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Alsavaf MB, Tardif J, Salem EH, Matrka L, Carrau RL. A Novel Approach for the Treatment of Intractable Aspiration After Supracricoid Laryngectomy. Ann Otol Rhinol Laryngol 2023; 132:1690-1695. [PMID: 37271983 DOI: 10.1177/00034894231176892] [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: 06/06/2023]
Abstract
OBJECTIVES This manuscript aims to present a novel and successful intervention for intractable aspiration following a supracricoid laryngectomy (SCL) that may avoid the need for total laryngectomy in patients experiencing intractable aspiration after SCL. STUDY DESIGN This report describes a novel approach to treat intractable aspiration and feeding tube-dependency due to an incomplete posterior apposition of the laryngeal surface of the epiglottis to the arytenoids after a SCL in a 67-year-old man. METHODS The right and left aryepiglottic folds and the median glossoepiglottic fold were denuded using a CO2 laser. Then, an arytenoepiglottopexy was completed by placing 4-0 Vicryl between the lateral aspect of the epiglottis and arytenoids; thus, approximating these structures. RESULTS Two weeks after surgery, fiberoptic endoscopic evaluation of swallowing demonstrated improved closure of the larynx upon swallowing with great upgrading in the Penetration-Aspiration scale (PAS). PAS improved from a 6 to 2, corresponding to, transient penetration for moderately thick liquids and puree solids. He also demonstrated improved secretion management and airway protection. Following a 4-week course of intensive dysphagia therapy, a modified barium swallow revealed a significant improvement in airway protection, with a PAS score of 1 (no airway invasion). CONCLUSIONS Chronic aspiration is a life-threatening condition that can severely reduce patients' quality of life. Despite the use of current therapeutic approaches, a subset of patients will remain plagued by persistent symptoms. We introduce an innovative, simple, and quick endoscopic technique that offers benefit in controlling aspiration after SCL. LEVEL OF EVIDENCE NA.
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Affiliation(s)
- Mohammad Bilal Alsavaf
- Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, OH, USA
| | - Jacqueline Tardif
- Department of Speech and Hearing Science, The Ohio State University, Columbus, OH, USA
| | - Eman H Salem
- Department of Otolaryngology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Laura Matrka
- Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, OH, USA
| | - Ricardo L Carrau
- Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, OH, USA
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Verro B, Saraniti C. Failure of OPHL type IIb due to undiagnosed Eagle syndrome. BMJ Case Rep 2021; 14:e244589. [PMID: 34417247 PMCID: PMC8381297 DOI: 10.1136/bcr-2021-244589] [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] [Accepted: 08/10/2021] [Indexed: 11/03/2022] Open
Abstract
A 52-year-old man with glottic-supraglottic tumour underwent open partial horizontal laryngectomy (OPHL) IIb. On the 12th day postoperative, laryngoscopy showed necrotic tissue at the level of pexy and an increased distance between tongue base and neoglottis; the neck CT showed cricoid arch rupture and rupture of the pexy. By re-examining the preoperative CT images, the ossification of stylohyoid ligament (Eagle syndrome) was detected and supposed as the possible cause of cricoid rupture due to its traction on the hyoid bone and therefore on the pexy. The stylohyoid ligaments were cut at their insertion on the hyoid bone and a tracheohyoidopexy was performed. Two months after surgery, the patient had only some swallowing impairments. This case represents a complication in OPHL II never reported in literature caused by an undiagnosed Eagle syndrome in preoperative, pointing out the importance to search for any anatomical anomaly that could jeopardise the success of the surgery.
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Affiliation(s)
- Barbara Verro
- Faculty of Medicine and Surgery, University of Palermo, Palermo, Italy
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Garcia AM, Dias FL, Gonçalves AJ, Cernea CR, Freitas EQ, Menezes MB, Kulcsar MAV. Supratracheal laryngectomy: a multi-institutional study. Braz J Otorhinolaryngol 2019; 86:609-616. [PMID: 31175040 PMCID: PMC9422495 DOI: 10.1016/j.bjorl.2019.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 04/07/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Supratracheal laryngectomy has been described as a surgical procedure for glottic or supraglottic cancer extending to the subglottic region and/or involving the cricoarytenoid joint, aiming to preserve laryngeal function (breathing, phonation and swallowing), without diminishing locoregional cancer control. The choice of supracricoid laryngectomy in these cases could result in a high risk of compromised resection margins. Objective To determine the safety, viability, adequacy of surgical margins and the supratracheal laryngectomy results for intermediate and advanced laryngeal cancer by reviewing the results at three different institutions in Brazil. Methods This is a retrospective study that analyzed the charts of 29 patients submitted to supratracheal laryngectomy from October 1997 to June 2017. The type of laryngectomy performed was classified according to the European Laryngological Society classification for horizontal laryngectomies. Early and late results were evaluated. Survival rates (overall, specific, disease-free and total laryngectomy-free survival) were calculated. The mean follow-up time was 44 months. Results Of the 29 patients submitted to supratracheal laryngectomy, 25 had no previous treatment. One patient (3.4%) had compromised margins. Four patients (13.8%) had recurrence. Of these, three had local recurrence and one had regional recurrence. Five patients (17.2%) required a total laryngectomy, two due to ruptured pexy and three due to local recurrence. Four of these patients (80%) achieved a successful total procedure. Four patients (13.8%) died, two due to postoperative complications and two due to recurrence. Overall, specific, disease-free and total laryngectomy-free survival at 5 years were, respectively, 82.1%; 88.2%; 83.0% and 80.2%. Conclusion Selected patients with intermediate and advanced laryngeal cancer may benefit from supratracheal laryngectomy, that resulted in total laryngectomy-free survival and specific survival of 80.2% and 88.2%, respectively.
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Affiliation(s)
- Ariana M Garcia
- Instituto Nacional de Câncer (INCA), Serviço de Cirurgia de Cabeça e Pescoço, Rio de Janeiro, RJ, Brazil.
| | - Fernando L Dias
- Instituto Nacional de Câncer (INCA), Serviço de Cirurgia de Cabeça e Pescoço, Rio de Janeiro, RJ, Brazil
| | - Antônio J Gonçalves
- Irmandade Santa Casa de Misericórdia de São Paulo (ISCMSP), Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Claudio R Cernea
- Universidade de São Paulo (USP), Hospital das Clínicas (HC), Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Emilson Q Freitas
- Instituto Nacional de Câncer (INCA), Serviço de Cirurgia de Cabeça e Pescoço, Rio de Janeiro, RJ, Brazil
| | - Marcelo B Menezes
- Irmandade Santa Casa de Misericórdia de São Paulo (ISCMSP), Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Marco Aurélio V Kulcsar
- Universidade de São Paulo (USP), Hospital das Clínicas (HC), Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
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Nakayama M, Miyamoto S, Seino Y, Okamoto T, Kano K. Neoglottal revisions after supracricoid laryngectomy with cricohyoidoepiglottopexy. Jpn J Clin Oncol 2016; 46:642-5. [PMID: 27162314 DOI: 10.1093/jjco/hyw044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 03/17/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Meijin Nakayama
- Department of Otorhinolaryngology-Head and Neck Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Shunsuke Miyamoto
- Department of Otorhinolaryngology-Head and Neck Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Yutomo Seino
- Department of Otorhinolaryngology-Head and Neck Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Tabito Okamoto
- Department of Otorhinolaryngology-Head and Neck Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Koichi Kano
- Department of Otorhinolaryngology-Head and Neck Surgery, Kitasato University School of Medicine, Kanagawa, Japan
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Loyo M, Espinoza S, Giraud P, Laccourreye O. Early and severe dyspnea after supracricoid partial laryngectomy. Ann Otol Rhinol Laryngol 2014; 123:53-7. [PMID: 24574424 DOI: 10.1177/0003489414521386] [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: 11/17/2022]
Abstract
We present the case of a not-yet-reported complication that occurred during the immediate postoperative period after supracricoid partial laryngectomy. We include a review of the literature on complications following this procedure, emphasizing technical considerations that are critical during this surgery. Clinical, diagnostic, and operative findings are presented, as is a differential diagnosis for early and severe postoperative dyspnea following supracricoid laryngectomy.
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Affiliation(s)
- Myriam Loyo
- Departments of Otorhinolaryngology-Head and Neck Surgery (Loyo, Laccourreye), Université Paris Descartes Sorbonne Paris Cité, HEGP, APHP, Paris, France
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'Flaccid neoglottis' following supracricoid partial laryngectomy: laryngoscopic revision assisted by navigation system. The Journal of Laryngology & Otology 2011; 125:1315-9. [PMID: 21888753 DOI: 10.1017/s0022215111002386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Supracricoid partial laryngectomy is a reliable laryngeal preservation procedure for tumour stage 2 and selected stage 3 to 4 laryngeal cancers. Of 70 patients thus treated, two (3 per cent) had 'flaccid neoglottis', i.e. redundant mucosa at the inner arytenoid edge which intermittently obstructed the neoglottis. We discuss the mechanism and management of this complication. METHOD The two cases are presented. A navigation system was used to assist surgery. Neoglottal spatial alteration (specifically cross-sectional area) was assessed pre- and post-operatively using three-dimensional computed tomography. Voice was also evaluated. RESULTS Inspiratory stridor and delayed stomal closure were the main symptoms. Minimum neoglottal cross-sectional area was smaller in case one than in non-affected patients. Both patients had relatively rougher and breathier voices, but had adapted well to this. CONCLUSION Flaccid neoglottis is mainly due to excessive anterior retraction of residual laryngeal mucosa and to excessive mucosal pliability with age. A navigation system was useful for confirmation, but the potential for incorrect image recognition should be kept in mind. Flaccid neoglottis was treatable, with improved laryngeal function.
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Rifai M, Hassouna MS, Abdel Fattah AEF, Badran H. Experience with supracricoid laryngectomy variants. Head Neck 2010; 33:1177-83. [PMID: 21755561 DOI: 10.1002/hed.21593] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Revised: 02/05/2010] [Accepted: 07/28/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the outcomes after supracricoid laryngectomy (SCL) as an alternative to total laryngectomy (TL) for treatment of laryngeal cancer. METHODS This retrospective study involved 333 patients who underwent 4 types of SCL for squamous cell carcinoma of the larynx in an Egyptian hospital between May 1984 and May 2007. Both functional outcomes and oncological outcomes were evaluated. RESULTS Surgical margins were free from tumor invasion. The overall 5-year survival rate was 74%. Three hundred nine patients (92.8%) were decannulated, whereas 8 patients had permanent stenosis, 6 patients underwent TL, and 10 patients died. Only 7 patients (2.1%) had persistent aspiration; 6 of these patients underwent TL, whereas 1 patient died of pneumonia. The voice intelligibility score ranged from 70% to 100%, with a mean score of 89%. The score was highest when both arytenoids were preserved (mean, 95%). Ten patients died of complications directly related to the surgery. CONCLUSION Supracricoid laryngectomy is effective for managing laryngeal cancer. Modification of the technique to permit resection of both arytenoids is possible in select patients.
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Affiliation(s)
- Mohamed Rifai
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt.
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Nakayama M, Okamoto M, Seino Y, Miyamoto S, Hayashi S, Masaki T, Yokobori S, Takeda M. Inverted epiglottis: A postoperative complication of supracricoid laryngectomy with cricohyoidoepiglottopexy. Auris Nasus Larynx 2010; 37:609-14. [DOI: 10.1016/j.anl.2009.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Revised: 11/19/2009] [Accepted: 12/12/2009] [Indexed: 10/19/2022]
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Benito J, Holsinger FC, Pérez-Martín A, Garcia D, Weinstein GS, Laccourreye O. Aspiration after supracricoid partial laryngectomy: Incidence, risk factors, management, and outcomes. Head Neck 2010; 33:679-85. [DOI: 10.1002/hed.21521] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2009] [Revised: 05/03/2010] [Accepted: 05/12/2010] [Indexed: 11/06/2022] Open
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Nakayama M, Seino Y, Hayashi S, Miyamoto S, Takeda M, Masaki T, Yokobori S, Okamoto M. [Clinical review of supracricoid laryngectomy with CHEP and CHP: 50 patients treated in 11 years]. NIHON JIBIINKOKA GAKKAI KAIHO 2009; 112:540-9. [PMID: 19670796 DOI: 10.3950/jibiinkoka.112.540] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
An analysis of clinical data on 50 patients undergoing supracricoid laryngectomy (SCL) between 1997 and 2008 i.e., cricohyoidoepiglottopexy (CHEP) in 47 and cricohyoidopexy (CHP) in 3 cases showed that the number of SCL cases operated on within a year surpassed that of Total Laryngectomy after 2003. Selection criteria included performance status 0-1 and blood gas PO2>80 torr, especially in those patients over 70-years-old. Postoperative wound infection occurred in 16 patients (32%), with four requiring additional surgical intervention (two ruptured pexis and two chondritis induced by C3-C4 osteophytes). A history of radiotherapy and systemic complications, i.e., diabetes and renal failure, added to the risk of wound infection. Introducing a clinical pathway shortened hospitalization. Vocal function was achieved in 96% and swallowing function in 89% of patients. Five-year crude survival in CHEP was 69% and in TL 51%. Laryngeal preservation was 70%, increasing to 89% after the introduction of SCL. SCL-CHEP is thus indicated for unfavorable T2 (ASCO 2006), well-selected T3, T4, and rT1-4 (radiation failures). Effort should emphasize a good balance in prognosis and function in organ preservation for laryngeal cancer.
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Affiliation(s)
- Meijin Nakayama
- Department of Otorhinolaryngology, Kitasato University School of Medicine, Sagamihara
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Holsinger FC, Nussenbaum B, Nakayama M, Saraiya S, Sewnaik A, Ark N, Ferris RL, Tufano RP, McWhorter AJ. Current concepts and new horizons in conservation laryngeal surgery: An important part of multidisciplinary care. Head Neck 2009; 32:656-65. [DOI: 10.1002/hed.21208] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Bakhos D, Lescanne E, Beutter P, Morinière S. Indications of cricohyoidoepiglottopexy versus anterior frontal laryngectomy: the role of contralateral vocal fold spread. Head Neck 2009; 30:1408-14. [PMID: 18704961 DOI: 10.1002/hed.20888] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The aim of the retrospective study was to compare the indications, the postoperative outcomes, and the survival of the supracricoid laryngectomy with cricohyoidoepiglottopexy and the anterior frontal laryngectomy. METHOD Nineteen patients who underwent cricohyoidoepiglottopexy (group I) and 23 patients who underwent reconstructive anterior frontal laryngectomy (group II) from January 1992 and December 2004 have been reviewed. We have compared their respective indications and postoperative outcomes. RESULTS There were no differences for median time before decanulation. Median time for removal feeding tube, for first oral alimentation, and hospital stay period were significantly shorter in group II. Five-year survival was 85% (group I) and 95% (group II). Local tumor control was obtained in 83% in group I and in 87% in group II. CONCLUSION Cricohyoidoepiglottopexia (CHEP) was used more often than anterior frontal laryngectomy when there was contralateral vocal fold spread but resulted in longer postoperative outcomes.
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Affiliation(s)
- David Bakhos
- Department of ENT, Head and Neck Surgery, Bretonneau Hospital, 2 Boulevard Tonellé, 37000 Tours, France.
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Tufano RP, Stafford EM. Organ Preservation Surgery for Laryngeal Cancer. Otolaryngol Clin North Am 2008; 41:741-55, vi. [DOI: 10.1016/j.otc.2008.01.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Laryngeal chondritis induced by C3-4 osteophyte following supracricoid laryngectomy with cricohyoidoepiglottopexy: report of two cases. The Journal of Laryngology & Otology 2008; 122:745-9. [PMID: 18331655 DOI: 10.1017/s0022215108001825] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES We have performed supracricoid laryngectomy with cricohyoidoepiglottopexy or with cricohyoidopexy for tumour (T) stage T2 and T3 laryngeal cancer cases and some T4 cases. We report the clinical symptoms and management, using this technique to avoid complications. CASE REPORT Among patients undergoing the procedure, two cases manifested laryngeal chondritis following laryngectomy with cricohyoidoepiglottopexy. This complication was caused by C3-4 cervical osteophytes physically contacting the cricoid cartilage. Laryngeal microlaryngoscopy was performed, which revealed white, necrotic tissue in the posterior wall of the pharynx and persistent oedema of the neoglottis. CONCLUSIONS When encountering a patient with an excessive osteophyte formation at the level of C3-4, one needs to take extra precautions when undertaking laryngectomy with cricohyoidoepiglottopexy or with cricohyoidopexy.
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Nakayama M, Okamoto M, Miyamoto S, Takeda M, Yokobori S, Masaki T, Seino Y. Supracricoid laryngectomy with cricohyoidoepiglotto-pexy or cricohyoido-pexy: Experience on 32 patients. Auris Nasus Larynx 2008; 35:77-82. [PMID: 17869042 DOI: 10.1016/j.anl.2007.04.018] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2006] [Revised: 03/14/2007] [Accepted: 04/06/2007] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Supracricoid laryngectomy (SCL) with Cricohyoidoepiglotto-pexy (CHEP) or Cricohyoido-pexy (CHP) is an organ preservation surgery indicated for early and selected advanced laryngeal cancers. To verify the clinical usefulness of supracricoid laryngectomy versus total laryngectomy, a retrospective review was conducted. METHODS We summarized the clinical and postoperative data of 32 patients who received SCL over the past 9 years (1997-2005). Five-year survival rate of the SCL patient group (29 cases) was compared with that of the patient group receiving total laryngectomy (35 cases) within the same period. RESULTS Wound infection was detected in 12 patients (38%). Those with severe infection, which required surgical intervention, included two cases of ruptured pexis and two cases showing cricoid cartilage necrosis induced by Forestier disease. There were two T4 cases that resulted in extensive excision. In one case, excision involved the posterior part of the cricoid cartilage resulting in insufficient closure of the neoglottis; the patient received total laryngectomy 30 months after SCL-CHEP because of persistent aspiration of liquid diet. In the other T4 case, the tumor invaded the thyroid and arytenoid cartilages but not the cricoid cartilage. Reposition of the remaining corniculate cartilage resulted in sufficient closure of the neoglottis; this patient subsequently acquired satisfactory laryngeal function. The 5-year overall survival rate was 86% for SCL group and 61% for the total laryngectomy group (limited to Stages III and IV glottic cancers). The causes of the four deaths were distant metastasis, neck metastasis, and intercurrent disease, respectively. Two patients are alive with distant disease. CONCLUSION Through our experience in this series, the functional and oncological results of SCL showed certain advantages over those of total laryngectomy. Particularly, the clinical impact of SCL-CHEP was impressive; this technique needs is recommended to both head and neck surgeons and patients.
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Affiliation(s)
- Meijin Nakayama
- Department of Otorhinolaryngology, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara, Kanagawa 228-8555, Japan
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Abstract
The open organ preservation surgical procedures are an important part of the head and neck surgeon's armamentarium for treating laryngeal cancer. The principles of organ preservation surgery as they apply to laryngeal cancer must be thoroughly appreciated and strictly applied for oncologic and functional success. The selection of eligible patients for these procedures is an art and requires a keen clinical acumen. The vertical partial laryngectomy and supraglottic laryngectomy have defined clinical applications that are relatively well accepted. The supracricoid laryngectomy continues gaining acceptance as a means of treating more extensive glottic and transglottic lesions while maintaining physiologic speech and swallowing without the need for a permanent tracheostoma. The inability to include and use the open surgical organ preservation approaches in the organ preservation paradigm for larynx cancer severely limits the patient's treatment options. Total laryngectomy and medical organ preservation protocols may not be acceptable to the patient from a quality-of-life standpoint. Therefore, it is incumbent upon the head and neck surgeon to have a thorough understanding of all the options available for treatment in the organ preservation paradigm for laryngeal cancer. These options must be skillfully evaluated as they relate to the patient's disease process and confidently used to provide the best oncologic and functional outcome.
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Affiliation(s)
- Ralph P Tufano
- Department of Otolaryngology, Head and Neck Surgery, 6th Floor, Johns Hopkins Outpatient Center, 601 N. Caroline Street, Baltimore, MD 21287, USA.
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Lima RRMA, Freitas EDQ, Kligerman J, Sá GMD, Santos IC, Farias T. Laringectomia supracricóide (chep) para câncer glótico. Rev Col Bras Cir 2001. [DOI: 10.1590/s0100-69912001000400004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVOS: Com a intenção de se avaliar os resultados funcionais e terapêuticos da laringectomia supracricóide com crico-hióide-epiglote-pexia (CHEP) foram estudados 50 casos de pacientes com carcinoma epidermóide da glote classificados como T2/T3 submetidos a esta técnica em nossa instituição. MÉTODOS: Foi realizada uma análise retrospectiva entre 1996 e 1999. Classificamos 18 pacientes como T2N0M0 e 32 pacientes como T3N0M0. Quarenta e um pacientes foram submetidos a esvaziamento cervical seletivo lateral bilateralmente, quatro foram submetidos ao mesmo esvaziamento unilateralmente, e cinco não foram esvaziados. Analisamos as complicações e a sobrevida livre de doença pelo método de Kaplan-Meyer. RESULTADOS: Dez pacientes tiveram complicações pós-operatórias, dois foram tratados com complementação da laringectomia. Os 48 pacientes restantes mantiveram a via aérea normal, deglutição e a voz. Três pacientes no grupo submetido a esvaziamento cervical apresentaram linfonodo metastático. Quatro pacientes tiveram recidiva da doença, três com recidiva local, sendo dois tratados com laringectomia total e estão vivos e sem doença, o outro com doença avançada alcançou o óbito pela doença. O paciente que teve recidiva no pescoço foi tratado com esvaziamento cervical mais radioterapia e morreu com doença. Dois pacientes tiveram um segundo tumor primário em orofaringe, sendo um tratado com radioterapia paliativa e morreu com doença e o outro tratado com cirurgia está vivo e sem doença. A sobrevida livre de doença em três anos foi de 88% para pacientes T2 e 72% para pacientes T3. CONCLUSÕES: Esta técnica é útil no tratamento de casos selecionados de carcinoma epidermóide da glote T2/T3 sempre se considerando a extensão da doença. A incidência de complicações necessitando laringectomia total de resgate não compromete a funcionalidade desta técnica. A sobrevivência é comparável aos pacientes submetidos a laringectomia total e laringectomia "near-total".
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Diaz EM, Laccourreye L, Veivers D, Garcia D, Brasnu D, Laccourreye O. Laryngeal stenosis after supracricoid partial laryngectomy. Ann Otol Rhinol Laryngol 2000; 109:1077-81. [PMID: 11090001 DOI: 10.1177/000348940010901115] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to review the incidence, risks, management, and outcomes of nontumoral laryngeal stenosis after supracricoid partial laryngectomy (SCPL) in a case series of 376 consecutive SCPLs performed at 1 institution from 1975 to 1995 with a minimum of 3 years of follow-up. Post-SCPL nontumoral symptomatic laryngeal stenosis was defined as an inability to decannulate patients before the 60th postoperative day (group 1) or the development of dyspnea (in patients without local recurrence) after an initial period of prolonged, successful decannulation (group 2). Of 376 SCPLs performed, nontumoral symptomatic laryngeal stenosis developed in 14 (3.7%). There were 7 patients (1.85%) in group 1 and 7 patients (1.85%) in group 2. In univariate analysis, none of the following variables appeared to be statistically related to the risk of immediate stenosis (group 1): age, gender, comorbidity, diabetes mellitus, symptomatic gastroesophageal reflux, arteritis, preoperative radiotherapy, arytenoid cartilage disarticulation, type of reconstruction performed, and postoperative radiotherapy. A delayed laryngeal stenosis (group 2) was statistically more likely to occur if the reconstruction performed at the time of SCPL was a cricohyoidopexy (p = .01). Successful management of the laryngeal stenosis without permanent tracheostomy was achieved in 5 group 1 patients and 3 group 2 patients. We believe that stenosis in group I patients arose through technical error, whereas group 2 patients seemed to suffer from problems of healing, mainly cicatricial narrowing of the airway at the site of the cricohyoidal impaction, or pexis. As a result, whereas laryngeal stenosis in group 1 patients was usually more easily correctable through dilation, laser incision, or resection of redundant tissue or revision of the impaction, laryngeal stenosis in group 2 patients presented a more difficult and frustrating complication. The management and outcomes of these patients are presented.
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Affiliation(s)
- E M Diaz
- Department of Otorhinolaryngology-Head and Neck Surgery, Laënnec Hospital, University of Paris V, France
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Ferlito A, Silver CE, Howard DJ, Laccourreye O, Rinaldo A, Owen R. The role of partial laryngeal resection in current management of laryngeal cancer: a collective review. Acta Otolaryngol 2000; 120:456-65. [PMID: 10958395 DOI: 10.1080/000164800750045938] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
A spectrum of treatment plans and surgical procedures is available for management of early and moderately advanced laryngeal cancer. While the approach of chemotherapy and irradiation, or irradiation alone, followed by total laryngectomy for failure is often employed in practice by present day clinicians, the options of conventional conservation surgery (CCS), transoral endoscopic laser surgery (TLS) and supracricoid partial laryngectomy (SCPL) provide a wide choice of treatments that may help attain the goal of cure with preservation of laryngeal function and integrity of the airway. While CCS has been supplanted for many early-stage lesions by TLS and for more advanced stages by SCPL, centres throughout the world have reported favourable results with CCS, which is often modified to include resection of more extensive tumours than was previously possible. During the past decade a number of extended CCS procedures have been developed for management of glottic tumours involving both vocal cords and the anterior commissure, the paraglottic space and with vocal cord fixation, and for supraglottic tumours involving the glottis or hypopharynx. TLS has proved an effective, minimally invasive and functionally satisfactory procedure for management of suitable T1 and T2 glottic cancers, and stage I-III supraglottic cancers. The procedure may be effectively employed in combination with neck dissection and postoperative radiotherapy when necessary, particularly for moderately advanced supraglottic carcinomas. SCPL has proven effective in management of glottic and supraglottic cancers of all stages, even with involvement of paraglottic space and thyroid cartilage, provided at least one arytenoid unit can be preserved with clear margins. Invasion of cricoid cartilage is the most significant limitation for this procedure. All three surgical approaches have been employed for irradiation failure, but with greatly increased failure and complication rates compared with the results of treatment of non-irradiated patients. Thus a decision to treat laryngeal cancer initially with irradiation may preclude a satisfactory result from partial laryngectomy should radiation fail. The treatment of laryngeal cancer should be individualized according to the size and extent of the tumour, the age and physical condition of the patient, and the skill and experience of the surgeon with various treatment modalities and surgical procedures.
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Affiliation(s)
- A Ferlito
- Department of Otolaryngology--Head and Neck Surgery, University of Udine, Italy.
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