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Lechien JR, Hans S, Crevier-Buchman L. Influence of age on voice quality after transoral CO 2 laser microsurgery. J Otolaryngol Head Neck Surg 2023; 52:59. [PMID: 37697412 PMCID: PMC10496204 DOI: 10.1186/s40463-023-00664-3] [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: 07/17/2022] [Accepted: 08/28/2023] [Indexed: 09/13/2023] Open
Abstract
OBJECTIVE To study the post-operative evolution of voice quality of patients treated by transoral CO2 laser microsurgery (TLM) according to the age. METHODS Patients treated by type I to VI TLM and post-operative speech therapy were prospectively recruited from our hospital. The voice quality was assessed pre-, 1-, 3- 6- and 12-month posttreatment with voice handicap index (VHI), dysphonia, roughness, breathiness, asthenia, strain (GRBAS), maximal phonation time (MPT), F0, F0 standard deviation (STD), percent jitter, percent shimmer, noise-to-harmonic ratio (NHR), vocal fold vibration assessment and speech fluency. Evolution of voice outcomes was analyzed considering age of patients (< 60 vs. ≥ 60 years). RESULTS Seventy-five patients completed the evaluations. Thirty-four and forty-one patients were < 60 or ≥ 60 yo, respectively. Subjective and objective voice parameters (VHI, G, R, B), jitter and fluency significantly improved from 1- to 6-month post-TLM in < 60 yo individuals. The voice parameters improved 12-month post-TLM in the ≥ 60 yo group at the exception of VHI that improved 3-month post-TLM. There were positive associations between age and 12-month NHR, G and A parameters. CONCLUSION The post-operative evolution of voice quality parameters may vary between patients according to the age. Preoperative VHI is predictive of 12-month subjective and objective voice outcomes.
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Affiliation(s)
- Jerome R Lechien
- 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.
- Department of Otolaryngology-Head & Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, Brussels, Belgium.
- Department of Otolaryngology, Polyclinic of Poitiers, Elsan Hospital, Poitiers, France.
- Faculty of Medicine, Department of Human Anatomy and Experimental Oncology, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.
- Phonetics and Phonology Lab, CNRS UMR7018, Univ. Sorbonne University, Paris, France.
| | - Stephane Hans
- 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
- Phonetics and Phonology Lab, CNRS UMR7018, Univ. Sorbonne University, Paris, France
| | - Lise Crevier-Buchman
- 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
- Phonetics and Phonology Lab, CNRS UMR7018, Univ. Sorbonne University, Paris, France
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Lechien JR, Crevier-Buchman L, Circiu MP, De Mones E, de Pemille GV, Julien-Laferriere A, Saussez S, Baudouin R, Remacle M, Hans S. Voice Quality Outcomes After Transoral CO 2 Laser Cordectomy: A Longitudinal Prospective Study. Otolaryngol Head Neck Surg 2023; 168:422-428. [PMID: 35998041 DOI: 10.1177/01945998221114762] [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] [Received: 02/08/2022] [Accepted: 06/29/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the evolution of voice quality in patients after type I-VI transoral CO2 laser cordectomy (TLC) by using validated voice outcome measures over a 12-month period. STUDY DESIGN Prospective uncontrolled study. SETTING Monocenter study. METHODS Patients with laryngeal carcinoma who were eligible for type I-IV TLC were prospectively recruited from a tertiary medical center. The following outcomes were assessed throughout the 12-month posttreatment period: Voice Handicap Index (VHI), GRBAS (grade of dysphonia, roughness, breathiness, asthenia, strain), maximal phonation time, fundamental frequency (F0), F0 standard deviation, percentage jitter, percentage shimmer, noise-to-harmonic ratio, and speech fluency. Analyses were performed considering 2 groups of cordectomies: type I-III vs IV-VI. RESULTS A total of 131 patients completed the evaluations, totaling 76 type I-III and 55 type IV-VI cordectomies. In type IV-VI, breathiness and maximal phonation time significantly worsened from pretreatment to 1 month posttreatment (P < .05). In the type I-III cordectomy group, VHI, shimmer, roughness, breathiness, and strain significantly improved from pretreatment to 3 months posttreatment, while VHI, F0 standard deviation, shimmer, jitter, grade of dysphonia, roughness, breathiness, and strain improved from baseline to 6 months. Assessments at 12 months posttreatment revealed significant improvements for VHI, shimmer, jitter, noise-to-harmonic ratio, grade of dysphonia, roughness, breathiness, and strain. In the type IV-VI group, VHI significantly improved from baseline to 3, 6, and 12 months posttreatment. Strain improved at 6 and 12 months while roughness improved from baseline to 12 months. Maximal phonation time significantly worsened over the 12-month evaluation period. CONCLUSION The effect of TLC on voice quality depends on its type. VHI was identified as the most indicative tool of voice changes irrespective of TLC type.
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Affiliation(s)
- Jerome R Lechien
- Department of Otolaryngology, Elsan Hospital, Paris, France
- Department of Otolaryngology-Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, Brussels, Belgium
- 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
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium
| | - Lise Crevier-Buchman
- 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
- Phonetics and Phonology Lab, CNRS UMR7018, Sorbonne University, Paris, France
| | - Marta P Circiu
- 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
| | - Erwan De Mones
- Department of Otolaryngology-Head and Neck Surgery, Pellegrin Hospital, University Hospital, CHU Bordeaux, Bordeaux, 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
| | - Sven Saussez
- Department of Otolaryngology-Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, Brussels, Belgium
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium
| | - Robin Baudouin
- 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
| | - Marc Remacle
- Department of Otolaryngology-Head and Neck Surgery, Eich Luxembourg Hospital, Luxembourg, Luxembourg
| | - Stephane Hans
- 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
- Phonetics and Phonology Lab, CNRS UMR7018, Sorbonne University, Paris, France
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Colizza A, Ralli M, D'Elia C, Greco A, de Vincentiis M. Voice quality after transoral CO 2 laser microsurgery (TOLMS): systematic review of literature. Eur Arch Otorhinolaryngol 2022; 279:4247-4255. [PMID: 35505113 PMCID: PMC9363323 DOI: 10.1007/s00405-022-07418-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/20/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Transoral laser microsurgery (TOLMS) with carbon dioxide is a safe approach for laryngeal carcinoma. In literature there are three main methods for evaluating speech outcomes: acoustic and aerodynamics analysis, perceptual evaluation and patient-reported outcomes (PROs). The aim of this study was to systematically review the literature about the voice quality outcomes of TOLMS according to type of cordectomy. METHODS A systematic literature review was performed and all the results until December 2021 were extrapolated. We evaluated the acoustic and aerodynamics parameters (fundamental frequency, harmonics to noise ratio, jitter, shimmer and maximum phonation time), perceptual data (GRBAS scale) and patient-related outcomes (VHI scale). RESULTS 24 studies met the inclusion criteria for a total number of 1207 patients enrolled. The number for each type of cordectomy are: 287 type I (23.78%), 311 type II (25.78%), 328 type III (27.14%), 129 type 4 (10.69%) and 152 type V (12.60%). Patients are grouped according to the type of cordectomy in: limited cordectomy (type I and II) and extended cordectomy (types III-IV-V). The difference between two groups is statistically significative in terms of acoustic analysis, perceptual data and patient-related outcomes (p < 0.05). CONCLUSIONS Patients who underwent type I or II cordectomy have significantly better quality of voice in terms of VHI, perceptual voice quality evaluations and acoustic parameters compared to type III, IV and V cordectomies. The effect of TOLMS on the voice should depend from the extent of the resection and in particular from the scar of the vocal muscle.
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Affiliation(s)
- Andrea Colizza
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy.
| | - Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy
| | - Chiara D'Elia
- Otorhinolaryngology Unit, Policlinico Umberto I, Rome, Italy
| | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy
| | - Marco de Vincentiis
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
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Printz T, Mehlum CS, Godballe C, Iwarsson J, Pedersen SG, Christensen JH, Jørkov AS, Grøntved ÅM. Vocal Outcome After Cordectomy by Transoral CO 2 Laser Microsurgery in Patients With Laryngeal Intraepithelial Neoplasia and Non-neoplastic Lesions. J Voice 2022:S0892-1997(22)00129-1. [PMID: 35732537 DOI: 10.1016/j.jvoice.2022.04.018] [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: 12/09/2021] [Revised: 04/24/2022] [Accepted: 04/25/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study investigates vocal outcome after cordectomy by transoral CO2 laser microsurgery (TLM-cordectomy) in patients with laryngeal intra-epithelial neoplasia (LIN) or non-neoplastic lesions (NNL), for improved individual patient advice and potential adjustment of national treatment strategy by which patients suspected to have glottic LIN or T1a cancer are offered TLM-cordectomy, without prior biopsy. STUDY DESIGN Prospective, longitudinal, quasi-experimental time series. METHODS Consecutively included patients (n = 155) with LIN (n = 84) or NNL (n = 71) who underwent voice assessments before and after TLM-cordectomy. The multi-dimensional voice assessment protocol comprised voice and speech range profiles, aerodynamics, acoustic analysis, self-evaluated voice handicap, and perceptual auditory voice ratings. RESULTS Median follow-up time was 195 (range 50-1121) days for patients with LIN and 193 (range 69-1294) days for patients with NNL. Statistically significant changes, LIN: in voice handicap index (VHI) and breathiness after TLM-cordectomy. Statistically significant changes, NNL: voice range profile (voice range area, intensity range, and frequency range) and VHI after TLM-cordectomy. All group-wise changes were to less disordered voices. Previous smokers had the largest decreases in VHI and breathiness. Patients with baseline VHI scores >65 had smaller increases in VHI, however 13-19% of the patients had increases in VHI above the clinically relevant threshold after TLM-cordectomy. CONCLUSION Overall, TLM-cordectomy in patients with LIN and NNL improved vocal outcome and our study thus supports the current Danish treatment strategy and improves the basis for proper patient advice. Multi-dimensional voice assessment is suggested preoperatively and six-nine months postoperatively, with focus on individual vocal differences and voice demands.
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Affiliation(s)
- Trine Printz
- Department of Oto-Rhino-Laryngology - Head & Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark
| | - Camilla Slot Mehlum
- Department of Oto-Rhino-Laryngology - Head & Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark.
| | - Christian Godballe
- Department of Oto-Rhino-Laryngology - Head & Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark
| | - Jenny Iwarsson
- Department of Scandinavian Studies and Linguistics, University of Copenhagen, Copenhagen, Denmark
| | - Solveig Gunvor Pedersen
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | | | - Andreas Schellerup Jørkov
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | - Ågot Møller Grøntved
- Department of Oto-Rhino-Laryngology - Head & Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark
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Lechien JR, Crevier-Buchman L, Circiu MP, Lisan Q, Hans S. Evolution of Voice Quality in Type 1-2 Transoral CO 2 Laser Cordectomy: A Prospective Comparative Study. Laryngoscope 2021; 132:1421-1426. [PMID: 34704611 DOI: 10.1002/lary.29924] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/11/2021] [Accepted: 10/13/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To compare the 12-month evolution of voice quality outcomes in patients who benefited from types 1-2 transoral CO2 laser cordectomy (TLC) for an early-stage vocal fold squamous cell carcinoma (VFSCC). STUDY DESIGN Prospective uncontrolled study. METHODS Sixty patients with cT1 VFSCC were consecutively recruited from a single medical center. Thirty patients benefited from type 1 TLC, while type 2 TCL was performed in 30 patients. The following voice quality outcomes were evaluated at baseline, 3-, 6-, and 12-month post-TLC: voice handicap index (VHI), GRBAS, speech rate, maximum phonation time (MPT), and acoustic parameters. Voice quality evolution was compared between type 1 and type 2 TLC. RESULTS Fifty-seven patients completed the evaluations. Type 1 TLC patients reported significant improvements of VHI, grade of dysphonia, and breathiness at 3-, 6-, and 12-month post-TLC. Speech rate and jitter values improved 6- and 12-month post-TLC. A few voice quality outcomes reported 3- or 6-month post-TLC improvements in type 2 TLC group, while VHI, grade of dysphonia improved at 6- and 12-month post-TLC. MPT significantly decreased at 6- and 12-month post-TLC, while there were no acoustic measurement changes in type 2 TLC. CONCLUSIONS The effect of TLC on voice quality may depend on the type of TLC. Type 1 TLC was associated with faster voice quality improvements compared with type 2 TLC. VHI and dysphonia grade were identified as the most relevant tool of voice changes irrespective to the TLC type. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Jerome R Lechien
- Department of Otolaryngology, Elsan Hospital, Paris, France.,Department of Otorhinolaryngology-Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Brussels, Belgium.,Department of Otorhinolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, Paris Saclay University, Paris, France
| | - Lise Crevier-Buchman
- Department of Otorhinolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, Paris Saclay University, Paris, France.,Phonetics and Phonology Lab, CNRS UMR7018, University of Sorbonne-Nouvelle, Paris, France
| | - Marta P Circiu
- Department of Otorhinolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, Paris Saclay University, Paris, France
| | - Quentin Lisan
- Department of Otorhinolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, Paris Saclay University, Paris, France
| | - Stephane Hans
- Department of Otorhinolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, Paris Saclay University, Paris, France.,Phonetics and Phonology Lab, CNRS UMR7018, University of Sorbonne-Nouvelle, Paris, France
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T1a Glottic Cancer: Advances in Vocal Outcome Assessment after Transoral CO 2-Laser Microsurgery Using the VEM. J Clin Med 2021; 10:jcm10061250. [PMID: 33802971 PMCID: PMC8002749 DOI: 10.3390/jcm10061250] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/10/2021] [Accepted: 03/15/2021] [Indexed: 12/18/2022] Open
Abstract
Patients with unilateral vocal fold cancer (T1a) have a favorable prognosis. In addition to the oncological results of CO2 transoral laser microsurgery (TOLMS), voice function is among the outcome measures. Previous early glottic cancer studies have reported voice function in patients grouped into combined T stages (Tis, T1, T2) and merged cordectomy types (lesser- vs. larger-extent cordectomies). Some authors have questioned the value of objective vocal parameters. Therefore, the purpose of this exploratory prospective study was to investigate TOLMS-associated oncological and vocal outcomes in 60 T1a patients, applying the ELS protocols for cordectomy classification and voice assessment. Pre- and postoperative voice function analysis included: Vocal Extent Measure (VEM), Dysphonia Severity Index (DSI), auditory-perceptual assessment (GRB), and 9-item Voice Handicap Index (VHI-9i). Altogether, 51 subjects (43 male, eight female, mean age 65 years) completed the study. The 5-year recurrence-free, overall, and disease-specific survival rates (Kaplan–Meier method) were 71.4%, 94.4%, and 100.0%. Voice function was preserved; the objective parameter VEM (64 ± 33 vs. 83 ± 31; mean ± SD) and subjective vocal measures (G: 1.9 ± 0.7 vs. 1.3 ± 0.7; VHI-9i: 18 ± 8 vs. 9 ± 9) even improved significantly (p < 0.001). The VEM best reflected self-perceived voice impairment. It represents a sensitive measure of voice function for quantification of vocal performance.
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Chien PJ, Hung LT, Wang LW, Yang MH, Chu PY. Oncologic results and quality of life in patients with T3 glottic cancer after transoral laser microsurgery. Eur Arch Otorhinolaryngol 2021; 278:2983-2992. [PMID: 33403435 DOI: 10.1007/s00405-020-06445-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/14/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE CO2 transoral laser microsurgery (CO2 TOLMS) is an alternative approach to non-surgical organ preservation in selected T3 glottic squamous cell carcinoma (SCC). This study aimed to assess the oncologic results and quality of life (QOL) of patients with T3 glottic SCC after CO2 TOLMS. METHODS Of the 44 patients who underwent CO2 TOLMS, 38 underwent QOL evaluations. QOL was measured using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 and head and neck module, Voice Handicap Index-30, and M. D. Anderson Dysphagia Inventory at least 6 months postoperatively. RESULTS The patients were predominantly male (98%), with a median age of 61 years. Cordectomy type included 1 type III, 4 type IV, 31 type V, and 8 type VI according to European Laryngological Society classification. Two patients (5%) had cervical lymph node metastasis and 21 patients (48%) underwent postoperative radiotherapy. With a mean follow-up of 65 months for all patients, 10 (23%) had tumor recurrence (9 local, 1 distant). After salvage surgery, four patients lived without disease, and the larynx was preserved in two. The 5-year local control and overall and disease-specific survival rates were 78%, 75%, and 84%, respectively. The overall laryngeal preservation rate was 82% (36/44). Most patients had satisfactory QOL. CONCLUSIONS In selected T3 glottic SCC cases, CO2 TOLMS can achieve favorable oncologic results and a satisfactory QOL.
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Affiliation(s)
- Pei-Ju Chien
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
| | - Li-Ting Hung
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
| | - Ling-Wei Wang
- Department of Oncology Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,National Yang-Ming University, Taipei, Taiwan
| | - Muh-Hwa Yang
- Department of Oncology Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,National Yang-Ming University, Taipei, Taiwan
| | - Pen-Yuan Chu
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan.
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Hamzany Y, Crevier-Buchman L, Lechien JR, Bachar G, Brasnu D, Hans S. Multidimensional Voice Quality Evaluation After Transoral CO 2 Laser Cordectomy: A Prospective Study. EAR, NOSE & THROAT JOURNAL 2020; 100:27S-32S. [PMID: 32067482 DOI: 10.1177/0145561320906328] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To investigate voice quality changes of patients treated by transoral laser cordectomy (TLC) for early glottic cancer according to the type of cordectomies. METHODS A total of 164 consecutive male patients with an early glottic cancer were prospectively recruited from the Department of Otolaryngology-Head and Neck Surgery of the Georges Pompidou European Hospital. Depending on the tumor characteristics, patients benefited from type I to VI CO2 cordectomy regarding the European Laryngological Society classification. The following voice quality outcomes were pre- to postoperatively assessed: voice handicap index (VHI), perceptual grade of dysphonia, roughness, breathiness, maximum phonation time, and acoustic parameters. RESULTS Fifty-five patients with Tis, T1, or T2 vocal fold cancer completed the study (mean age: 61.7 years). Of these patients, 34 and 21 composed group 1 (types I-III TLC) and group 2 (types IV-VI TLC), respectively. Voice handicap index, grade of dysphonia, and breathiness significantly improved from pre- to 3- and 6-month posttreatment in group 1. In group 2, only VHI significantly improved from pre- to 3- and 6-month posttreatment. Acoustic and aerodynamic measurements did not change throughout the postoperative course. Patients with types I to III TLC exhibited better postoperative voice outcomes compared to those treated by types IV to VI TLC. CONCLUSION Irrespective to the types of TLC, the subjective voice quality of patients treated by CO2 laser cordectomy for early glottic cancer significantly improved from pre- to 3- and 6-month posttreatment. The usefulness of aerodynamic and acoustic measurements as postoperative outcomes of voice quality changes remain controversial and require future studies considering multidimensional assessment of voice.
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Affiliation(s)
- Yaniv Hamzany
- Department of Otolaryngology-Head and Neck Surgery, 36632Rabin Medical Center, Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lise Crevier-Buchman
- Department of Otolaryngology-Head and Neck Surgery, 37918Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Jérôme R Lechien
- Department of Otolaryngology-Head and Neck Surgery, 37918Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France.,Laryngology Study Group of Young Otolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Paris, France
| | - Gideon Bachar
- Department of Otolaryngology-Head and Neck Surgery, 36632Rabin Medical Center, Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Brasnu
- Department of Otolaryngology-Head Neck Surgery, 55659Fondation A. Rothschild, Paris Descartes University (Sorbonne), Paris, France
| | - Stéphane Hans
- Department of Otolaryngology-Head and Neck Surgery, 37918Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
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Demir B, Binnetoglu A, Gurol E, Oysu C. Comparison of Voice Quality of Life in Early Stage Glottic Carcinoma Treated with Endoscopic Cordectomy Using Radiofrequency Microdissection Electrodes, Laser Cordectomy, and Radiotherapy. J Voice 2019; 35:477-482. [PMID: 31784258 DOI: 10.1016/j.jvoice.2019.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/04/2019] [Accepted: 11/06/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE To compare the quality of life of patients with early glottic carcinoma who have been treated using three treatment modalities: endoscopic cordectomy using radiofrequency microdissection electrodes (ECRM), transoral laser cordectomy, and radiotherapy (RT). ECRM, transoral laser cordectomy, and RT can all be used as alternatives to invasive open surgery to treat the early stages of glottic cancer such as stage T1. Patients treated using these different modalities could have different outcomes with respect to voice quality of life. MATERIALS AND METHODS The voice quality of life was measured in patients who underwent ECRM, transoral diode laser excision, or RT for early laryngeal cancer. Post-treatment quality of voice was assessed using the Turkish version of the Voice-Related Quality of Life questionnaire in all patients after 1 year of cancer-free survival. A comparison was then made between the outcomes of the three groups. RESULTS The total score of the ECRM group, when compared independently to that of the laser and the RT groups, was found to be statistically higher in both cases. However, no statistically significant differences were found between laser and RT groups in terms of any parameters. There was a statistically significant difference between the RT group and the other groups in terms of percentage jitter, percentage shimmer, and fundamental frequency (F0) (P < 0.05). While the RT group had the longest maximum phonation time (P < 0.001), no significant differences were found between the maximum phonation time of the ECRM and the laser groups (P < 0.001). CONCLUSIONS Overall, the worst outcome with respect to voice quality of life is seen with ECRM. Since there were no significant differences in quality of life between the other two treatment modalities, it is recommended to leave the choice between RT and laser surgery up to the patient.
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Affiliation(s)
- Berat Demir
- Department of Otorhinolaryngology-Head and Neck Surgery, Pendik Training and Research Hospital, Marmara University Medical Faculty, Istanbul, Turkey.
| | - Adem Binnetoglu
- Department of Otorhinolaryngology-Head and Neck Surgery, St. Elizabeth's Medical Center 736 Cambridge St. Brighton, MA 02135/USA
| | - Ece Gurol
- Department of Otorhinolaryngology-Head and Neck Surgery, Pendik Training and Research Hospital, Marmara University Medical Faculty, Istanbul, Turkey
| | - Cagatay Oysu
- Department of Otorhinolaryngology-Head and Neck Surgery, Pendik Training and Research Hospital, Marmara University Medical Faculty, Istanbul, Turkey
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Mihashi R, Chitose SI, Sato F, Tanaka H, Sato K, Ono T, Fukahori M, Sueyoshi S, Kurita T, Sato K, Umeno H. Endoscopic Sealing With a Polyglycolic Acid Sheet for Restoration of Vocal Fold Mucosa in Dogs. Laryngoscope 2019; 130:E436-E443. [PMID: 31693183 DOI: 10.1002/lary.28357] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 09/23/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Voice outcomes of cordectomy for early glottic cancer are often poor due to vocal fold scarring and tissue defects. Improvements in this aspect could make cordectomy a more acceptable treatment option than radiotherapy. We hypothesized that a polyglycolic acid (PGA) sheet could be used to cover vocal fold defects. The present study aimed to prevent vocal fold scarring after cordectomy using the PGA sheet. STUDY DESIGN Animal experiment. METHODS Nine male beagles were divided into three groups including a control group (n = 3). Following cordectomy, the vocal fold defect was covered with the PGA sheet plus fibrin glue (PGA group; n = 3) or with the PGA sheet plus fibrin glue containing basic fibroblast growth factor (bFGF; the PGA-bFGF group, n = 3). Vocal folds were chronologically observed, and larynges were removed 6 months after surgery. Mucosal amplitude was measured using a high-speed camera, and histological analysis was performed. RESULTS The re-epithelialization process was delayed in the PGA and PGA-bFGF groups compared with the control group. The mucosal amplitude was significantly more normalized and the thickness ratio significantly higher in the PGA and PGA-bFGF groups compared with the control group. The PGA-bFGF group had the highest elastic fiber density, followed by the PGA group and then the control group, with a significant difference between the PGA-bFGF and control groups. CONCLUSIONS The PGA sheet plus fibrin glue could serve as an effective regenerative scaffold for reconstructing vocal fold morphology and function after cordectomy, with the potential benefit of establishing an endoscopic sealing method for vocal fold defects. LEVEL OF EVIDENCE NA Laryngoscope, 130:E436-E443, 2020.
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Affiliation(s)
- Ryota Mihashi
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Shun-Ichi Chitose
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Fumihiko Sato
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Hisaichiro Tanaka
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Kiminori Sato
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Takeharu Ono
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Mioko Fukahori
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Shintaro Sueyoshi
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Takashi Kurita
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Kiminobu Sato
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Hirohito Umeno
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
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Vella O, Blanchard D, de Raucourt D, Rame JP, Babin E. Function evaluation of laryngeal reconstruction using infrahyoid muscle after partial laryngectomy in 37patients. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 137:7-11. [PMID: 31540850 DOI: 10.1016/j.anorl.2019.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Treatment of small laryngeal cancerous lesions (T1 and T2) is based on partial endoscopic or open surgery and radiotherapy. In addition to the oncological imperative, these techniques must optimally preserve the functions of breathing, swallowing and phonation. OBJECTIVE To analyze the above functions in patients treated with supracricoid laryngectomy and reconstruction using infrahyoid muscle. MATERIALS AND METHODS Breathing, swallowing and phonation were analyzed in 37patients treated in two institutes between 2005 and 2015. All patients undergoing the above type of reconstruction with a minimum 1year's follow-up were included. Respiratory study noted any tracheotomy and measured peak inspiratory flow. Preservation of cricoarytenoid units and nasogastric intubation time, and DHI-30 self-administered questionnaire results were collected to analyze swallowing function. Phonation was assessed on the VHI-30 self-administered questionnaire. RESULTS The rate of primary surgery without tracheotomy was 64.9% (13patients), with rapid resumption of oral feeding (mean intubation time, 13days). Mean VHI score was 28.3 and mean DHI 30score 2.7. Mean peak inspiratory flow was 203.3mL/min. CONCLUSION Supracricoid laryngectomy with reconstruction using subhyoid muscle is an alternative technique for the treatment of small laryngeal cancerous lesions, providing uncomplicated functional outcome.
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Affiliation(s)
- O Vella
- Service d'ORL et de chirurgie cervico-faciale, CHU de Caen, Avenue de la Côte de Nacre, 14033 Caen, France.
| | - D Blanchard
- Service d'ORL et de chirurgie cervico-faciale, CLCC François-Baclesse, 3, avenue du Général-Harris, 14000 Caen, France
| | - D de Raucourt
- Service d'ORL et de chirurgie cervico-faciale, CLCC François-Baclesse, 3, avenue du Général-Harris, 14000 Caen, France
| | - J P Rame
- Service d'ORL et de chirurgie cervico-faciale, CLCC François-Baclesse, 3, avenue du Général-Harris, 14000 Caen, France
| | - E Babin
- Service d'ORL et de chirurgie cervico-faciale, CHU de Caen, Avenue de la Côte de Nacre, 14033 Caen, France
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12
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Şencan Z, Cömert E, Tunçel Ü, Kılıç C. Voice and Quality-of-Life Outcomes of Diode Laser for Tis-T1a Glottic Cancer. EAR, NOSE & THROAT JOURNAL 2019; 99:229-234. [PMID: 31012346 DOI: 10.1177/0145561319839868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of this prospective study was to analyze the voice and quality-of-life outcomes of microscopic diode laser surgery (MDLS). The study was conducted on a series of 46 patients with Tis-T1a glottic carcinoma treated with microscopic endolaryngeal diode laser surgery. Patients were asked to complete the Voice Handicap Index and quality-of-life questionnaires of the European Organization for Research and Treatment of Cancer. When comparing the pre- and postoperative scores, there were significant difference on the physical scores (P = .014) of the patients who underwent type III cordectomy and functional (P = .022), emotional (P = .002), and overall scores (P = .005) of the patients who underwent type IV cordectomy, in the direction of better quality of voice after MDLS. The postoperative functional, physical, emotional, and overall scores of groups were significantly increased with the extension of resection.
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Affiliation(s)
- Ziya Şencan
- Department of Otolaryngology, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Ela Cömert
- Department of Otolaryngology, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Ümit Tunçel
- Ankara Oncology Education and Research Hospital, Clinic of Otolaryngology, Ankara, Turkey
| | - Caner Kılıç
- Ankara Oncology Education and Research Hospital, Clinic of Otolaryngology, Ankara, Turkey
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13
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Oncological outcomes of early glottic carcinoma treated with transoral robotic surgery. Auris Nasus Larynx 2019; 46:285-293. [DOI: 10.1016/j.anl.2018.08.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/20/2018] [Accepted: 08/23/2018] [Indexed: 11/22/2022]
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14
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Longitudinal analysis of Voice Handicap Index in early glottic cancer patients treated with transoral laser microsurgery: age, gender, stage and time dependence. The Journal of Laryngology & Otology 2019; 133:318-323. [DOI: 10.1017/s0022215119000392] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectivesTransoral laser microsurgery is an increasingly common treatment modality for glottic carcinoma. This study aimed to determine the effect of age, gender, stage and time on voice-related quality of life using the Voice Handicap Index-10.MethodsPrimary early glottic carcinoma patients treated with transoral laser microsurgery were included in the study. Self-reported Voice Handicap Index testing was completed pre-operatively, three months post-operatively, and yearly at follow-up appointments.ResultsVoice Handicap Index improvement was found to be dependent on age and tumour stage, while no significant differences were found in Voice Handicap Index for gender. Voice Handicap Index score was significantly improved at 12 months and 24 months. Time versus Voice Handicap Index modelling revealed a preference for non-linear over linear regression.ConclusionAge and stage are important factors, as younger patients with more advanced tumours show greater voice improvement post-operatively. Patient's Voice Handicap Index is predicted to have 95 per cent of maximal improvement by 5.5 months post-operatively.
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15
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Hendriksma M, van Loon Y, Klop WMC, Hakkesteegt MM, Heijnen BJ, El Hasnaoui I, de Jong M, Langeveld TPM, van Benthem PPG, Baatenburg de Jong RJ, Sjögren EV. Quality of life and voice outcome of patients treated with transoral CO 2 laser microsurgery for early glottic carcinoma (T1-T2): a 2-year follow-up study. Eur Arch Otorhinolaryngol 2019; 276:805-814. [PMID: 30810819 PMCID: PMC6411677 DOI: 10.1007/s00405-019-05348-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 02/13/2019] [Indexed: 02/06/2023]
Abstract
Purpose Longitudinal studies in laryngeal cancer can provide clinicians information about short-term and long-term functional outcomes, like quality of life (QoL) and voice outcome. This information is important when counseling patients or choosing a primary treatment modality. The present study assessed long-term (2 years) QoL and voice outcome in patients with extended T1 and limited T2 glottic carcinoma treated with transoral CO2 laser microsurgery (TLM) (unilateral type III or bilateral type II resections). Methods Three questionnaires were administered: the Voice Handicap Index (VHI), the European Organization for Research and Treatment of Cancer (EORTC) QoL questionnaire (QLQ)-C30, the EORTC QLQ-HN35. A perceptual voice evaluation at six different time points was conducted: preoperatively, and postoperatively at 6 weeks, 3 months, 6 months, 1 year, and 2 years. Fluctuations over time were investigated. Results Sixty-one patients were included in the analysis. Patients reported high-level functioning and low symptom scores 2 years postoperatively. Gender significantly affected the VHI scores at 2 years (mean VHI scores: female 8.7 vs. male, 23.9; p = 0.023). The major improvement in VHI scores was observed within the first 6 months. The tumor stage (T1a, T1b, and T2) significantly impacted the grade (mean scores at 2 years: 1.0, 1.9, and 1.7; p = 0.001). These scores stabilized at 6 months. Conclusions Patients show good long-term QoL with low symptom scores, a low voice handicap, and mild to moderate dysphonia, 2 years postoperatively. Scores stabilize at 6 months and provide a clear indication of status at 1 and 2 years.
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Affiliation(s)
- Martine Hendriksma
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands.
| | - Yda van Loon
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - W Martin C Klop
- Department of Head and Neck Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Marieke M Hakkesteegt
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Bas J Heijnen
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Ibtissam El Hasnaoui
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin de Jong
- Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Ton P M Langeveld
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter Paul G van Benthem
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Robert J Baatenburg de Jong
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Elisabeth V Sjögren
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
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16
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van Loon Y, Hendriksma M, Heijnen BJ, van de Kamp VAH, Hakkesteegt MM, Böhringer S, Langeveld TPM, de Jong MA, Klop WMC, Baatenburg de Jong RJ, Sjögren EV. Voice outcome after unilateral ELS type III or bilateral type II resections for T1-T2 glottic carcinoma: Results after 1 year. Head Neck 2019; 41:1638-1647. [PMID: 30652373 PMCID: PMC6590407 DOI: 10.1002/hed.25582] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 08/22/2018] [Accepted: 12/07/2018] [Indexed: 12/14/2022] Open
Abstract
Background Voice outcome was assessed in patients with extended T1 and limited T2 glottic carcinoma, treated with a unilateral type III or a bilateral type II resection according to the European Laryngological Society (ELS) classification. Methods Objective evaluation (acoustic and aerodynamic parameters), perceptual evaluation (GRBAS), and patients' self‐assessment (voice handicap index [VHI]) were performed before and 1 year after treatment. Results were evaluated according to ELS resection type and the involvement of the anterior commissure. Results The majority of voice parameters in all resection subgroups showed an improvement of the mean score 1 year postoperatively. Grade of dysphonia varied between 1.15 and 1.66 postoperatively and VHI score varied from 23.3 to 24.5. Conclusion Voice outcome after ELS unilateral type III or a bilateral type II resection for extended T1 and limited T2 glottic carcinoma is good with mild to very moderate perceptive dysphonia and low self‐reported voice impairment.
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Affiliation(s)
- Yda van Loon
- Department of Otorhinolaryngology, Head & Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Martine Hendriksma
- Department of Otorhinolaryngology, Head & Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Bas J Heijnen
- Department of Otorhinolaryngology, Head & Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Vivienne A H van de Kamp
- Department of Otorhinolaryngology, Head & Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Marieke M Hakkesteegt
- Department of Otorhinolaryngology, Head & Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Stefan Böhringer
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Ton P M Langeveld
- Department of Otorhinolaryngology, Head & Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - M A de Jong
- Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands
| | - W Martin C Klop
- Department of Head and Neck Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Robert J Baatenburg de Jong
- Department of Otorhinolaryngology, Head & Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Elisabeth V Sjögren
- Department of Otorhinolaryngology, Head & Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
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17
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Hamzany Y, Shoffel-Havakuk H, Devons-Sberro S, Shteinberg S, Yaniv D, Mizrachi A. Single Stage Transoral Laser Microsurgery for Early Glottic Cancer. Front Oncol 2018; 8:298. [PMID: 30155441 PMCID: PMC6102390 DOI: 10.3389/fonc.2018.00298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 07/17/2018] [Indexed: 11/13/2022] Open
Abstract
Objectives: The purpose of the study was to present the outcome of our management protocol of a single stage transoral laser microsurgery (SSTLM), with the intention of complete removal of a lesion, considered to be an early glottic cancer. Methods: Between January 2015 to February 2017 patients with the clinical appearance of an early glottic cancer, who were candidates for (SSTLM) management protocol, were included in this study. Type of cordectomy was determined by pre- and intra-operative evaluation of the extent of lesion in cord layers. Results: Thirty patients (6 females, 24 males; mean age 65 years) underwent SSTLM. Twenty-two patients had malignant histopathological diagnosis of severe dysplasia or Cis in 4 patients, microinvasice carcinoma in 3 patients and invasive carcinoma in 15 patients (T1a tumor in 14 and T1b tumor in 1). Eight patients had a nonmalignant histological diagnosis of keratosis without atypia in 2 patients, mild dysplasia in 2 patients and moderate dysplasia in 3 patients. Based on pre- and intra-operative evaluation, 14 subepithelial (type I), 10 subligamental (type II), and 6 transmuscular (type III) cordectomies were performed. Comparison of cordectomies types with postoperative histopathologic diagnosis showed an adequate extent of resection in 26 out of 30 patients (87%). Considering only patients without recent background of direct laryngoscopy and biopsy, an adequate resection was performed in 90% of patients. None of the patients was further treated by external beam radiation. At average follow-up of 21 months, none of the patients developed local recurrence. Conclusion: In selected cases, a SSTLM for clinical appearance of an early glottic cancer, allows a reliable histopathologic diagnosis and a high local control rate with favorable cost effectiveness. A careful pre- and intraoperative evaluation for selecting the appropriate cases for this management is required in order to avoid under- or over-treatment.
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Affiliation(s)
- Yaniv Hamzany
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hagit Shoffel-Havakuk
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Shani Shteinberg
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute for Speech, Swallowing and Voice Rehabilitation, Rabin Medical Center, Petach Tikva, Israel
| | - Dan Yaniv
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviram Mizrachi
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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18
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Oncological Outcomes Following Transoral CO 2 Laser Microsurgery for T1 Glottic Cancer. Indian J Otolaryngol Head Neck Surg 2018; 71:542-547. [PMID: 31742018 DOI: 10.1007/s12070-018-1394-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 05/07/2018] [Indexed: 10/16/2022] Open
Abstract
The objective of this study is to analyze oncological outcomes for treatment of Tis and T1 glottic squamous cell carcinoma after transoral laser microsurgery. This study is retrospective analysis of previously untreated, suspected lesion of glottis, staged cT1a and cT1b squamous cell carcinoma in a tertiary care hospital and 53 patients were included in the study. End points for analysis were local control, overall and disease specific survival rates. The local control, ultimate local control with laser alone, 3-year overall survival, 3-year disease specific survival and organ preservation rates were 86.7, 90.5, 92.4, 98.1 and 98.1% respectively. The involvement of anterior commissure did not show any significant impact on local control or survival. TLM is safe and effective treatment of early glottis cancer, associated with less morbidity and a high percentage of local control, survival and organ preservation rates.
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19
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Rzepakowska A, Sielska-Badurek E, Cruz R, Sobol M, Osuch-Wójcikiewicz E, Niemczyk K. Voice Profile Recovery and Quality of Life Changes After Microdirect Laryngoscopy in Three Categories of Glottis Lesions: Benign, Precancerous, and Malignant. J Voice 2017; 33:382.e11-382.e20. [PMID: 29198815 DOI: 10.1016/j.jvoice.2017.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 09/18/2017] [Accepted: 10/27/2017] [Indexed: 10/18/2022]
Abstract
The aim of the study was comparison of voice and life quality after microdirect laryngoscopy in three patient histopathological categories: benign, precancerous, and malignant glottic lesions. A totalnof 137 patients treated with microdirect laryngoscopy were included in the study. Each patient was evaluated with a multidimensional protocol before and 3, 6, and 12 months after treatment. Final 1-year evaluations were achieved in 74.5% (102). The assessment included laryngovideostroboscopy (LVS), perceptual (GRBAS) grading, aerodynamic measures including maximum phonation time and phonation quotient and acoustic measurements (Kay Elemetrics Multi-Speech program), Voice Handicap Index (VHI), Voice-Related Quality of Life questionnaire; and World Health Organization Quality of Life Scale-Brief Version (WHOQoL-BREF). An improvement in mean value of LVS ratings was obtained in all three groups; however, only in benign lesion group was it consistently statistically significant for each time period (P < 0.001). Perceptual evaluation revealed significant improvement of G, R, and B parameters in benign lesions for each time period. In malignant neoplasms R and B parameters improved 3 and 6 months post microsurgery. In patients with benign lesions the maximum phonation time increased, but the improvement was significant only after 3 months. The acoustic parameters improved in all three groups. VHI significantly improved in patients with benign lesions after 3 and 12 months. VHI in the malignant neoplasm group significantly worsened on the first follow-up visit. Considering quality of life (QoL) results, only in patients with benign lesions was there a significant improvement in overall assessment of their QoL and general health.
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Affiliation(s)
- Anna Rzepakowska
- Otolaryngology Department, Warsaw Medical University, Warsaw, Poland.
| | | | - Raul Cruz
- Otolaryngology Department, Kaiser Permanente Medical Center, Oakland, United States
| | - Maria Sobol
- Biophysics and Human Physiology Department, Warsaw Medical University, Warsaw, Poland
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Abstract
PURPOSE OF REVIEW To give an overview of the evolvement of transoral laser microsurgery (TLM) in the treatment of early glottic carcinoma and highlight the contribution of recent literature. RECENT FINDINGS The indications and limits of TLM have been well specified. Effects on swallowing have been well documented. Introduction of narrow-band imaging (NBI) and diffusion-weighted magnetic resonance has been shown of additional value for outcome. The first reports on transoral robotic surgery show that it may be of added value in the future. SUMMARY TLM for early glottic carcinoma (Tis-T2) has very good oncological outcomes with indications of higher larynx preservation in TLM than that in radiotherapy. The anterior commissure is a risk factor if involved in the cranio-caudal plane, and reduced vocal fold mobility is a risk factor when this is due to arytenoid involvement. The best voice results are achieved when the anterior commissure can be left intact along with part of the vocal fold muscle although even in larger resections, patient self-reported voice handicap is still limited.
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Affiliation(s)
- E V Sjögren
- Department of ENT and Head and Neck Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
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21
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Moore J, Greenberg C, Thibeault SL. Predictors of Six-month Change in the Voice Handicap Index in a Treatment-seeking Population. J Voice 2016; 31:41-47. [PMID: 26952321 DOI: 10.1016/j.jvoice.2016.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 02/03/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate predictors of longitudinal change in patient-perceived voice impact as determined by the Voice Handicap Index (VHI). STUDY DESIGN Prospective, survey study. METHODS Patients consented to the University of Wisconsin Voice and Swallow Clinics Outcomes Database with voice, concerns with a baseline clinic visit from November 2012 to January 2014 were eligible for the study. The VHI was sent to patients 6 months post clinic visit to determine change in voice handicap from baseline. General health was screened using the 12-item Short Form Health Survey, using physical component summary and mental component summary scores. Predictor variables included treatment (medical and/or behavioral); dysphonia sub-diagnosis; grade, roughness, breathiness, asthenia, and strain rating; age; sex; socioeconomic factors; smoking history; and comorbidity score. RESULTS Two hundred thirty-seven patients met study criteria and were followed longitudinally. Eighty-two patients returned 6-month surveys. The VHI was significantly correlated with mental component summary scores. Patients with a higher grade in baseline grade, roughness, breathiness, asthenia, and strain score were more likely to receive voice intervention (P = 0.04). Six-month improvement in VHI score was associated with both higher initial VHI score and higher educational level in both univariate (P < 0.01, P = 0.04) and multivariate analyses (P < 0.01, P = 0.02). Voice treatment (medical and/or behavioral) was not a significant factor for improvement in VHI score. CONCLUSIONS Our results suggest that it is important to consider baseline self-perceived voice impact measures and educational level in setting expectations for voice treatment. Future studies examining the relationship between treatment patterns and voice-related patient outcomes are warranted.
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Affiliation(s)
- Jaime Moore
- Department of Surgery and Communication Sciences and Disorders, 5107 Wisconsin Institutes for Medical Research, University of Wisconsin-Madison, 1111 Highland Ave., Madison, Wisconsin 53705-2275
| | - Caprice Greenberg
- Department of Surgery and School of Medicine and Public Health, 7375 Clinical Science Center, K6/148, University of Wisconsin-Madison, 600 Highland Ave., Madison, Wisconsin 53792
| | - Susan L Thibeault
- Department of Surgery, 5107 Wisconsin Institutes for Medical Research, University of Wisconsin-Madison, 1111 Highland Ave., Madison, Wisconsin 53705-2275..
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22
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Wang CC, Liu SA, Wu SH, Lin WJ, Jiang RS, Wang L. Transoral robotic surgery for early glottic carcinoma involving anterior commissure: Preliminary reports. Head Neck 2015; 38:913-8. [PMID: 26714200 DOI: 10.1002/hed.24354] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 09/02/2015] [Accepted: 11/04/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Transoral robotic surgery (TORS) for early glottic cancer has been reported, but the issue of anterior commissure involvement has seldom been addressed. Therefore, the purpose of this study was to preliminarily report the treatment results of TORS in this disease entity. METHODS Eight patients with T1 and T2 glottic carcinoma with anterior commissure involvement were selected to receive TORS. The clinical parameters, including rates of adjuvant radiotherapy (RT), survivals, as well as organ and function preservation, were retrospectively analyzed. RESULTS TORS was successfully performed in all patients without temporary tracheostomy. There were no major complications and no patient received adjuvant RT to the larynx after surgery. With a mean follow-up of 40 months, all patients survived with their larynx preserved and no local recurrence, tracheostomy, or tube feeding dependence. CONCLUSION TORS is a feasible approach for selected patients with early T classification glottic carcinoma with anterior commissure involvement. The preliminary oncologic and functional outcomes are satisfactory. © 2015 Wiley Periodicals, Inc. Head Neck 38: 913-918, 2016.
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Affiliation(s)
- Chen-Chi Wang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,School of Speech Language Pathology and Audiology, Chung Shan Medical University, Taichung, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shih-An Liu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shang-Heng Wu
- Department of Otolaryngology-Head and Neck Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wen-Jiun Lin
- Department of Otolaryngology-Head and Neck Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Rong-San Jiang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Lily Wang
- Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan
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23
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Lee HS, Kim JS, Kim SW, Noh WJ, Kim YJ, Oh D, Hong JC, Lee KD. Voice outcome according to surgical extent of transoral laser microsurgery for T1 glottic carcinoma. Laryngoscope 2015; 126:2051-6. [PMID: 26934846 DOI: 10.1002/lary.25789] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 10/07/2015] [Accepted: 10/27/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate the outcomes of transoral laser microsurgery (TLM) for T1 glottic carcinoma using longitudinal voice analysis. STUDY DESIGN Retrospective analysis of medical records. METHODS We conducted a retrospective review of 57 patients (50 T1a, seven T1b) who underwent TLM for T1 glottic carcinoma, and longitudinal voice analysis was performed before surgery, during the early postoperative period (within 3 months), and during the late postoperative period (more than 6 months). Acoustic, perceptual (Grade, Roughness, Breathiness, Asthenia, Strain scale), and subjective voice analysis using the Voice Handicap Index (VHI) was conducted. RESULTS Voice quality deteriorated in the early postoperative period in terms of several parameters. However, no significant differences in voice quality were observed in the late postoperative period, whereas Grade (from 1.85 ± 0.83 to 1.50 ± 0.90) and Roughness (from 1.74 ± 0.73 to 1.48 ± 0.87) had improved significantly. Patients who underwent lesser-extent cordectomy (type I, II) showed improvement in VHI-Physical (from 12.93 ± 11.10 to 6.07 ± 8.69) and Grade (from 1.60 ± 0.68 to 0.98 ± 0.83), whereas improvement was not identified in those who underwent larger-extent cordectomy (type III, IV, V). Improvement in Grade (from 1.70 ± 0.80 to 1.23 ± 0.91) and Roughness (from 1.77 ± 0.73 to 1.25 ± 0.76) was identified in patients who had unilateral tumor without involvement of anterior commissure. However, those with involvement of the anterior commissure or bilateral vocal cord showed a tendency toward deterioration in voice quality. CONCLUSIONS Voice quality of patients following TLM for T1 glottic carcinoma may improve significantly over time in cases with lesser-extent types of cordectomy or unilateral tumor without involvement of the anterior commissure. LEVEL OF EVIDENCE 4 Laryngoscope, 126:2051-2056, 2016.
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Affiliation(s)
- Hyoung Shin Lee
- Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea.,Innovative Biomedical Technology Research Center, College of Medicine, Kosin University, Busan, Korea
| | - Ji Su Kim
- Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea
| | - Sung Won Kim
- Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea.,Innovative Biomedical Technology Research Center, College of Medicine, Kosin University, Busan, Korea
| | - Woong Jae Noh
- Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea
| | - Young Joon Kim
- Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea
| | - Dasol Oh
- Kosin University College of Medicine, Busan, Korea
| | - Jong Chul Hong
- Department of Otolaryngology-Head and Neck Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Kang Dae Lee
- Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea
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24
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Abstract
Quality of life preservation has become an essential goal of treatment in the management of laryngeal carcinoma. Although established treatments of reference such as total laryngectomy and chemoradiation protocols have focused on survival and anatomic preservation of the larynx, they still generate considerable functional morbidity with detrimental effects on quality of life. Transoral and transcervical partial laryngectomy techniques can offer significant advantages when used prudently after proper patient selection. The growing relevance of those techniques in the management of advanced and recurrent laryngeal carcinoma deserves particular attention, with potential for improved quality of life without compromising oncologic outcomes.
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25
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Hartl DM, Laoufi S, Brasnu DF. Voice Outcomes of Transoral Laser Microsurgery of the Larynx. Otolaryngol Clin North Am 2015; 48:627-37. [PMID: 26096137 DOI: 10.1016/j.otc.2015.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Transoral laser microsurgery (TLM) is the mainstay in the treatment of early (TisT1T2) glottic cancer. Current knowledge concerning voice quality and voice-related quality of life in patients treated using TLM is based on small cohort studies using various instruments to evaluate these functional results. The bulk of the literature indicates that subjective and objective measurements of voice quality can return to normal or almost normal values after TLM, generally after 6 to 12 months and particularly after cordectomy types I, II, and III.
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Affiliation(s)
- Dana M Hartl
- Service Rhône, Department of Head and Neck Oncology, Institut de Cancérologie Gustave Roussy, 114 rue Edouard Vaillant, Villejuif 94805, France.
| | - Samia Laoufi
- Department of Head and Neck Oncology, Institut de Cancérologie Gustave Roussy, 114 rue Edouard Vaillant, Villejuif 94805, France
| | - Daniel F Brasnu
- Otolaryngology-Head and Neck Surgery, University Hospital Cancer Specialities Pole, University Paris Descartes and Sorbonne Nouvelle, Hôpital Européen Georges Pompidou, 20, rue Leblanc, Paris 75908 Cedex 15, France
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26
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Mau T, Palaparthi A, Riede T, Titze IR. Effect of resection depth of early glottic cancer on vocal outcome: an optimized finite element simulation. Laryngoscope 2015; 125:1892-9. [PMID: 26010240 DOI: 10.1002/lary.25267] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2015] [Indexed: 11/05/2022]
Abstract
OBJECTIVES/HYPOTHESIS To test the hypothesis that subligamental cordectomy produces superior acoustic outcome than subepithelial cordectomy for early (T1-2) glottic cancer that requires complete removal of the superficial lamina propria but does not involve the vocal ligament. STUDY DESIGN Computer simulation. METHODS A computational tool for vocal fold surgical planning and simulation (the National Center for Voice and Speech Phonosurgery Optimizer-Simulator) was used to evaluate the acoustic output of alternative vocal fold morphologies. Four morphologies were simulated: normal, subepithelial cordectomy, subligamental cordectomy, and transligamental cordectomy (partial ligament resection). The primary outcome measure was the range of fundamental frequency (F0 ) and sound pressure level (SPL). A more restricted F0 -SPL range was considered less favorable because of reduced acoustic possibilities given the same range of driving subglottic pressure and identical vocal fold posturing. RESULTS Subligamental cordectomy generated solutions covering an F0 -SPL range 82% of normal for a rectangular vocal fold. In contrast, transligamental and subepithelial cordectomies produced significantly smaller F0 -SPL ranges, 57% and 19% of normal, respectively. CONCLUSION This study illustrates the use of the Phonosurgery Optimizer-Simulator to test a specific hypothesis regarding the merits of two surgical alternatives. These simulation results provide theoretical support for vocal ligament excision with maximum muscle preservation when superficial lamina propria resection is necessary but the vocal ligament can be spared on oncological grounds. The resection of more tissue may paradoxically allow the eventual recovery of a better speaking voice, assuming glottal width is restored. Application of this conclusion to surgical practice will require confirmatory clinical data. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Ted Mau
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Anil Palaparthi
- National Center for Voice and Speech, University of Utah, Salt Lake City, Utah
| | - Tobias Riede
- National Center for Voice and Speech, University of Utah, Salt Lake City, Utah.,Department of Physiology, Midwestern University, Glendale, Arizona
| | - Ingo R Titze
- Department of Communication Sciences and Disorders, The University of Iowa, Iowa City, Iowa, U.S.A
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27
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Voice Outcomes After Transoral Laser Microsurgery for Early Glottic Cancer—Considering Signal Type and Smoothed Cepstral Peak Prominence. J Voice 2015; 29:370-81. [DOI: 10.1016/j.jvoice.2014.08.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 05/07/2014] [Indexed: 11/21/2022]
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28
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Greulich MT, Parker NP, Lee P, Merati AL, Misono S. Voice outcomes following radiation versus laser microsurgery for T1 glottic carcinoma: systematic review and meta-analysis. Otolaryngol Head Neck Surg 2015; 152:811-9. [PMID: 25837666 DOI: 10.1177/0194599815577103] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 02/20/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Systematic review of literature on patient-reported voice handicap following T1 glottic squamous cell carcinoma treatment using transoral laser microsurgery or radiation therapy. DATA SOURCES PubMed, Web of Science, and Scopus (1997-2013). REVIEW METHODS These data sources were searched for papers reporting Voice Handicap Index (VHI) after treatment of early glottic carcinoma. Review and reference cross-checking were performed using a priori selection criteria. Study data were abstracted and publication quality categorized independently by 2 authors. Corresponding authors were contacted to maximize data for analysis. Meta-analysis was performed only with studies that included both treatment modalities, to reduce heterogeneity and maximize rigor; random effects modeling was used to pool results. RESULTS Eighteen publications were identified that reported VHI data following surgery and radiotherapy for T1 glottic carcinoma. No studies were randomized. When studies that reported multiple T-stages or systematic treatment selection bias were excluded, 8 retrospective cohort studies describing 362 patients were suitable for meta-analysis. Follow-up time (mean, 47 months; range, 1-298 mo) and extent of surgical excision varied across studies. Six studies showed no VHI difference between treatment arms; 2 favored radiotherapy over surgery (1 of which reported transmuscular cordectomy for all surgical patients); and none favored surgery. Meta-analysis showed no significant difference in posttreatment VHI between radiotherapy and surgery (mean difference, -5.52; 95% confidence interval, -11.40, 0.36; heterogeneity I (2) = 61%, P = .01). CONCLUSION VHI scores were comparable following transoral laser microsurgery and radiation therapy for T1 glottic carcinoma in the current literature, suggesting no clinically significant difference in functional voice outcomes between treatment types.
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Affiliation(s)
- Matthew T Greulich
- Department of Otolaryngology, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - Noah P Parker
- The Voice Clinic of Indiana, Carmel, Indiana, USA The Department of Speech and Hearing Sciences, Indiana University, Bloomington, Indiana, USA
| | - Philip Lee
- Department of Otolaryngology, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - Albert L Merati
- Department of Otolaryngology, University of Washington Medical Center, Seattle, Washington, USA
| | - Stephanie Misono
- Department of Otolaryngology, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
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29
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Panwar A, Lindau R, Wieland A. Management of premalignant lesions of the larynx. Expert Rev Anticancer Ther 2014; 13:1045-51. [DOI: 10.1586/14737140.2013.829643] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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30
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Stomeo F, Tosin E, Morolli F, Bianchini C, Ciorba A, Pastore A, Pelucchi S. Comparison of Subjective and Objective Tools in Transoral Laser Cordectomy for Early Glottic Cancer: Importance of Voice Handicap Index. Int J Immunopathol Pharmacol 2013; 26:445-51. [DOI: 10.1177/039463201302600217] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Several studies in recent years have already reported good oncologic results with laser microsurgery in the treatment of early glottic carcinoma. We conducted a longitudinal voice evaluation, in patients with early glottic cancer who underwent transoral laser cordectomy, in order to assess the voice quality outcome and its relationship with objective and subjective (voice handicap index questionnaire and GIRBAS scale) means. Twenty-four previously untreated patients underwent transoral laser cordectomy for early glottic cancer. All patients underwent subjective and objective voice assessment according to the multidimensional voice protocol recommended by the European Laryngological Society including acoustic, perceptual and stroboscopic analysis combined to patient self assessment of voice (voice handicap index-VHI). These evaluations were performed before treatment and 6 months after the treatment. Vocal fold healing was complete in all cases by 6 months following surgery. Main voice parameters (subjective and objective) resulted improved at the 6-month control after surgery. In particular, voice handicap index (VHI) and GIRBAS scale resulted reliable for voice assessment and for the postoperative follow-up. In conclusion, VHI, GIRBAS, multidimensional voice program (MDVP) and spectroacoustic parameters showed a close trend in the present study, and this confirms the validity of the voice analysis performed by each tool.
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Affiliation(s)
- F. Stomeo
- ENT Department, University Hospital of Ferrara, Italy
| | - E. Tosin
- ENT Department, University Hospital of Ferrara, Italy
| | - F. Morolli
- ENT Department, University Hospital of Ferrara, Italy
| | - C. Bianchini
- ENT Department, University Hospital of Ferrara, Italy
| | - A. Ciorba
- ENT Department, University Hospital of Ferrara, Italy
| | - A. Pastore
- ENT Department, University Hospital of Ferrara, Italy
| | - S. Pelucchi
- ENT Department, University Hospital of Ferrara, Italy
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