology, Chengdu, 610000, China
| | - 碧澜 李
- />四川省人民医院 电子科技大学附属医院耳鼻咽喉头颈外科(成都,610000)Department of Otolaryngology Head and Neck Surgery, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology, Chengdu, 610000, China
| | - 勇 冯
- />四川省人民医院 电子科技大学附属医院耳鼻咽喉头颈外科(成都,610000)Department of Otolaryngology Head and Neck Surgery, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology, Chengdu, 610000, China
| | - 晓旭 余
- />四川省人民医院 电子科技大学附属医院耳鼻咽喉头颈外科(成都,610000)Department of Otolaryngology Head and Neck Surgery, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology, Chengdu, 610000, China
| | - 建刚 樊
- />四川省人民医院 电子科技大学附属医院耳鼻咽喉头颈外科(成都,610000)Department of Otolaryngology Head and Neck Surgery, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology, Chengdu, 610000, China
| | - 刚 何
- />四川省人民医院 电子科技大学附属医院耳鼻咽喉头颈外科(成都,610000)Department of Otolaryngology Head and Neck Surgery, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology, Chengdu, 610000, China
| | - 彬 李
- />四川省人民医院 电子科技大学附属医院耳鼻咽喉头颈外科(成都,610000)Department of Otolaryngology Head and Neck Surgery, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology, Chengdu, 610000, China
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17
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Mialland A, Kinsiklounon B, Tian G, Noûs C, Bonvilain A. Submental MechanoMyoGraphy (MMG) to Characterize the Swallowing Signature. Ing Rech Biomed 2022. [DOI: 10.1016/j.irbm.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Wu C, Zhang D, Yuan X, Chen L, Tao L. Indications and complications of secondary tracheoesophageal puncture in Chinese laryngectomees. Acta Otolaryngol 2022; 142:721-730. [PMID: 36264159 DOI: 10.1080/00016489.2022.2128407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Although there are many literatures about secondary tracheoesophageal puncture (TEP) for voice prosthesis. Most of the description of indications is not specific and the description of complications is not so vivid, which is not of great value for novice doctors. OBJECTIVE To show specific indications and vivid complications of secondary TEP with typical clinical pictures for novice doctors. MATERIAL AND METHODS The clinical data of 20 patients undergoing secondary TEP for Provox Vega voice prosthesis in our hospital were analyzed. The surgical indications and the prevention and treatment of common perioperative complications were summarized. RESULTS The surgical indications included: no obvious stenosis of the stoma and the entrance of esophagus; no obvious scar constitution, mouth opening restriction and backward restraint of the neck, etc. The common postoperative complications included: TEP fistula infection (2 cases), bleeding of the fistula (1 case), deep neck abscess (1 case), granulation hyperplasia at the inner side of the fistula (1 case), invagination of the voice prosthesis (2 cases) and leakage (2 cases). CONCLUSIONS AND SIGNIFICANCE The secondary TEP for Provox Vega voice prosthesis is clinically safe, but certain indications should be mastered. Common postoperative complications can be solved through preventive and remedial treatment schemes.
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Affiliation(s)
- Chunping Wu
- Department of Otorhinolaryngology Head and Neck Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, PR China
| | - Duo Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, PR China
| | - Xiaohui Yuan
- Department of Otorhinolaryngology Head and Neck Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, PR China
| | - Ling Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, PR China
| | - Lei Tao
- Department of Otorhinolaryngology Head and Neck Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, PR China
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Zheng L, Luo Z, Wang H, Liu S, Li X, Peng D, Liu Y, Ye S, Lu Y, Chen J, Mei Z, Wei L, Qian Y, Lin X, Xu C. Effectiveness of a nurse-led coaching of self-care agency intervention for elderly patients with total laryngectomy: study protocol for a randomised controlled trial. BMJ Open 2022; 12:e061238. [PMID: 36008060 PMCID: PMC9422826 DOI: 10.1136/bmjopen-2022-061238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Due to functional defects and structural destruction after total laryngectomy, patients experienced the poor quality of life, especially for elderly. The barriers to accessing self-care in elderly patients were considered to result from complex and multifaceted interactions of biologic and social factors. Therefore, specific efforts to improve elderly patients' quality of life are needed. The purpose of our study is to verify nurse-led coaching of elderly patient self-care approaches, which can reduce logistic burden of patients and obtain the successful functional rehabilitation ultimately. METHODS AND ANALYSIS Elderly patients (n=60) scheduled for total laryngectomy will be randomly divided into the intervention group and the control group. Patients in the control group received routinely nursing during hospitalisation and thereby at home after discharge received conventional family care without regular supervision of nurses. Patients in the intervention group will receive a series of self-care intervention based on the transtheoretical model during hospitalisation. During home after discharge, nurses will additionally evaluate and supervise the self-care effect of patients. The two groups of patients' self-care agency, self-efficacy, quality of life and nutritional status will be recorded separately at different time points. Primary outcome is the improvement of patients' self-care agency, and secondary outcome is the improvements of patients' self-efficacy, quality of life, nutritional states and 3-month unplanned readmission rate. ETHICS AND DISSEMINATION The Ethics Committee of Hubei Cancer Hospital has approved this protocol (KYLLBA2020006). The findings of the trial will be disseminated through peer-reviewed journals, national or international conferences. TRIAL REGISTRATION NUMBER ChiCTR2100043731.
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Affiliation(s)
- Liyuan Zheng
- Department of Head and Neck Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhen Luo
- Department of Head and Neck Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huifen Wang
- Department of Nursing, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shu'e Liu
- Department of Head and Neck Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xue Li
- Department of Head and Neck Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Danxia Peng
- Department of Head and Neck Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Liu
- Department of Head and Neck Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sanxia Ye
- Department of Head and Neck Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuchen Lu
- Department of Head and Neck Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jian Chen
- Department of Head and Neck Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhidan Mei
- Department of Head and Neck Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lai Wei
- Department of Radiotherapy, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Qian
- Department of Thoracic Medicine, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xi Lin
- Department of Thoracic Medicine, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chun Xu
- Department of Head and Neck Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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20
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Umezawa H, Umezawa M, Hokazono Y, Matsutani T, Ogawa R. Relationship between pharyngeal or esophageal reconstruction and esophageal pressure after swallowing. Cancer Rep (Hoboken) 2022; 6:e1619. [PMID: 35384372 PMCID: PMC9875660 DOI: 10.1002/cnr2.1619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 01/23/2022] [Accepted: 03/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND High-resolution manometry, which measures esophageal luminal pressure changes after swallowing, could shed more light on food-transport dynamics after pharyngeal/esophageal reconstruction. This prospective cohort study assessed the influence of two head-and-neck and esophageal tumor-resection and reconstruction approaches on esophageal pressure. METHODS The cohort consisted of 17 patients who underwent esophageal/pharyngeal resection/reconstruction for cancer and then participated in postoperative high-resolution manometry. Five healthy controls also underwent manometry for comparison. RESULTS Partial pharyngectomy with patch grafts associated with smooth and continuous esophageal/pharyngeal movement. By contrast, surgery that removed the thoracic esophagus led to complete loss of peristalsis and poor food transport. CONCLUSIONS High-resolution manometry effectively characterized the changes in food-transport dynamics caused by pharyngeal/esophageal resection/reconstruction. These findings suggest that continuous and smooth movement of the pharynx and esophagus is important for swallowing and high resolution manometry could be useful in patients after pharyngeal/esophageal resection/reconstruction.
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Affiliation(s)
- Hiroki Umezawa
- Department of Plastic, Reconstructive and Aesthetic SurgeryNippon Medical SchoolTokyoJapan
| | - Mariko Umezawa
- Department of GastroenterologyNippon Medical SchoolTokyoJapan
| | - Yu Hokazono
- Department of Plastic, Reconstructive and Aesthetic SurgeryNippon Medical SchoolTokyoJapan
| | | | - Rei Ogawa
- Department of Plastic, Reconstructive and Aesthetic SurgeryNippon Medical SchoolTokyoJapan
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21
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Tsao CK, Marchi F, Kang CJ, Sampieri C, Lu YA, Huang SF, Chen YT, Giordano G, Peretti G, Parrinello G, Iandelli A, Fang TJ. Comprehensive Evaluation of Vocal Outcomes and Quality of Life after Total Laryngectomy and Voice Restoration with J-Flap and Tracheoesophageal Puncture. Cancers (Basel) 2022; 14:cancers14030544. [PMID: 35158812 PMCID: PMC8833548 DOI: 10.3390/cancers14030544] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/13/2022] [Accepted: 01/17/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Laryngopharyngectomy is still the treatment of choice in locally advanced pharyngolaryngeal tumors not eligible for organ preservation protocols. Loss of speech capacity has been reported as one of the factors that most affect the patient-reported quality of life. Thus, the reconstructive goals are restoring the pharynx and possibly the voice in such a scenario. For decades, tracheoesophageal puncture (TEP) has allowed proper voice rehabilitation; however, TEP has a non-neglectable financial expenditure and complication rate. Therefore, we recently reported a novel flap design and surgical technique that shares the same principles of TEP, without the need to change any device over time, named J-flap. This study aimed to analyze both techniques’ subjective and objective vocal outcomes and their impact on overall and voice-related quality of life. Abstract Background: Tracheoesophageal puncture with a voice prosthesis is the gold standard for speech rehabilitation in patients that receive a laryngopharyngectomy. However, a novel surgical technique, using a tubularized anterolateral tight flap, named “J-flap,” has been demonstrated to produce adequate voice restoration. We aimed to compare the outcomes and the quality of life of patients who underwent voice rehabilitation with both techniques. Methods: We enrolled patients that underwent laryngopharyngectomy and voice restoration surgery. The control group received a tracheoesophageal puncture with a voice prosthesis, while the study group received J-flap reconstruction. A total of 20 patients received voice prosthesis rehabilitation, while 18 received J-flap reconstruction. Speech and vocal outcomes and quality of life metrics were collected. Results: The objective phonatory performances and the acoustic voice analysis did not outline a significant difference. Speech pathologists judged the consonant pronunciation in the J-flap group as less accurate (p < 0.001). The voice handicap index revealed a moderate impairment for the J-flap group (p < 0.001). Quality of life scores were higher for the voice prosthesis group. Conclusion: Voice prostheses and J-flaps share similar objective phonatory outcomes. Quality of life was more impaired in the J-flap group. In our view, these two techniques possess complementary characteristics in clinical practice, taking into account health care system regulations and patients’ social background.
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Affiliation(s)
- Chung-Kan Tsao
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taipei 333, Taiwan; (C.-K.T.); (F.M.); (Y.-T.C.)
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Filippo Marchi
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taipei 333, Taiwan; (C.-K.T.); (F.M.); (Y.-T.C.)
- Department of Otolaryngology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (C.S.); (G.G.); (G.P.); (G.P.)
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
| | - Chung-Jan Kang
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taipei 333, Taiwan; (C.-J.K.); (Y.-A.L.); (S.-F.H.)
| | - Claudio Sampieri
- Department of Otolaryngology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (C.S.); (G.G.); (G.P.); (G.P.)
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
| | - Yi-An Lu
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taipei 333, Taiwan; (C.-J.K.); (Y.-A.L.); (S.-F.H.)
| | - Shiang-Fu Huang
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taipei 333, Taiwan; (C.-J.K.); (Y.-A.L.); (S.-F.H.)
| | - Yu-Ting Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taipei 333, Taiwan; (C.-K.T.); (F.M.); (Y.-T.C.)
| | - Giorgio Giordano
- Department of Otolaryngology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (C.S.); (G.G.); (G.P.); (G.P.)
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
| | - Giorgio Peretti
- Department of Otolaryngology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (C.S.); (G.G.); (G.P.); (G.P.)
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
| | - Giampiero Parrinello
- Department of Otolaryngology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (C.S.); (G.G.); (G.P.); (G.P.)
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
| | - Andrea Iandelli
- Department of Otolaryngology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (C.S.); (G.G.); (G.P.); (G.P.)
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taipei 333, Taiwan; (C.-J.K.); (Y.-A.L.); (S.-F.H.)
- Correspondence: (A.I.); (T.-J.F.)
| | - Tuan-Jen Fang
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taipei 333, Taiwan; (C.-J.K.); (Y.-A.L.); (S.-F.H.)
- Correspondence: (A.I.); (T.-J.F.)
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22
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Hans S, Chebib E, Chekkoury-Idrissi Y, Distinguin L, Circiu M, Vialatte de Pemille G, Julien-Laferriere A, Crevier-Buchman L, Lechien JR. Surgical and oncological outcomes of transoral robotic total laryngectomy: A case series. Oral Oncol 2021; 121:105511. [PMID: 34474271 DOI: 10.1016/j.oraloncology.2021.105511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 08/01/2021] [Accepted: 08/22/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the oncological, functional and voice rehabilitation outcomes of transoral robotic surgery for total laryngectomy (TORS-TL). METHODS A retrospective chart review of patients treated by TORS-TL was conducted at a single academic medical center. The following outcomes were studied: indication; average robotic set-up and operative times; mean estimated blood loss; postoperative complications; re-feeding features; mean hospital stay; need of adjuvant therapy and voice rehabilitation type. RESULTS TORS-TL was performed in 10 patients for the following indications: nonfunctional larynx (N = 2); low-grade cricoid chondrosarcoma (N = 3) and recurrent laryngeal cancer after (chemo) radiation (N = 5). Two patients were excluded because the larynx was not exposable. Average robotic set-up and operative times were 20 and 278 min, respectively. The mean estimated blood loss was 50 mL. The mean hospital stay was 13.9 days (8-28 days). There was no local recurrence in patients operated for cancer recurrence (N = 5) 5 years after the surgery. Distant metastases occurred in one patient. A patient with laryngeal chondrosarcoma experienced local failure 3 years after TORS-TL. The voice rehabilitation consisted of esophageal voice (N = 2) and tracheoesophageal prosthesis (Provox®, N = 8). The main reasons for prosthesis replacement were transprosthetic (79%) and periprosthetic leaks (21%). The median lifespan of prostheses was 81 days. CONCLUSION TORS-TL may be a safe and effective surgical approach for selected surgical indications. Future controlled studies are needed to determine additional indications and limitations of this procedure.
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Affiliation(s)
- Stéphane Hans
- Robotic Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Emilien Chebib
- Robotic Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Younès Chekkoury-Idrissi
- Robotic Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Léa Distinguin
- Robotic Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Marta Circiu
- Robotic Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Grégoire Vialatte de Pemille
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Aude Julien-Laferriere
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Lise Crevier-Buchman
- Robotic Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Jérôme R Lechien
- Robotic Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.
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23
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Gheorghe DC, Ilie A, Niculescu AG, Grumezescu AM. Preventing Biofilm Formation and Development on Ear, Nose and Throat Medical Devices. Biomedicines 2021; 9:1025. [PMID: 34440229 PMCID: PMC8394763 DOI: 10.3390/biomedicines9081025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/10/2021] [Accepted: 08/14/2021] [Indexed: 12/17/2022] Open
Abstract
Otorhinolaryngology is a vast domain that requires the aid of many resources for optimal performance. The medical devices utilized in this branch share common problems, such as the formation of biofilms. These structured communities of microbes encased in a 3D matrix can develop antimicrobial resistance (AMR), thus making it a problem with challenging solutions. Therefore, it is of concern the introduction in the medical practice involving biomaterials for ear, nose and throat (ENT) devices, such as implants for the trachea (stents), ear (cochlear implants), and voice recovery (voice prosthetics). The surface of these materials must be biocompatible and limit the development of biofilm while still promoting regeneration. In this respect, several surface modification techniques and functionalization procedures can be utilized to facilitate the success of the implants and ensure a long time of use. On this note, this review provides information on the intricate underlying mechanisms of biofilm formation, the large specter of implants and prosthetics that are susceptible to microbial colonization and subsequently related infections. Specifically, the discussion is particularized on biofilm development on ENT devices, ways to reduce it, and recent approaches that have emerged in this field.
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Affiliation(s)
- Dan Cristian Gheorghe
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- “M.S. Curie” Clinical Emergency Hospital for Children, 077120 Bucharest, Romania
| | - Andrei Ilie
- Faculty of Engineering in Foreign Languages, University Politehnica of Bucharest, 060042 Bucharest, Romania; (A.I.); (A.-G.N.)
| | - Adelina-Gabriela Niculescu
- Faculty of Engineering in Foreign Languages, University Politehnica of Bucharest, 060042 Bucharest, Romania; (A.I.); (A.-G.N.)
- Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 060042 Bucharest, Romania
| | - Alexandru Mihai Grumezescu
- Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 060042 Bucharest, Romania
- Research Institute of the University of Bucharest—ICUB, University of Bucharest, 050657 Bucharest, Romania
- Academy of Romanian Scientists, 3 Ilfov Street, 50044 Bucharest, Romania
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Anjos LMD, Ferreira TEDS, Pernambuco L. Biomechanics of the tongue during swallowing after total laryngectomy: an integrative review. Codas 2021; 33:e20200102. [PMID: 34190810 DOI: 10.1590/2317-1782/20202020102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 10/12/2020] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To synthesize the state of scientific knowledge about biomechanics of the tongue during swallowing after total laryngectomy. RESEARCH STRATEGY The PICO question and combinations of descriptors and single terms were formulated in the PubMed/Medline, EMBASE, LILACS, and SciELO databases. SELECTION CRITERIA Articles in Portuguese, English, or Spanish were included, without time limit, with results on the biomechanics of the tongue during swallowing and total laryngectomy, and studies on randomized or non-randomized clinical trials, cohort, case control, cross-sectional, case series, and case studies. DATA ANALYSIS year, country, population, objective, study design, assessment methods, main outcomes, and methodological quality were analyzed. RESULTS There were four studies in the United States, one in Australia, and one in Brazil, all published between 1986 and 2014. In all studies, the biomechanics of the tongue was the secondary outcome. Most articles had low methodological quality, small samples, predominance of the male gender, and a prevalent cross-sectional design. The assessment instruments were fluoroscopy, manometry, accelerometer or a device to capture tongue pressure. Main results indicated a higher propulsion force of the tongue base to overcome the high resistance of the neopharynx to the bolus flow, reduced contact and pressure between the base of the tongue and the posterior pharyngeal wall, residues in the tongue base after swallowing, increased pressure, and reduced resistance of the oral tongue. CONCLUSION There are indications of compensatory tongue movements during swallowing after total laryngectomy; however, the scientific evidence is insufficient.
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Affiliation(s)
- Larissa Mendonça Dos Anjos
- Programa Associado de Pós-graduação em Fonoaudiologia, Universidade Federal da Paraíba - UFPB - João Pessoa (PB), Brasil
| | | | - Leandro Pernambuco
- Programa Associado de Pós-graduação em Fonoaudiologia, Universidade Federal da Paraíba - UFPB - João Pessoa (PB), Brasil.,Departamento de Fonoaudiologia, Universidade Federal da Paraíba - UFPB, João Pessoa (PB), Brasil
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25
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Gazzini L, Laura E. "How I Do It" Secondary tracheoesophageal puncture for voice reconstruction after total laryngectomy: The blind technique procedure with video. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138 Suppl 2:55-57. [PMID: 34119454 DOI: 10.1016/j.anorl.2021.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/23/2021] [Accepted: 02/11/2021] [Indexed: 10/21/2022]
Affiliation(s)
- L Gazzini
- Division of Otolaryngology, "San Maurizio" Hospital, Bolzano, Italy
| | - E Laura
- Division of Otolaryngology, Department of Surgery, Dentistry Pediatrics and Gynecology, University of Verona, Verona, Italy.
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26
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Bozec A, Boscagli M, Serris M, Chamorey E, Dassonville O, Poissonnet G, Culié D, Scheller B, Benezery K, Gal J. Long-term functional and quality of life outcomes in laryngectomized patients after successful voice restoration using tracheoesophageal prostheses. Surg Oncol 2021; 38:101580. [PMID: 33862577 DOI: 10.1016/j.suronc.2021.101580] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/01/2021] [Accepted: 04/07/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess long-term functional and quality of life (QoL) outcomes and their predictive factors in laryngectomized patients after successful voice restoration using tracheoesophageal prostheses (TEP). METHODS This cross-sectional study was conducted in alive and disease-free patients at least 1 year after total laryngectomy ± partial pharyngectomy. Patients completed the European Organization for Research and Treatment of Cancer (EORTC) Core (QLQ-C30) and Head and Neck Cancer (QLQ-H&N35) QoL questionnaires, the Voice Handicap Index (VHI-10) questionnaire and the Hospital Anxiety and Depression Scale (HADS). The level of dysphagia was evaluated using the Dysphagia Handicap Index (DHI) and the Dysphagia Outcomes and Severity Scale (DOSS). Predictive factors of these clinical outcomes were determined in univariate and multivariate analysis. RESULTS A total of 48 patients were included in this study. Long-term QoL and functioning scales scores were all superior to 70%. Main persistent symptoms were fatigue, dyspnea, senses, speech and coughing problems. A DOSS score ≥6, indicating normal/subnormal swallowing function, and a VHI-10 score ≤20, representing light to medium voice disorders, were found in at least 75% of patients. An anxiodepressive disorder (HADS global score ≥ 15) was reported by 15 (31%) patients and represented the main predictor of QoL and voice outcomes. A strong correlation was found between VHI-10 and global QoL scores. CONCLUSIONS After successful voice restoration, laryngectomized patients achieved satisfactory QoL and functional outcomes. Psychological distress was the main determinant of long-term QoL and is therefore of critical importance in the multidisciplinary management of laryngectomized patients.
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Affiliation(s)
- Alexandre Bozec
- Institut Universitaire de La Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France.
| | - Maxime Boscagli
- Institut Universitaire de La Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Marilou Serris
- Institut Universitaire de La Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Emmanuel Chamorey
- Department of Statistics, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Olivier Dassonville
- Institut Universitaire de La Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Gilles Poissonnet
- Institut Universitaire de La Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Dorian Culié
- Institut Universitaire de La Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Boris Scheller
- Institut Universitaire de La Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Karen Benezery
- Department of Radiotherapy, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Jocelyn Gal
- Department of Statistics, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
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27
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Tourinho AMDC, da Silva AR, Dos Santos LRM, Thomaz FB, Vieira EG. A study on tracheoesophageal phonation based on a collapsible channel model. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2021; 149:1979. [PMID: 33765807 DOI: 10.1121/10.0003817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 03/01/2021] [Indexed: 06/12/2023]
Abstract
Laryngeal cancer afflicts a large number of people worldwide, and some will need surgery to contain the disease. Currently, tracheoesophageal (TE) speech is a common method of voice rehabilitation for patients who have had their larynges excised. However, despite the relatively high success rate, not everyone is capable of producing the TE voice, usually due to the tonicity of the pharyngoesophageal segment (PES). The present work studies how the tonicity of the muscles of the PES affects TE phonation, focusing mainly on hypotonicity. A simplified collapsible channel model is used. Steady-state solutions are obtained and a linear stability analysis is performed. It is then shown that the steady-state solutions of the model are similar to the wide variety of possible PES configurations that are reported in the literature. The linear stability analysis results provide a simple expression for the estimation of the minimum tonicity required for self-sustained oscillations of the PES.
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Affiliation(s)
- André Miazaki da Costa Tourinho
- Departamento de Engenharia Mecânica, Campus Universitário Trindade, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina 88040-900, Brazil
| | - Andrey Ricardo da Silva
- Departamento de Engenharia Mecânica, Campus Universitário Trindade, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina 88040-900, Brazil
| | | | - Fabiana Barroso Thomaz
- Centro de Pesquisas Oncológicas, Rodovia Admar Gonzaga 655, Florianópolis, Santa Catarina 88034-000, Brazil
| | - Elisa Gomes Vieira
- Centro de Pesquisas Oncológicas, Rodovia Admar Gonzaga 655, Florianópolis, Santa Catarina 88034-000, Brazil
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28
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Gazzini L, Laura E, Molteni G, Marchioni D, Pighi GP. Secondary tracheoesophageal puncture with the blind technique: 10 years' experience. Eur Arch Otorhinolaryngol 2021; 278:4459-4467. [PMID: 33582848 DOI: 10.1007/s00405-021-06674-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/01/2021] [Indexed: 11/27/2022]
Abstract
PROPOSE The aim of the present article is to propose an alternative technique to the traditional secondary tracheoesophageal puncture (TEP) for voice rehabilitation after total laryngectomy, describing the procedure step-by-step, analyzing the complications and long-term results. METHODS A retrospective study was conducted on patients who underwent secondary TEP with the blind technique using a rigid hysterometer. The main steps in this technique are described and illustrated. Patient demographics and surgical outcomes were assessed. RESULTS Thirty-two patients were enrolled in this study. In all but one case, risk factors that could hinder rigid esophagoscopy were identified (37.5% neopharyngeal/esophageal post-surgical issues, 81.3% prior radiotherapy, 21.9% cervical arthrosis, and 12.5% prior coloplasty or gastric transposition). No intra- or postoperative surgical complications were noted. CONCLUSION The blind technique offers an alternative method to perform a secondary TEP safely and efficiently in patients with unfavorable anatomical or clinical conditions, lowering the risk of procedure-related complications.
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Affiliation(s)
- Luca Gazzini
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Verona, Piazzale Aristide Stefani, 1, 37126, Verona, Italy
| | - Elisa Laura
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Verona, Piazzale Aristide Stefani, 1, 37126, Verona, Italy.
| | - Gabriele Molteni
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Verona, Piazzale Aristide Stefani, 1, 37126, Verona, Italy
| | - Daniele Marchioni
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Verona, Piazzale Aristide Stefani, 1, 37126, Verona, Italy
| | - Gian Paolo Pighi
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Verona, Piazzale Aristide Stefani, 1, 37126, Verona, Italy
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Sherratt S. What are the implications of climate change for speech and language therapists? INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2021; 56:215-227. [PMID: 33258529 DOI: 10.1111/1460-6984.12587] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND The emerging global issue of climate change has large-scale effects on health and well-being, including communication disorders. The broad range of the speech and language therapy profession's scope of practice incorporates prevention, advocacy and equality in service delivery. These act as a springboard for involvement in climate change and health. AIMS This is an appeal to speech and language therapists (SLTs) to focus and take action on this issue and its considerable effects on communication and swallowing disorders. METHODS & PROCEDURES This article discusses the importance of taking a public health position on prevention and equality of services to manage environmental determinants of communication and swallowing disorders. It also describes the extent to which climate change affects these disorders and exacerbates the inequality of healthcare services in low- and middle-income countries. MAIN CONTRIBUTION Five strategies are provided for action on fulfilling therapists' roles in reducing the incidence, development and exacerbation of climate-related communication and swallowing disorders, as well as the role of SLTs in acting as advocates. The case is made for expanding the scope of services to focus on prevention and service equality so as to best meet the needs of the wider community. CONCLUSIONS & IMPLICATIONS Despite other challenges currently facing SLTs, climate change and its increasing effects on communication disorders and dysphagia is difficult to ignore. SLTs owe it to their clients, the wider community, low- and middle-income countries, the economy, and the future to take action. What this paper adds What is already known on the subject Multiple studies published in peer-reviewed scientific journals show that climate change is extremely likely to be due to human activities. The global effects will be higher temperatures, changes in precipitation, more droughts and heatwaves, stronger and more intense hurricanes, and a rising sea level which directly threaten the health of entire populations. Other health professions are beginning to take climate change into account in training and practice. What this paper adds to existing knowledge Many disorders of communication and swallowing are caused or exacerbated by the effects of climate change. Increasing temperatures, extremes of precipitation, population displacement and air pollution contribute to cardiovascular and cerebrovascular events, respiratory disease, malnutrition, premature birth, air- and water-borne diseases, and mental illness. These may affect the communication and swallowing abilities across the lifespan, but particularly those of children and older adults. What are the potential or actual clinical implications of this work? SLTs' roles in prevention, advocacy and education act as a starting point for involvement in climate change and health. Three practical strategies for action include educating SLTs and other health professionals on climate change and its effects on communication and swallowing, promoting awareness with clients and their families, and gathering and disseminating reliable data.
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Affiliation(s)
- Sue Sherratt
- Communication Research Australia, Rankin Park, NSW, Australia
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30
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Feng AL, Zenga J, Varvares MA. Novel voice prosthesis after total laryngectomy with laryngoplasty reconstruction. Head Neck 2020; 43:1321-1330. [PMID: 33372408 DOI: 10.1002/hed.26592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/02/2020] [Accepted: 12/17/2020] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Although many patients achieve serviceable speech after total laryngectomy (TL), others are limited by un-naturally low pitch. We describe a cadaveric study to provide proof of concept for a novel voice prosthesis after TL with free tissue laryngoplasty. METHODS Devices were implanted into fresh frozen cadavers after TL and free tissue laryngoplasty. Phonation pressures were measured using a custom Blom-Singer Manometer (InHealth Technologies, Carpinteria, CA) and acoustic files were analyzed using Praat, a speech analysis software. RESULTS Two fresh frozen cadavers were implanted with the voice prosthesis. Both prostheses demonstrated appropriate stenting of the laryngoplasty. Successful sound production was achieved after airflow generation at the proximal trachea. An average phonation pressure of 3.5 cmH2 O (SD 1.7 cmH2 O) was necessary to generate a sound intensity of 80.6 dB (SD 0.2 dB) at an average fundamental frequency of 299.5 Hz (SD 112.6 Hz). CONCLUSIONS The novel voice prosthesis described herein offers a feasible voice generation mechanism.
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Affiliation(s)
- Allen L Feng
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Joseph Zenga
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Mark A Varvares
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
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Wypych A, Wierzchowska M, Burduk P, Zawada E, Nadolska K, Serafin Z. Cortical presentation of language functions in patients after total laryngectomy: a fMRI study. Neuroradiology 2020; 62:843-849. [PMID: 32253455 PMCID: PMC7311494 DOI: 10.1007/s00234-020-02407-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 03/13/2020] [Indexed: 11/26/2022]
Abstract
Purpose The aim of this study is to use functional magnetic resonance (fMRI) to analyse the cortical presentation of selected language functions in patients after a total laryngectomy. Methods Eighteen patients after total laryngectomy treated with electrolarynx speech and 18 volunteers were included. The mean number of patients’ post-operative speech rehabilitation sessions was five (range of 3–8 sessions). Four paradigms were used, including noun generation, pseudoword reading, reading phrases with pseudowords, and nonliteral sign reproduction. Results In noun, the most significant difference between the groups was the stronger activation of both lingual gyri in the volunteers. Pseudoword reading resulted in stronger activations in patients than in volunteers in the lingual gyri, the right cerebellum, the right Broca’s area, and the right parietal operculum. Reading phrases with pseudowords involved different parts of the Brodmann area 40. During nonliteral sign reproduction, there was a stronger activation of the left Broca’s area in volunteers and a stronger activation of the left premotor cortex in patients. Conclusion This study provides evidence of altered cortical activation in response to language tasks in patients after a laryngectomy compared with healthy volunteers, which may be considered brain plasticity in response to a laryngectomy.
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Affiliation(s)
- Aleksandra Wypych
- The Interdisciplinary Center for Modern Technologies, Nicolaus Copernicus University, Toruń, Poland
| | - Małgorzata Wierzchowska
- Department of Otolaryngology, Oncology and Oral and Maxillofacial Surgery, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland
| | - Paweł Burduk
- Department of Otolaryngology, Oncology and Oral and Maxillofacial Surgery, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland
| | - Elżbieta Zawada
- Department of Radiology and Diagnostic Imaging, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland
- Department of Geriatrics, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland
| | - Katarzyna Nadolska
- Department of Radiology and Diagnostic Imaging, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland
| | - Zbigniew Serafin
- Department of Radiology and Diagnostic Imaging, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland.
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Bozec A, Culié D, Poissonnet G, Dassonville O. Current Role of Total Laryngectomy in the Era of Organ Preservation. Cancers (Basel) 2020; 12:cancers12030584. [PMID: 32138168 PMCID: PMC7139381 DOI: 10.3390/cancers12030584] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 01/02/2023] Open
Abstract
In this article, we aimed to discuss the role of total laryngectomy (TL) in the management of patients with larynx cancer (LC) in the era of organ preservation. Before the 1990s, TL followed by radiotherapy (RT) was the standard treatment for patients with locally advanced LC. Over the last 30 years, various types of larynx preservation (LP) programs associating induction or concurrent chemotherapy (CT) with RT have been developed, with the aim of treating locally advanced LC patients while preserving the larynx and its functions. Overall, more than two-thirds of patients included in a LP program will not require total laryngectomy (TL) and will preserve a functional larynx. However, despite these advances, the larynx is the only tumor site in the upper aero-digestive tract for which prognosis has not improved during recent decades. Indeed, none of these LP protocols have shown any survival advantage compared to primary radical surgery, and it appears that certain LC patients do not benefit from an LP program. This is the case for patients with T4a LC (extra-laryngeal tumor extension through the thyroid cartilage) or with poor pretreatment laryngeal function and for whom primary TL is still the preferred therapeutic option. Moreover, TL is the standard salvage therapy for patients with recurrent tumor after an LP protocol.
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Affiliation(s)
- Alexandre Bozec
- Correspondence: ; Tel.: +0033-4-92-03-17-66; Fax: +0033-4-92-03-17-64
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van Sluis KE, Kornman AF, van der Molen L, van den Brekel MWM, Yaron G. Women's perspective on life after total laryngectomy: a qualitative study. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2020; 55:188-199. [PMID: 31674722 PMCID: PMC7079180 DOI: 10.1111/1460-6984.12511] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 09/26/2019] [Accepted: 10/02/2019] [Indexed: 05/06/2023]
Abstract
BACKGROUND Physical and psychosocial challenges are common after total laryngectomy. The surgery leads to lifelong changes in communication, airway, swallowing and appearance. As we move towards health models driven by patient-centred care, understanding the differential impacts of surgical procedures on subgroups of patients can help improve our care models, patient education and support systems. This paper discusses the experiences of women following total laryngectomy. AIMS To gain an insight into the impact of total laryngectomy on women's daily life while identifying their specific rehabilitation needs. METHODS & PROCEDURES This paper is based on in-depth, semi-structured interviews with eight women who had undergone total laryngectomy. These interviews were conducted with women at least 1 year after they had undergone total laryngectomy, and the participants did not have recurrent disease. Using an interview guide, participants were encouraged to discuss their everyday experiences, while also focusing on issues typical to women. The transcribed interview data were analysed by thematic analysis, taking interpretative phenomenological analysis as a lead. OUTCOMES & RESULTS The interviews revealed three main themes: disease and treatment as a turning point, re-establishing meaningful everyday activities, and persistent vulnerability. Participants reported experiencing challenges in their rehabilitation process due to physical disabilities, dependency on others and experienced stigma. Women-specific challenges arose in dealing with the altered appearance and voice, performing care activities, and the spousal relationship (including intimacy). CONCLUSIONS & IMPLICATIONS Women who undergo total laryngectomy are likely to experience issues in returning to work, the performance of informal care-work, the spousal relationship, intimacy and social interaction due to stigmatization. Medical pretreatment counselling and multidisciplinary rehabilitation programmes should help patients form realistic expectations and prepare them for the changes they will face. A gender- and age-matched laryngectomized patient visitor can contribute to this process. Rehabilitation programmes should incorporate the partner and offer psychosocial support for women following total laryngectomy to return to their former roles in family life, social life and work-related activities.
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Affiliation(s)
- Klaske E. van Sluis
- Department of Head and Neck Oncology and SurgeryNetherlands Cancer Institute‐Antoni van LeeuwenhoekAmsterdamthe Netherlands
- Amsterdam Center for Language and CommunicationUniversity of AmsterdamAmsterdamthe Netherlands
| | - Anne F. Kornman
- Department of Head and Neck Oncology and SurgeryNetherlands Cancer Institute‐Antoni van LeeuwenhoekAmsterdamthe Netherlands
| | - Lisette van der Molen
- Department of Head and Neck Oncology and SurgeryNetherlands Cancer Institute‐Antoni van LeeuwenhoekAmsterdamthe Netherlands
| | - Michiel W. M. van den Brekel
- Department of Head and Neck Oncology and SurgeryNetherlands Cancer Institute‐Antoni van LeeuwenhoekAmsterdamthe Netherlands
- Amsterdam Center for Language and CommunicationUniversity of AmsterdamAmsterdamthe Netherlands
| | - Gili Yaron
- Department of Head and Neck Oncology and SurgeryNetherlands Cancer Institute‐Antoni van LeeuwenhoekAmsterdamthe Netherlands
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtthe Netherlands
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Scherl C, Kauffels J, Schützenberger A, Döllinger M, Bohr C, Dürr S, Fietkau R, Haderlein M, Koch M, Traxdorf M, Mantsopoulos K, Müller S, Iro H. Secondary Tracheoesophageal Puncture After Laryngectomy Increases Complications With Shunt and Voice Prosthesis. Laryngoscope 2020; 130:E865-E873. [DOI: 10.1002/lary.28517] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 12/18/2019] [Accepted: 01/02/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Claudia Scherl
- Department of Otorhinolaryngology–Head and Neck Surgery University of Erlangen Nuremberg Germany
| | - Julia Kauffels
- Department of Otorhinolaryngology–Head and Neck Surgery University of Erlangen Nuremberg Germany
| | - Anne Schützenberger
- Department of Otorhinolaryngology–Head and Neck Surgery University of Erlangen Nuremberg Germany
| | - Michael Döllinger
- Department of Otorhinolaryngology–Head and Neck Surgery University of Erlangen Nuremberg Germany
| | - Christopher Bohr
- Department of Otorhinolaryngology–Head and Neck Surgery University of Erlangen Nuremberg Germany
| | - Stephan Dürr
- Department of Otorhinolaryngology–Head and Neck Surgery University of Erlangen Nuremberg Germany
| | - Rainer Fietkau
- Department of Radiation Oncology University of Erlangen Nuremberg Germany
| | - Marlen Haderlein
- Department of Radiation Oncology University of Erlangen Nuremberg Germany
| | - Michael Koch
- Department of Otorhinolaryngology–Head and Neck Surgery University of Erlangen Nuremberg Germany
| | - Maximilian Traxdorf
- Department of Otorhinolaryngology–Head and Neck Surgery University of Erlangen Nuremberg Germany
| | | | - Sarina Müller
- Department of Otorhinolaryngology–Head and Neck Surgery University of Erlangen Nuremberg Germany
| | - Heinrich Iro
- Department of Otorhinolaryngology–Head and Neck Surgery University of Erlangen Nuremberg Germany
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Farlow JL, Birkeland AC, Hardenbergh A, Lyden T, Brenner JC, Shuman AG, Chinn SB, Stucken CL, Malloy KM, Moyer JS, Casper KA, Prince MEP, Bradford CR, Wolf GT, Chepeha DB, Rosko AJ, Spector ME. Speech and swallowing outcomes after laryngectomy for the dysfunctional irradiated larynx. Eur Arch Otorhinolaryngol 2020; 277:1459-1465. [PMID: 31989269 DOI: 10.1007/s00405-020-05809-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 01/18/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To characterize outcomes of total laryngectomy for the dysfunctional larynx after radiation. METHODS Retrospective case series of all subjects who underwent total laryngectomy for the irradiated dysfunctional larynx between 2000 and 2018 at an NCI-designated comprehensive cancer center at a single tertiary care academic medical center. Main outcomes included enteral tube feeding dependency, functional tracheoesophageal speech, and number and timing of postoperative pharyngeal dilations. RESULTS Median time from radiation to laryngectomy was 2.8 years (range 0.5-27 years). Functional outcomes were analyzed for the 32 patients with 1-year follow-up. Preoperatively, 81% required at least partial enteral tube feeding, as compared to 34% 1-year postoperatively (p = 0.0003). At 1 year, 81% had achieved functional tracheoesophageal speech, which was associated with cricopharyngeal myotomy (p = 0.04, HR 0.04, 95% CI 0.002-0.949). There were 34% of subjects who required at least one pharyngeal dilation for stricture by 1 year postoperatively. Over half (60%) of the cohort were dilated over the study period. CONCLUSIONS Laryngectomy for the dysfunctional larynx improves speech and swallowing outcomes in many patients. Cricopharyngeal myotomy is associated with improved postoperative voice. While the need for enteral feeding is decreased, persistent postoperative swallowing dysfunction is common. Careful patient selection and education regarding functional expectations are paramount.
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Affiliation(s)
- Janice L Farlow
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Andrew C Birkeland
- Department of Otolaryngology, Head and Neck Surgery, University of California Davis, Sacramento, CA, 98517, USA
| | - Anna Hardenbergh
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Teresa Lyden
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - J Chad Brenner
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Andrew G Shuman
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Steven B Chinn
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Chaz L Stucken
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Kelly M Malloy
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Jeffrey S Moyer
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Keith A Casper
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Mark E P Prince
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Carol R Bradford
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Gregory T Wolf
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA
| | - Douglas B Chepeha
- Department of Otolaryngology, University of Toronto, Toronto, ON, Canada
| | - Andrew J Rosko
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA.
| | - Matthew E Spector
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5312, USA.
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Treatment of end-stage pharyngeal strictures after laryngectomy with fasciocutaneous microvascular reconstruction. Oral Oncol 2020; 103:104556. [PMID: 31924531 DOI: 10.1016/j.oraloncology.2019.104556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 12/24/2019] [Indexed: 11/24/2022]
Abstract
Pharyngeal strictures can develop after laryngectomy for larynx cancer, particularly in combination with radiation. Some patients develop intractable strictures where conservative swallowing therapy and pharyngeal dilations fail. Secondary reconstruction of these patients has not been described in the literature. We report our experience with completion pharyngectomy and fasciocutaneous free tissue reconstruction for this patient population. Five subjects who had undergone laryngectomy and radiation were successfully reconstructed with fasciocutaneous free tissue transfer using the radial forearm or anterolateral thigh with minimal post-operative complications. Following surgery, enteral tube feeding requirements were eliminated, and all diets were advanced. A few patients still required a modified diet or continued dilations. We thus demonstrate that pharyngectomy with secondary reconstruction is an effective option for end-stage pharyngeal strictures, though this should only be undertaken with careful patient selection.
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37
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Petersen JF, Pézier TF, van Dieren JM, van der Noort V, van Putten T, Bril SI, Janssen L, Dirven R, van den Brekel MW, de Bree R. Dilation after laryngectomy: Incidence, risk factors and complications. Oral Oncol 2019; 91:107-112. [DOI: 10.1016/j.oraloncology.2019.02.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/12/2019] [Accepted: 02/23/2019] [Indexed: 12/30/2022]
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Affiliation(s)
- Stephen Kang
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, OH, USA.
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