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Ananthapadmanabhan S, Jabbour J, Lai S, Suruliraj A, Smith M, Riffat F, Devadas M, Liem H, Sritharan N. A Multidisciplinary Approach to Secondary Tracheoesophageal Puncture for Voice Prosthesis Insertion Using Flexible Esophagoscopy. J Voice 2024; 38:1255.e1-1255.e8. [PMID: 35418350 DOI: 10.1016/j.jvoice.2022.03.009] [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: 01/10/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Tracheoesophageal puncture (TEP) with voice prosthesis (VP) insertion is the gold standard of surgical voice restoration in postlaryngectomy patients. The conventional technique involves rigid esophagoscopes and trocar performed by ENT surgeons alone, with technical limitations encountered in patients with cervical abnormalities - in particular those with free or rotational flap reconstructions and postradiotherapy strictures. We report our technique using flexible endoscopy which we show to be feasible and without major safety events, as a possible consideration in the anticipated difficult TEP. METHODS Our study describes a multidisciplinary approach to secondary TEP involving a combined upper gastrointestinal (UGI) and (Ear, Nose, and Throat) ENT procedure, under the guidance of flexible esophagoscopy, with intraoperative involvement of the speech pathologist to guide VP insertion and placement. The procedure was performed with ease without major complications. RESULTS We identified nine postlaryngectomy and laryngopharyngectomy patients in our institution who underwent secondary TEP with VP insertion using flexible esophagoscopy and multidisciplinary intra-operative involvement. All patients had pharyngeal reconstruction, including radial forearm free flap (n = 4), pectoralis major rotational flap (n = 3), and anterolateral thigh flap (n = 2). Eight out of nine patients underwent adjuvant radiotherapy. The technique was successfully performed in all patients. There were three cases of early TEP displacement in two patients, of which one patient had a successful repeat procedure. We found the technique advantageous in terms of feasibility and practicality compared to the conventional approach, and without intraoperative difficulties encountered in achieving the desired field of views or navigating the challenging anatomy in a free flap and post-radiotherapy patients. This includes distorted cervical anatomy, the presence of bulky and hair-bearing flap skin, and stricture formation. Minor complications in our cohort included pharyngo-esophageal spasm, TEP displacement, granulation tissue, and peri-prosthetic leaks. CONCLUSION Our multidisciplinary approach to secondary TEP was performed with flexible esophagoscopy without major related complications. The technique is advantageous in the surgical approach to VP insertion in postlaryngectomy and laryngopharyngectomy patients who have had radiotherapy or pharyngeal reconstruction. It allows for safe anatomical insertion and thorough evaluation of the upper aerodigestive tract for comorbid benign or malignant esophageal pathology.
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Affiliation(s)
| | - Joe Jabbour
- Department of Otolaryngology, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Stephanie Lai
- Department of Speech Pathology, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Anand Suruliraj
- Department of Otolaryngology, Nepean Hospital, Kingswood, New South Wales, Australia; Department of Otolaryngology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Mark Smith
- Department of Otolaryngology, Nepean Hospital, Kingswood, New South Wales, Australia; Department of Otolaryngology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Faruque Riffat
- Department of Otolaryngology, Nepean Hospital, Kingswood, New South Wales, Australia; Department of Otolaryngology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Michael Devadas
- Department of Upper GI Surgery, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Han Liem
- Department of Upper GI Surgery, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Niranjan Sritharan
- Department of Otolaryngology, Nepean Hospital, Kingswood, New South Wales, Australia; Department of Otolaryngology, Westmead Hospital, Westmead, New South Wales, Australia
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Azar SS, Shires CB, Dewan K, Chhetri DK. Total tracheoesophageal puncture failure: A scoping review of patient characteristics and etiologies. Head Neck 2024. [PMID: 39077940 DOI: 10.1002/hed.27901] [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: 01/01/2024] [Revised: 07/15/2024] [Accepted: 07/20/2024] [Indexed: 07/31/2024] Open
Abstract
OBJECTIVES Tracheoesophageal prosthesis (TEP) is a common method for post-laryngectomy speech rehabilitation. Despite its common use, some patients ultimately fail TEP rehabilitation. TEP dysfunction negatively affects quality of life due to poor voice quality and need for repeated interventions to restore TEP function. Occasionally, voice rehabilitation with TEP is completely unsuccessful. We performed a scoping review to characterize the main reasons for total TEP failure, in hopes of guiding selection of optimal TEP candidates. STUDY DESIGN Scoping review using PubMed of all English language articles from 1990 to 2020 addressing causes of TEP failure. METHODS This scoping review followed the population, intervention, comparison, outcome and study (PICOS) guidelines. Total TEP failure was defined as complete loss or abandonment of TEP voice or tract. A comprehensive search strategy using PubMed's MeSH subject headings and keywords was created. Causes and rates of failure were reviewed. RESULTS Among 544 peer-reviewed journal articles reviewed for inclusion. Seventy articles met inclusion criteria, resulting in a total of 4928 TEP voice restoration patients for analysis. 15.2% of these patients had total TEP failure. The most common reasons for failure were dissatisfaction with voice (26.3%), leakage (17.9%), inadequate patient motivation (14.7%), comorbidities (14.2%), stoma problems (11.6%), and abandonment of TEP after dislodgement (10.6%). CONCLUSION Common reasons for TEP failure included voice dissatisfaction, leakage, lack of patient motivation, patient comorbidities, and stoma problems. These factors should be considered when selecting candidates for TEP voice restoration.
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Affiliation(s)
- Shaghauyegh S Azar
- Department of Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | | | - Karuna Dewan
- Department of Otolaryngology - Head and Neck Surgery, Louisiana State University, Shreveport, Louisiana, USA
| | - Dinesh K Chhetri
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
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Williamson A, Shah F, Benaran I, Paleri V. Vascularized Tissue to Reduce Fistula After Salvage Total Laryngectomy: A Network Meta-analysis. Laryngoscope 2024; 134:2991-3002. [PMID: 38238878 DOI: 10.1002/lary.31287] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 12/18/2023] [Accepted: 01/02/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVE Salvage laryngectomy is more predisposed to complications than primary operations, with pharyngocutaneous fistula (PCF) being among the most challenging to manage. Vascularized flaps are increasingly employed during salvage laryngectomy, with a previous review finding a PCF incidence of 31.2% and 22.2% after primary and flap-assisted closure respectively. We aim to better define the role of vascularized flaps after salvage laryngectomy by performing an updated review comparing the rate of PCF in those undergoing primary or vascularized flap-assisted closure. DATA SOURCES Pubmed/Medline, CINAHL, and CENTRAL. REVIEW METHODS An updated literature review was conducted of English language literature from 2003 to 2023. A random effects and network meta-analysis of odds ratios (OR) and pooled proportions were conducted. RESULTS Literature search found 31 studies, including seven from the previous review. Overall random effects pooled PCF rate was 25% (95% CI 0.21; 0.30, I2 = 72%, p = <0.01), whereas incidence in primary closure was 37% (95% CI 0.32; 0.43, I2 = 60%, p = <0.01) and 19% (95% CI 0.12; 0.20, I2 = 47%, p = <0.01) after flap closure. Pooled OR was 0.39 (95% CI 0.28; 0.55, I2 = 36%, p = 0.04) in favor of vascularized tissues. The number needed to treat was 6.5. The rate of PCF was lower after free and pedicled flaps, and on-lay and patch closure compared to primary closure techniques. Network meta-analysis found all combinations of closure techniques and vascularized tissue were superior to primary closure. CONCLUSION The updated analysis has demonstrated a widening in the rates of PCF between primary and vascularized flap-assisted closure. Surgeons should strongly consider the use of free or pedicled flaps in any salvage laryngectomy procedure. Laryngoscope, 134:2991-3002, 2024.
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Affiliation(s)
- Andrew Williamson
- Department of Head and Neck Surgery, The Royal Marsden Hospital, International Centre for Recurrent Head and Neck Cancer (IReC), London, United Kingdom
- Institute for Cancer Research, London, United Kingdom
| | - Faizan Shah
- Department of Otolaryngology, Head and Neck Surgery, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Irene Benaran
- Department of Otolaryngology, Head and Neck Surgery, Monklands University Hospital, Glasgow, United Kingdom
| | - Vinidh Paleri
- Department of Head and Neck Surgery, The Royal Marsden Hospital, International Centre for Recurrent Head and Neck Cancer (IReC), London, United Kingdom
- Institute for Cancer Research, London, United Kingdom
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Kanyo EC, Wu SS, Reddy CA, Silver NL, Lamarre ED, Burkey BB, Prendes BL, Scharpf J, Lorenz RR, Kmiecik J, Ku JA. Primary fit tracheoesophageal puncture in primary versus salvage laryngectomy: Short-term and long-term complications and functional outcomes. Head Neck 2024. [PMID: 38655707 DOI: 10.1002/hed.27788] [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: 06/14/2023] [Revised: 02/09/2024] [Accepted: 04/16/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Primary fit tracheoesophageal puncture (TEP) is widely preferred for individuals who have not undergone prior radiation. However, there is no consensus on the relative utility of primary-fit TEP in the setting of salvage laryngectomy. METHODS A retrospective, single-center review was conducted of individuals undergoing laryngectomy with primary fit TEP between 2012 and 2018. Multivariable analysis was conducted to compare short-term and long-term complications, as well as speech and swallowing outcomes, of those who underwent primary versus salvage laryngectomy. RESULTS In this study, 134 patients underwent total laryngectomy with primary fit TEP. Aside from a higher rate of peristomal dehiscence (13.1% vs. 1.4%) found in the salvage group, there was no difference in incidence of all other complications, including pharyngocutaneous fistula formation. The groups had comparable speech and swallow outcomes. CONCLUSION Primary fit TEP is a safe and effective surgical choice for individuals undergoing salvage laryngectomy who desire a voice prosthesis.
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Affiliation(s)
- Emese C Kanyo
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Shannon S Wu
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Chandana A Reddy
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Eric D Lamarre
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brian B Burkey
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Joseph Scharpf
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Robert R Lorenz
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Joann Kmiecik
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jamie A Ku
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Che Z, Wan X, Xu J, Duan C, Zheng T, Chen J. Speaking without vocal folds using a machine-learning-assisted wearable sensing-actuation system. Nat Commun 2024; 15:1873. [PMID: 38472193 PMCID: PMC10933441 DOI: 10.1038/s41467-024-45915-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 02/06/2024] [Indexed: 03/14/2024] Open
Abstract
Voice disorders resulting from various pathological vocal fold conditions or postoperative recovery of laryngeal cancer surgeries, are common causes of dysphonia. Here, we present a self-powered wearable sensing-actuation system based on soft magnetoelasticity that enables assisted speaking without relying on the vocal folds. It holds a lightweighted mass of approximately 7.2 g, skin-alike modulus of 7.83 × 105 Pa, stability against skin perspiration, and a maximum stretchability of 164%. The wearable sensing component can effectively capture extrinsic laryngeal muscle movement and convert them into high-fidelity and analyzable electrical signals, which can be translated into speech signals with the assistance of machine learning algorithms with an accuracy of 94.68%. Then, with the wearable actuation component, the speech could be expressed as voice signals while circumventing vocal fold vibration. We expect this approach could facilitate the restoration of normal voice function and significantly enhance the quality of life for patients with dysfunctional vocal folds.
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Affiliation(s)
- Ziyuan Che
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Xiao Wan
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Jing Xu
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Chrystal Duan
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Tianqi Zheng
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Jun Chen
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA.
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Pires RC, Gama RR, da Silveira Júnior PS, Teixeira FM, Santos CR, de Castro Capuzzo R. Analysis of durability and replacement of vocal prostheses in total laryngectomy patients at a head and neck surgery referral center. Eur Arch Otorhinolaryngol 2024; 281:351-357. [PMID: 37776343 DOI: 10.1007/s00405-023-08180-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/07/2023] [Indexed: 10/02/2023]
Abstract
PURPOSE The use of tracheoesophageal prostheses has become the gold standard in vocal rehabilitation of patients undergoing total laryngectomy. However, this method also has limitations, such as the need for frequent replacement of prostheses due to leakage or other complications. We have designed a study to access the clinical profile of patients using tracheoesophageal prostheses as vocal rehabilitation after total laryngectomy and to determine the average rate of changes, as well as the main causes of prostheses replacement. METHODS A retrospective cohort study was performed based on patients who underwent rehabilitation with voice prostheses after total laryngectomy between 2008 and 2017. RESULTS The sample consisted of 93 patients and 432 vocal prostheses replacement events. The median change of prostheses per patient was 210.25 days, (range 57.33 to 651.50). The most frequent cause of prostheses replacement was leakage through the prostheses, 218 (50.46%). Lower level of education was associated to higher prostheses replacement rate. CONCLUSION The results of this study show that the median of prostheses durability is higher than that presented in the literature, the main cause of replacement was protheses leakage and that low educational level is associated to higher replacement rate.
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Affiliation(s)
- Rafael Cardoso Pires
- Head and Neck Surgery Department, Amazonia Cancer Hospital, Rodovia BR 364, Km 15, S/N, Área Rural, Porto Velho, Rondônia, Brazil.
| | - Ricardo Ribeiro Gama
- Head and Neck Surgery Department, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Paulo Sérgio da Silveira Júnior
- Head and Neck Surgery Department, Amazonia Cancer Hospital, Rodovia BR 364, Km 15, S/N, Área Rural, Porto Velho, Rondônia, Brazil
| | | | - Carlos Roberto Santos
- Head and Neck Surgery Department, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
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Saeedi A, Strum DP, Mir G, Chow MS, Bhatt N, Jacobson AS. Management of Enlarging Tracheoesophageal Fistula with Voice Prosthesis in Laryngectomized Patients. Laryngoscope 2024; 134:198-206. [PMID: 37366287 DOI: 10.1002/lary.30857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 06/28/2023]
Abstract
Management of Enlarging tracheoesophageal fistula (TEF) with Voice Prosthesis in Laryngectomized Head and Neck Cancer Patients. OBJECTIVES An enlarging TEF following voice prosthesis placement impacts patient quality of life, risks airway compromise, and can lead to aspiration pneumonia. Pharyngoesophageal strictures have previously been reported to be associated with TEF enlargement and leakage. We describe a series of patients with enlarging TEFs after Tracheoesophageal puncture (TEP) for voice prosthesis who required pharyngoesophageal reconstruction. METHODS Retrospective case series of laryngectomized H&N cancer patients with primary or secondary TEP who underwent surgical management for enlarging TEF site between 6/2016-11/2022. RESULTS Eight patients were included. The mean age was 62.8 years old. Seven patients had a history of hypothyroidism. Of seven with prior H&N radiation history, two had both historical and adjuvant radiation. Two of the eight TEPs were placed secondarily. Mean time from TEP to enlarging TEF diagnosis was 891.3 days. Radial forearm-free flaps were used in five patients. Six had stenosis proximal to the TEF whereas one had distal stenosis and one had no evidence of stenosis. Mean length of stay was 12.3 days. Mean follow-up was 400.4 days. Two required a second free flap for persistent fistula. CONCLUSION Surgical reconstruction of enlarging TEFs due to TEP/VP placement is effective in combination with addressing underlying pharyngeal/esophageal stenosis contributing to TEF enlargement and leakage. Radial forearm-free flaps have the additional benefit of a long vascular pedicle to access more distant and less-irradiated recipient vessels. Many fistulae are resolved after the first flap reconstruction, but some may require subsequent reconstruction in case of failure. LEVEL OF EVIDENCE 4 Laryngoscope, 134:198-206, 2024.
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Affiliation(s)
- Arman Saeedi
- Otolaryngology-Head and Neck Surgery, NYU Grossman School of Medicine, New York, New York, U.S.A
| | - David P Strum
- Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, U.S.A
| | - Ghayoour Mir
- Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, U.S.A
| | - Michael S Chow
- Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, U.S.A
| | - Nupur Bhatt
- Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, U.S.A
| | - Adam S Jacobson
- Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, U.S.A
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Johnson F, Knopf A. The Localisation of a Tracheoesophageal Shunt during Laryn(-gopharyn)gectomy Determines the Risk of Shunt Insufficiency. J Clin Med 2023; 12:7628. [PMID: 38137697 PMCID: PMC10743495 DOI: 10.3390/jcm12247628] [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: 10/11/2023] [Revised: 12/01/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Tracheoesophageal shunt insufficiency (TESI) is a common and potentially life-threatening complication after laryn(-gopharyn)gectomy (L(P)E). We investigated whether TESI could be the result of a specific shunt location. METHODS A monocentric, retrospective cohort analysis of 171 consecutively treated L(P)E patients was performed. Patients with a secondary prosthesis instillation and patients with insufficient postoperative imaging were excluded. Disease related data as well as location of primary voice prosthesis were assessed. RESULTS The cohort was divided into 62 TESI-positive and 109 TESI-negative individuals. The mean time from surgery to TESI was 32 months. No differences were observed in gender, age, tumor localization, T/R/M-status. Surgery without adjuvant therapy was more often performed in TESI-negative individuals when compared with their positive counterparts. However, Cox regression including T/N status, therapy and categorized distance of the tracheoesophageal shunt to the manubrium (≤1.5 cm vs. >1.5 cm) revealed that a distance of ≤1.5 cm was associated with a 2.1-fold increased risk of TESI, while all other parameters did not influence the event-free survival. CONCLUSIONS Primary shunt positioning ≤1.5 cm to the ridge of the manubrium is associated with an increased risk of TESI. In these individuals secondary shunt operation resulting in a position >1.5 cm distant to the manubrium should be recommended.
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Affiliation(s)
- Felix Johnson
- Department of Otorhinolaryngology, Head and Neck Surgery, Technical University of Munich, 80333 Munich, Germany;
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Innsbruck, 6020 Innsbruck, Austria
| | - Andreas Knopf
- Department of Otorhinolaryngology, Head and Neck Surgery, Technical University of Munich, 80333 Munich, Germany;
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Freiburg, 79085 Freiburg im Breisgau, Germany
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Jabbour N, Rodriggs T, O'Dea M, Mur T, Vitale K, L Faden D. Protocolized awake secondary tracheoesophageal puncture with immediate voicing. Head Neck 2023; 45:2735-2740. [PMID: 37671696 DOI: 10.1002/hed.27506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/25/2023] [Accepted: 08/20/2023] [Indexed: 09/07/2023] Open
Abstract
Tracheoesophageal (TE) puncture with voice prosthesis placement is a common method for vocal rehabilitation in patients who have undergone total laryngectomy. Tracheoesophageal voice prosthesis (TEP) placement after laryngectomy, known as secondary TE puncture, is traditionally done in the operating room, using rigid esophagoscopy. Traditional secondary TEP placement carries a number of downsides including risks associated with general anesthesia, high cost, and technical challenges associated with anatomical variables. As a result, in-office secondary TE puncture has become an increasingly utilized procedure with many advantages but currently lacks standardization. Here, we describe a kit-based, awake, in-office secondary TE puncture with primary TEP placement technique. This technique calls for an endoscopic snare in the event there is difficulty passing the guidewire in the cranial trajectory. No surgical technique videos demonstrating in-office secondary TE puncture currently exist. Here, we present a video tutorial of our technique, breaking down the procedure into 10 steps from analgesia to voicing.
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Affiliation(s)
- Nicolette Jabbour
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Timothy Rodriggs
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Meredith O'Dea
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Avedisian School of Medicine, Boston University Chobanian, Boston, Massachusetts, USA
- MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Taha Mur
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kailey Vitale
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Avedisian School of Medicine, Boston University Chobanian, Boston, Massachusetts, USA
| | - Daniel L Faden
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Avedisian School of Medicine, Boston University Chobanian, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
- Massachusetts Eye and Ear, Boston, Massachusetts, USA
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Landry V, Christopoulos A, Guertin L, Bissada E, Tabet P, Berania I, Royal-Lajeunesse É, Olivier MJ, Ayad T. Patterns of alaryngeal voice adoption and predictive factors of vocal rehabilitation failure following total laryngectomy. Head Neck 2023; 45:2657-2669. [PMID: 37646494 DOI: 10.1002/hed.27491] [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: 01/09/2023] [Revised: 07/10/2023] [Accepted: 08/13/2023] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVE We aimed to determine patterns of alaryngeal voice acquisition and predictive factors of vocal rehabilitation (VR) failure following total laryngectomy (TL) at a large Canadian tertiary care center. METHODS All consecutive patients having undergone a TL between January 1st, 2011 and December 31st, 2019, at the Centre Hospitalier de l'Université de Montréal were included. RESULTS One hundred and ninety-seven laryngectomized patients were identified. Successful VR was achieved in 86 (59.0%) patients, while 59 (41.0%) failed to use a method of alaryngeal voice as their principal means of communication at 1 year postoperatively. The use of tracheoesophageal puncture (TEP) was associated with higher VR success rates (70.6%) when compared with the artificial larynx (48.6%), and esophageal voice (18.8%). The only independent predictor of VR failure on multivariate analysis at all time points was a low socioeconomic status. CONCLUSION Failure to adopt an alaryngeal voice following TL is highly prevalent, despite comprehensive and free speech language pathologist services being offered at our center. A low resort to TEP at our institution and a poor acceptability and accessibility of alternative VR methods may contribute to this trend. The challenges of VR may be further exacerbated by the barriers linked to a lower socioeconomic status, which in turn may contribute to reduced candidacy for TEP.
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Affiliation(s)
- Vivianne Landry
- Faculty of Medicine, University of Montreal, Montréal, Québec, Canada
| | - Apostolos Christopoulos
- Division of Otolaryngology - Head and Neck Surgery, University of Montreal Hospital Center (CHUM), Montréal, Québec, Canada
| | - Louis Guertin
- Division of Otolaryngology - Head and Neck Surgery, University of Montreal Hospital Center (CHUM), Montréal, Québec, Canada
| | - Eric Bissada
- Division of Otolaryngology - Head and Neck Surgery, University of Montreal Hospital Center (CHUM), Montréal, Québec, Canada
| | - Paul Tabet
- Division of Otolaryngology - Head and Neck Surgery, University of Montreal Hospital Center (CHUM), Montréal, Québec, Canada
| | - Ilyes Berania
- Division of Otolaryngology - Head and Neck Surgery, University of Montreal Hospital Center (CHUM), Montréal, Québec, Canada
| | - Émilie Royal-Lajeunesse
- Division of Otolaryngology - Head and Neck Surgery, University of Montreal Hospital Center (CHUM), Montréal, Québec, Canada
| | - Marie-Jo Olivier
- Division of Otolaryngology - Head and Neck Surgery, University of Montreal Hospital Center (CHUM), Montréal, Québec, Canada
- Division of Otolaryngology - Head and Neck Surgery, Maisonneuve-Rosemont Hospital, Montréal, Québec, Canada
| | - Tareck Ayad
- Division of Otolaryngology - Head and Neck Surgery, University of Montreal Hospital Center (CHUM), Montréal, Québec, Canada
- Division of Otolaryngology - Head and Neck Surgery, Maisonneuve-Rosemont Hospital, Montréal, Québec, Canada
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Mouret F, Crevier-Buchman L, Pillot-Loiseau C. Intelligibility of pseudo-whispered speech after total laryngectomy. CLINICAL LINGUISTICS & PHONETICS 2023; 37:866-882. [PMID: 35818773 DOI: 10.1080/02699206.2022.2092425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 06/09/2022] [Accepted: 06/14/2022] [Indexed: 06/15/2023]
Abstract
This study aimed to assess the intelligibility of so-called 'pseudo-whispered speech' (pseudo-WS), as produced without voice nor pulmonic airstream by some alaryngeal patients prior to rehabilitation. Several perception tests were submitted to three experienced clinicians and three naive listeners, relying on the speech samples of 20 French native speakers: 10 alaryngeal speakers, solely using pseudo-WS when starting speech therapy up to six months after total laryngectomy, and 10 control speakers, recorded in the closest speech mode available, whispered speech (WS). Experts were asked to identify consonants (C) in the /a/+C+/a/ context and to rate intelligibility, unintended additive noise, and fluency on a likert-scale, while naive listeners completed a quantitative test of intelligibility. Intelligibility of WS was found to be high, with scores ranging from 46.33/54 to 53.67/54 (median 52.5, interquartile range 2.33) for the quantitative test, and segmental intelligibility ranging from 68.75% to 94.79% (median 87.5, interquartile range 17.71). Segmental confusion affected voicing in favour of unvoiced consonants, as previously reported in the literature. By contrast, intelligibility of pseudo-WS was found to be poor, with scores ranging from 1/54 (unintelligibility) to 28.33/54 (median 8.66, interquartile range 14.67) for the quantitative test, and segmental intelligibility ranging from 3.13% to 28.13% (median 9.24, interquartile range 14.58). Segmental intelligibility was not uniformly affected: stops, labials and unvoiced consonants were better identified than other categories. Finally, a significant correlation was found between global intelligibility and articulatory precision, while unintended additive noise and fluency seemed to play no role.
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Affiliation(s)
- François Mouret
- Université Rennes 2, UFR ALC, Rennes, France
- Laboratoire de Phonétique et Phonologie (LPP) UMR 7018, CNRS & Université Sorbonne Nouvelle, Institut de Linguistique et de Phonétique Générales et Appliquées, Paris, France
| | - Lise Crevier-Buchman
- Laboratoire de Phonétique et Phonologie (LPP) UMR 7018, CNRS & Université Sorbonne Nouvelle, Institut de Linguistique et de Phonétique Générales et Appliquées, Paris, France
| | - Claire Pillot-Loiseau
- Laboratoire de Phonétique et Phonologie (LPP) UMR 7018, CNRS & Université Sorbonne Nouvelle, Institut de Linguistique et de Phonétique Générales et Appliquées, Paris, France
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12
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Salvatori S, Tanvetyanon T. Fatal Tracheoesophageal Puncture Leakage Associated With Lenvatinib. Cureus 2023; 15:e43490. [PMID: 37719529 PMCID: PMC10499567 DOI: 10.7759/cureus.43490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2023] [Indexed: 09/19/2023] Open
Abstract
Tracheoesophageal puncture (TEP) is a voice restorative option adopted by many head and neck cancer patients following laryngectomy. Though generally safe, TEP may develop leakage. Lenvatinib is a tyrosine kinase inhibitor (TKI) with anti-tumoral activity against head and neck malignancies.TKIs, including lenvatinib, have been associated with organ perforation or fistula formation. There remains a paucity of literature on the association between lenvatinib and TEP leakage. In this report, we described a patient with adenoid cystic carcinoma of the larynx who had a TEP. After approximately two weeks of treatment with lenvatinib, the patient developed a leakage of TEP. Despite several interventions, the patient died three months afterward due to a retropharyngeal abscess secondary to Fusobacterium nucleatum. To our knowledge, this is the first report of fatal lenvatinib-associated TEP leakage. Clinicians should be cognizant of a potentially rapid development of this complication when prescribing TKI for patients with TEP.
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Affiliation(s)
- Sarah Salvatori
- Medicine, University of South Florida Morsani College of Medicine, Tampa, USA
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13
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Shaver TB, Youner E, Joshi AS. Placement of a tracheoesophageal prosthesis using intraoperative ultrasound: A novel technique. ULTRASOUND (LEEDS, ENGLAND) 2023; 31:236-238. [PMID: 37538964 PMCID: PMC10395383 DOI: 10.1177/1742271x221147719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/27/2022] [Indexed: 08/05/2023]
Abstract
Introduction In patients who undergo a total laryngectomy, one of the most common techniques for voice rehabilitation is a tracheoesophageal prosthesis. Typically, this is accomplished using an endoscope down the oesophagus to visualise puncturing of the posterior tracheal wall; however, we present a case in which the use of an endoscope was not feasible, and a novel technique had to be utilised. Case report A mid-70s male who had a total laryngectomy secondary to laryngeal carcinoma was undergoing tracheoesophageal puncture for prosthesis placement, when it was noted that he had significant stenosis of his proximal oesophagus, precluding the use of an endoscope. The senior author decided to use intraoperative ultrasound to visualise the oesophageal lumen for proper placement of the puncture. Discussion This case demonstrates the ability of intraoperative ultrasound to visualise the oesophageal lumen and accurately place the tracheoesophageal puncture in cases where an endoscope cannot be used. Conclusion We present a novel technique in which ultrasound was used to visualise the oesophageal lumen and identify the needle puncturing the posterior tracheal wall for placement of a tracheoesophageal prosthesis.
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Affiliation(s)
- Timothy Brandon Shaver
- Division of Otolaryngology-Head and Neck Surgery, George Washington University Medical Faculty Associates, Washington, DC, USA
| | - Emily Youner
- George Washington School of Medicine and Health Sciences, Washington, DC, USA
| | - Arjun S Joshi
- Division of Otolaryngology-Head and Neck Surgery, George Washington University Medical Faculty Associates, Washington, DC, USA
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Maskeliūnas R, Damaševičius R, Kulikajevas A, Pribuišis K, Ulozaitė-Stanienė N, Uloza V. Pareto-Optimized Non-Negative Matrix Factorization Approach to the Cleaning of Alaryngeal Speech Signals. Cancers (Basel) 2023; 15:3644. [PMID: 37509305 PMCID: PMC10377391 DOI: 10.3390/cancers15143644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/09/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
The problem of cleaning impaired speech is crucial for various applications such as speech recognition, telecommunication, and assistive technologies. In this paper, we propose a novel approach that combines Pareto-optimized deep learning with non-negative matrix factorization (NMF) to effectively reduce noise in impaired speech signals while preserving the quality of the desired speech. Our method begins by calculating the spectrogram of a noisy voice clip and extracting frequency statistics. A threshold is then determined based on the desired noise sensitivity, and a noise-to-signal mask is computed. This mask is smoothed to avoid abrupt transitions in noise levels, and the modified spectrogram is obtained by applying the smoothed mask to the signal spectrogram. We then employ a Pareto-optimized NMF to decompose the modified spectrogram into basis functions and corresponding weights, which are used to reconstruct the clean speech spectrogram. The final noise-reduced waveform is obtained by inverting the clean speech spectrogram. Our proposed method achieves a balance between various objectives, such as noise suppression, speech quality preservation, and computational efficiency, by leveraging Pareto optimization in the deep learning model. The experimental results demonstrate the effectiveness of our approach in cleaning alaryngeal speech signals, making it a promising solution for various real-world applications.
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Affiliation(s)
- Rytis Maskeliūnas
- Faculty of Informatics, Kaunas University of Technology, 44249 Kaunas, Lithuania
| | | | - Audrius Kulikajevas
- Faculty of Informatics, Kaunas University of Technology, 44249 Kaunas, Lithuania
| | - Kipras Pribuišis
- Department of Otorhinolaryngology, Academy of Medicine, Lithuanian University of Health Sciences, 44240 Kaunas, Lithuania
| | - Nora Ulozaitė-Stanienė
- Department of Otorhinolaryngology, Academy of Medicine, Lithuanian University of Health Sciences, 44240 Kaunas, Lithuania
| | - Virgilijus Uloza
- Department of Otorhinolaryngology, Academy of Medicine, Lithuanian University of Health Sciences, 44240 Kaunas, Lithuania
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Fitzgerald CWR, Davies JC, de Almeida JR, Rich JT, Orsini M, Eskander A, Monteiro E, Mimica X, Mclean T, Cracchiolo JR, Ganly I, Hessel A, Tam S, Wei D, Goepfert R, Su J, Xu W, Zafereo M, Goldstein DP, Cohen MA. Factors predicting pharyngocutaneous fistula in patients after salvage laryngectomy for laryngeal malignancy - A multicenter collaborative cohort study. Oral Oncol 2022; 134:106089. [PMID: 36057225 PMCID: PMC10190204 DOI: 10.1016/j.oraloncology.2022.106089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 08/10/2022] [Accepted: 08/15/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Pharyngocutaneous fistula (PCF) is a major morbidity of salvage total laryngectomy (TL). Understanding the factors predicting PCF is fundamental to managing laryngeal cancer. We aim to assess factors associated with PCF following salvage TL in a multicenter, international retrospective cohort study of academic centers in the US and Canada. RESULTS In total, 550 patients post-salvage TL were identified (mean [SD; range] age, 64 [10.4; 32-90] years; 465 [85 %] male and 84 [15 %] female) between 2000 and 2014. Rate of PCF was 23 % (n = 127) with median time to PCF of 2.9 weeks. Surgical management of PCF was required in 43 % (n = 54) while 57 % (n = 73) required wound care alone. Rates of PCF differed by primary treatment modality [radiation, 20 % (n = 76); chemoradiation, 27 % (n = 40); not available (n = 6)] and use of vascularized tissue in pharyngeal closure [free/regional flap, 18 % (n = 25); no vascularized tissue/primary closure, 24 % (n = 98); not available (n = 4)]. There was no statistically significant association between PCF and treatment with chemoradiation (HR, 1.32; 95 % CI, 0.91-1.93, p = 0.14) or lack of vascularized tissue reconstruction (HR, 1.41, 95 % CI 0.91-2.18, p = 0.12). Significant association between PCF and advanced stage (T3 or T4), positive margin, close margin (<5mm), lymphovascular invasion and pre-operative tracheostomy were identified on univariable analysis. Positive surgical margin (HR, 1.91; 95 % CI, 1.11 to 3.29) was the only significant association on multivariable analysis. CONCLUSION We highlight positive surgical margin as the only variable significantly associated with increased risk of PCF following salvage TL on multivariable analysis in a large cohort across several major head and neck oncology centers.
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Affiliation(s)
| | - Joel C Davies
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - John R de Almeida
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jason T Rich
- Department of Otolaryngology-Head & Neck Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Mario Orsini
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Otolaryngology-Head & Neck Surgery, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Eric Monteiro
- Department of Otolaryngology-Head & Neck Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ximena Mimica
- Head & Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tim Mclean
- Head & Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Ian Ganly
- Head & Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Amy Hessel
- Department of Head & Neck Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - Samantha Tam
- Department of Head & Neck Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - Dongmin Wei
- Department of Head & Neck Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - Ryan Goepfert
- Department of Head & Neck Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - Jie Su
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Mark Zafereo
- Department of Head & Neck Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - David P Goldstein
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Marc A Cohen
- Head & Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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16
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Secondary tracheoesophageal puncture with a flexible transillumination device: a new technique and its outcomes. Braz J Otorhinolaryngol 2022; 88 Suppl 4:S65-S69. [PMID: 34716110 DOI: 10.1016/j.bjorl.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/19/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES This study aims to describe a new secondary tracheoesophageal puncture technique with voice prosthesis insertion under local anesthesia with a low-cost device and evaluate its outcome. METHODS With a transoral flexible transillumination device of aluminum of 2.3 mm with fiberoptic light, the esophagus's anterior wall is visualized through the tracheostomy. A tracheoesophageal fistula is made with a blade and passed through the fistula. Then a bent trocar is introduced into the lumen using the device as a guidewire. Once in the lumen, a thin guide wire is passed through up to the mouth. The voice prosthesis is positioned with retrograde insertion. Then, the patient is discharged without hospitalization. RESULTS 15 patients submitted to this technique had a successful surgical outcome. There were no complications as pneumothorax, esophageal perforation, bleeding, or hospitalization. CONCLUSION The new device is feasible under local anesthesia.
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17
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Wu C, Zhang D, Yuan X, Chen L, Tao L. Indications and complications of secondary tracheoesophageal puncture in Chinese laryngectomees. Acta Otolaryngol 2022; 142:721-730. [PMID: 36264159 DOI: 10.1080/00016489.2022.2128407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Although there are many literatures about secondary tracheoesophageal puncture (TEP) for voice prosthesis. Most of the description of indications is not specific and the description of complications is not so vivid, which is not of great value for novice doctors. OBJECTIVE To show specific indications and vivid complications of secondary TEP with typical clinical pictures for novice doctors. MATERIAL AND METHODS The clinical data of 20 patients undergoing secondary TEP for Provox Vega voice prosthesis in our hospital were analyzed. The surgical indications and the prevention and treatment of common perioperative complications were summarized. RESULTS The surgical indications included: no obvious stenosis of the stoma and the entrance of esophagus; no obvious scar constitution, mouth opening restriction and backward restraint of the neck, etc. The common postoperative complications included: TEP fistula infection (2 cases), bleeding of the fistula (1 case), deep neck abscess (1 case), granulation hyperplasia at the inner side of the fistula (1 case), invagination of the voice prosthesis (2 cases) and leakage (2 cases). CONCLUSIONS AND SIGNIFICANCE The secondary TEP for Provox Vega voice prosthesis is clinically safe, but certain indications should be mastered. Common postoperative complications can be solved through preventive and remedial treatment schemes.
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Affiliation(s)
- Chunping Wu
- Department of Otorhinolaryngology Head and Neck Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, PR China
| | - Duo Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, PR China
| | - Xiaohui Yuan
- Department of Otorhinolaryngology Head and Neck Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, PR China
| | - Ling Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, PR China
| | - Lei Tao
- Department of Otorhinolaryngology Head and Neck Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, PR China
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Tracheo Esophageal Prosthesis Insertion Under Endoscopic Guidance and Local Anaesthesia- Feasibility and Outcome. Indian J Otolaryngol Head Neck Surg 2022; 74:39-44. [PMID: 35070924 PMCID: PMC8743319 DOI: 10.1007/s12070-020-02149-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/14/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Voice rehabilitation after laryngectomy is by tracheo esophageal puncture (TEP) and prosthesis insertion. Secondary TEP is very difficult due to neck fibrosis. Puncture under local anaesthesia with endoscopy guidance is a feasible option. METHODS Retrospective review of all laryngectomy patients from March 2009 till March 2019 was done and the methods of voice rehabilitation were assessed. The patients undergoing the procedure were classified according to the timing of insertion and type as primary insertion under general anaesthesia (Group P), secondary insertion under local anaesthesia (Group L), secondary insertion under general anaesthesia (Group G). The speech outcome and the procedure outcome were compared. RESULTS There were 148 patients who underwent laryngectomy, of which groups P, G, L were 12, 12 and 11. The rate of successful insertion was 100% in primary, 91.6% in secondary in general anaesthesia and 91% in secondary under local anaesthesia. All secondary TEP were done after surgery and radiotherapy. Complications related to the insertion techniques were minimal. Speech outcome were similar on intelligibility rating scale and longevity was not affected by the method. CONCLUSION TEP in local anaesthesia is feasible and has comparable outcome with TEP in general anaesthesia. Financial burden was very much less in group L compared to the other two groups.
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19
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Molteni G, Fulco G, Gazzini L, Laura E, Paiola G, Giacopuzzi S, Marchioni D, Pighi GP. Prosthetic voice rehabilitation after laryngoesophagectomy: surgical and functional outcomes. Eur Arch Otorhinolaryngol 2022; 279:4085-4092. [PMID: 35034188 DOI: 10.1007/s00405-022-07251-8] [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: 11/01/2021] [Accepted: 01/01/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Quality of Life (QoL) after extensive head and neck resections is of paramount importance, especially after pharyngolaryngectomy or pharyngolaryngoesophagectomy where complex digestive tract reconstruction is required (with gastric pull-up or colon transposition). Tracheodigestive puncture (TDP) is the only vocal restoration option in this group of patients. The aim of this study is to evaluate postoperative complications, vocal outcomes, voice-related and swallowing-related QoL after secondary TDP in this cohort of patients. METHODS A retrospective study was conducted in the tertiary referral center of Verona Hospital between June 2014 and June 2020. Patient demographics, clinical and surgical data were assessed. Speech objective and subjective evaluation was performed. QoL was assessed with Voice Handicap Index-10 (VHI-10) and M.D. Anderson Dysphagia Inventory (MDADI) questionnaires. RESULTS Seven patients met the inclusion criteria, but two had died before questionnaires were administered. No intraoperative complications were noted after TDP surgery. There were delayed complications in four cases (57.1%) and all were treated with restoration. Intelligible voice was restored in all patients. Maximum phonation time and maximal voice intensity recorded were 5.42 ± 3.27 s and 65.20 ± 5.45 dB, respectively. Acceptable average VHI-10 and MDADI scores were obtained in all patients. CONCLUSIONS Secondary TDP performed after gastric pull-up or colon transposition reconstructions are feasible and effective procedures. An intelligible voice was restored in all patients, with satisfactory patient-perceived voice-related and dysphagia-related quality-of-life outcomes.
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Affiliation(s)
- Gabriele Molteni
- Otolaryngology-Head and Neck Surgery, Department of Surgery, Dentistry, Gynecology, and Pediatrics, University of Verona, University Hospital of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Gianfranco Fulco
- Otolaryngology-Head and Neck Surgery, Department of Surgery, Dentistry, Gynecology, and Pediatrics, University of Verona, University Hospital of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Luca Gazzini
- Otolaryngology-Head and Neck Surgery, Department of Surgery, Dentistry, Gynecology, and Pediatrics, University of Verona, University Hospital of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Elisa Laura
- Otolaryngology-Head and Neck Surgery, Department of Surgery, Dentistry, Gynecology, and Pediatrics, University of Verona, University Hospital of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy.
| | - Giuliana Paiola
- Otolaryngology-Head and Neck Surgery, Department of Surgery, Dentistry, Gynecology, and Pediatrics, University of Verona, University Hospital of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Simone Giacopuzzi
- General and Upper GI Surgery Division, University Hospital of Verona, Verona, Italy
| | - Daniele Marchioni
- Otolaryngology-Head and Neck Surgery, Department of Surgery, Dentistry, Gynecology, and Pediatrics, University of Verona, University Hospital of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Gian Paolo Pighi
- Otolaryngology-Head and Neck Surgery, Department of Surgery, Dentistry, Gynecology, and Pediatrics, University of Verona, University Hospital of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
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20
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Informing patient choice and service planning in surgical voice restoration: valve usage over three years in a UK head and neck cancer unit. The Journal of Laryngology & Otology 2021; 136:158-166. [PMID: 34881692 DOI: 10.1017/s0022215121004060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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21
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Massaro N, Verro B, Greco G, Chianetta E, D'Ecclesia A, Saraniti C. Quality of Life with Voice Prosthesis after Total Laryngectomy. IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY 2021; 33:301-309. [PMID: 34692577 PMCID: PMC8507945 DOI: 10.22038/ijorl.2021.53724.2832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 07/24/2021] [Indexed: 11/06/2022]
Abstract
Introduction The loss of voice after total laryngectomy is one of the main impairments in personal and social life. In order to prevent potential psycho-social consequences in the patient and his family, the restoration of phonatory function is the main objective of post-laryngectomy rehabilitation. The aim of this study was to assess quality of life in patients who received prosthetic voice after total laryngectomy. Materials and Methods Over a one-year period, 51 patients with voice prostheses after total laryngectomy were recruited. 32 patients (62.74%) were administered radiation therapy and 9 patients (17.64%) underwent to surgical reconstruction with flaps. Each patient was administered the VHI-10 and V-RQOL self-assessment questionnaires. Results The study showed that vocal restoration with voice prosthesis allows patients to recover a significant degree of quality of life after total laryngectomy. The average score on the V-RQOL questionnaire was 75.9 and on the VHI-10 questionnaire was 13.5. It has not been shown a statistically significant correlation between quality of life after tracheoesophageal prosthesis and radiation therapy, chemotherapy or reconstruction flaps. Younger patients showed, on average, a higher score at V-RQOL. These results allow to state that, after prosthetic rehabilitation, at least 75% of patients experienced an increase in quality of life. Moreover, the prosthetic technique (primary vs secondary) does not affect the long-term outcome and radiotherapy, chemotherapy or reconstruction flaps are not absolute contraindications to rehabilitation with voice prosthesis. Conclusion After total laryngectomy, rehabilitation with tracheoesophageal prosthesis is a satisfactory choice to restore the patient's ability to communicate verbally.
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Affiliation(s)
- Nicola Massaro
- Department of Biomedicine, Neurosciences and Advanced Diagnostic, University of Palermo, Palermo (PA) Italy
| | - Barbara Verro
- Department of Biomedicine, Neurosciences and Advanced Diagnostic, University of Palermo, Palermo (PA) Italy
| | - Giuseppe Greco
- Department of Biomedicine, Neurosciences and Advanced Diagnostic, University of Palermo, Palermo (PA) Italy
| | - Enzo Chianetta
- Department of Biomedicine, Neurosciences and Advanced Diagnostic, University of Palermo, Palermo (PA) Italy
| | - Aurelio D'Ecclesia
- ENT and Maxillo-Facial Clinic, IRCSS - Casa Sollievo Della Sofferenza - San Giovanni Rotondo, Foggia (FG), Italy
| | - Carmelo Saraniti
- Department of Biomedicine, Neurosciences and Advanced Diagnostic, University of Palermo, Palermo (PA) Italy
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22
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Gazzini L, Laura E. "How I Do It" Secondary tracheoesophageal puncture for voice reconstruction after total laryngectomy: The blind technique procedure with video. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138 Suppl 2:55-57. [PMID: 34119454 DOI: 10.1016/j.anorl.2021.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/23/2021] [Accepted: 02/11/2021] [Indexed: 10/21/2022]
Affiliation(s)
- L Gazzini
- Division of Otolaryngology, "San Maurizio" Hospital, Bolzano, Italy
| | - E Laura
- Division of Otolaryngology, Department of Surgery, Dentistry Pediatrics and Gynecology, University of Verona, Verona, Italy.
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Gazzini L, Laura E, Molteni G, Marchioni D, Pighi GP. Secondary tracheoesophageal puncture with the blind technique: 10 years' experience. Eur Arch Otorhinolaryngol 2021; 278:4459-4467. [PMID: 33582848 DOI: 10.1007/s00405-021-06674-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/01/2021] [Indexed: 11/27/2022]
Abstract
PROPOSE The aim of the present article is to propose an alternative technique to the traditional secondary tracheoesophageal puncture (TEP) for voice rehabilitation after total laryngectomy, describing the procedure step-by-step, analyzing the complications and long-term results. METHODS A retrospective study was conducted on patients who underwent secondary TEP with the blind technique using a rigid hysterometer. The main steps in this technique are described and illustrated. Patient demographics and surgical outcomes were assessed. RESULTS Thirty-two patients were enrolled in this study. In all but one case, risk factors that could hinder rigid esophagoscopy were identified (37.5% neopharyngeal/esophageal post-surgical issues, 81.3% prior radiotherapy, 21.9% cervical arthrosis, and 12.5% prior coloplasty or gastric transposition). No intra- or postoperative surgical complications were noted. CONCLUSION The blind technique offers an alternative method to perform a secondary TEP safely and efficiently in patients with unfavorable anatomical or clinical conditions, lowering the risk of procedure-related complications.
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Affiliation(s)
- Luca Gazzini
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Verona, Piazzale Aristide Stefani, 1, 37126, Verona, Italy
| | - Elisa Laura
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Verona, Piazzale Aristide Stefani, 1, 37126, Verona, Italy.
| | - Gabriele Molteni
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Verona, Piazzale Aristide Stefani, 1, 37126, Verona, Italy
| | - Daniele Marchioni
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Verona, Piazzale Aristide Stefani, 1, 37126, Verona, Italy
| | - Gian Paolo Pighi
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Verona, Piazzale Aristide Stefani, 1, 37126, Verona, Italy
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Cabrera CI, Joseph Jones A, Philleo Parker N, Emily Lynn Blevins A, Weidenbecher MS. Pectoralis Major Onlay vs Interpositional Reconstruction Fistulation After Salvage Total Laryngectomy: Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2020; 164:972-983. [PMID: 32988281 DOI: 10.1177/0194599820957962] [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: 12/13/2022]
Abstract
OBJECTIVE To evaluate the difference in pharygocutaneous fistula (PCF) development between pectoralis major flap onlay and interpositional reconstructions after salvage total laryngectomy (STL). DATA SOURCES Medline, Cochrane, Embase, Web of Science, CINAHL, and ClinicalTrials.gov. REVIEW METHODS A systematic review was performed during January 2020. English articles were included that described minor and major PCF rates after STL reconstructed with pectoralis major onlay or interposition. PCFs were classified as major when conservative therapy was unsuccessful and/or revision surgery was needed. Articles describing total laryngopharyngectomies were excluded. Meta-analyses of the resulting data were performed. RESULTS Twenty-four articles met final criteria amassing 1304 patients. Three articles compared onlay with interposition, and 18 compared onlay with primary closure. Pectoralis interposition demonstrated elevated odds ratio (OR) of PCF formation as compared with onlay (OR, 2.34; P < .001). Onlay reconstruction reduced overall (OR, 0.32; P < .001) and major (OR, 0.21; P < .001) PCF development as compared with primary pharyngeal closure alone. Data were insufficient to compare interposition against primary closure. CONCLUSIONS This research shows evidence that pectoralis onlay after STL diminishes the odds of total and major PCF development. Pectoralis interposition reconstruction showed elevated odds of PCF formation as compared with pectoralis onlay.
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Affiliation(s)
- Claudia I Cabrera
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Alexander Joseph Jones
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Noah Philleo Parker
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Amy Emily Lynn Blevins
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Mark S Weidenbecher
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Department of Otolaryngology-Head and Neck Surgery, MetroHealth Medical Center, Cleveland, Ohio, USA
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Cocuzza S, Maniaci A, Grillo C, Ferlito S, Spinato G, Coco S, Merlino F, Stilo G, Santoro GP, Iannella G, Vicini C, La Mantia I. Voice-Related Quality of Life in Post-Laryngectomy Rehabilitation: Tracheoesophageal Fistula's Wellness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124605. [PMID: 32604875 PMCID: PMC7344397 DOI: 10.3390/ijerph17124605] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/21/2020] [Accepted: 06/24/2020] [Indexed: 02/07/2023]
Abstract
(1) Introduction: Laryngeal cancer is one of the most common types of cancer affecting the upper aerodigestive tract. Despite ensuring good oncological outcome in many locoregionally advanced cases, total laryngectomy is associated with relevant physical and psychological sequelae. Treatment through tracheo-esophageal speech, if promising, can lead to very variable outcomes. Not all laryngectomee patients with vocal prosthesis benefit from the same level of rehabilitation mainly due to the development of prosthetic or fistula related problems. The relating sequelae in some cases are even more decisive in the patient quality of life, having a higher impact than communicational or verbal skills. (2) Material and Methods: A retrospective study was conducted on 63 patients initially enrolled with a history of total laryngectomy and voice rehabilitation, treated at the University Hospital of Catania from 1 January 2010 to 31 December 2018. Quality of life (QoL) evaluation through validated self-administrated questionnaires was performed. (3) Results: The Voice-Related Quality of Life questionnaire revealed significantly better outcomes in both socio-emotional and functional domains of the tracheoesophageal patient group compared to the esophageal group (p = 0.01; p = 0.01, respectively), whereas in the Voice Handicap Index assessment, statistically significant scores were not achieved (p = 0.33). (4) Discussion: The significant differences reported through the V-RQOL and Voice Handicap Index scales in the presence of fistula related problems and device lifetime reduction when compared to the oesophageal speech group have demonstrated, as supported by the literature, a crucial role in the rehabilitative prognosis. (5) Conclusions: The criteria of low resistance to airflow, optimal tracheoesophageal retention, prolonged device life, simple patient maintenance, and comfortable outpatient surgery are the reference standard for obtaining good QoL results, especially over time. Furthermore, the correct phenotyping of the patient based on the main outcomes achieved at clinical follow-up guarantees the primary objective of the identification of a better quality of life.
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Affiliation(s)
- Salvatore Cocuzza
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95100 Catania, Italy; (S.C.); (C.G.); (S.F.); (S.C.); (F.M.); (G.S.); (I.L.M.)
| | - Antonino Maniaci
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95100 Catania, Italy; (S.C.); (C.G.); (S.F.); (S.C.); (F.M.); (G.S.); (I.L.M.)
- Correspondence:
| | - Calogero Grillo
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95100 Catania, Italy; (S.C.); (C.G.); (S.F.); (S.C.); (F.M.); (G.S.); (I.L.M.)
| | - Salvatore Ferlito
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95100 Catania, Italy; (S.C.); (C.G.); (S.F.); (S.C.); (F.M.); (G.S.); (I.L.M.)
| | - Giacomo Spinato
- Section of Otorhinolaryngology, University of Padova, 31100 Treviso, Italy;
| | - Salvatore Coco
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95100 Catania, Italy; (S.C.); (C.G.); (S.F.); (S.C.); (F.M.); (G.S.); (I.L.M.)
| | - Federico Merlino
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95100 Catania, Italy; (S.C.); (C.G.); (S.F.); (S.C.); (F.M.); (G.S.); (I.L.M.)
| | - Giovanna Stilo
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95100 Catania, Italy; (S.C.); (C.G.); (S.F.); (S.C.); (F.M.); (G.S.); (I.L.M.)
| | - Giovanni Paolo Santoro
- Head and Neck and Robotic Surgery, Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy;
| | - Giannicola Iannella
- Head and Neck Department, ENT & Oral Surgery Unit, G.B. Morgagni, L. Pierantoni Hospital, 47121 Forlì, Italy; (G.I.); (C.V.)
- Department of Organi di Senso, University “Sapienza”, 00185 Rome, Italy
| | - Claudio Vicini
- Head and Neck Department, ENT & Oral Surgery Unit, G.B. Morgagni, L. Pierantoni Hospital, 47121 Forlì, Italy; (G.I.); (C.V.)
- Department of Otolaryngology, Head and Neck Surgery, University of Ferrara, 44121 Ferrara, Italy
| | - Ignazio La Mantia
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95100 Catania, Italy; (S.C.); (C.G.); (S.F.); (S.C.); (F.M.); (G.S.); (I.L.M.)
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Outcomes of tracheoesophageal puncture in twice-radiated patients. Am J Otolaryngol 2019; 40:102272. [PMID: 31445930 DOI: 10.1016/j.amjoto.2019.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/02/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Previous research has demonstrated the safety of tracheoesophageal puncture voice prosthesis (TEP) placement in radiated patients; however, there is a growing population of twice-radiated patients with limited research on the outcomes of TEP-placement in this cohort. METHODS After Institutional Review Board approval, a retrospective review of 80 patients that underwent TEP from 2006 to 2017 at a single institution was conducted, of which 16 patients underwent two courses of radiation. Outcome measures include TEP removal, complication and duration of usage. RESULTS Half of twice-radiated patients had ultimate removal of their voice prosthesis with removal occurring at a median of 24.9 months after placement. Reasons for prosthesis removal included widening tracheoesophageal fistula, local recurrence, and dysphagia/esophageal stenosis. Nearly one-third of these patients required surgical intervention for closure of a widening fistula. In contrast, only 17% of once-radiated patients had their prosthesis removed with removal occurring at a median of 28.1 months. This was statistically fewer than the twice-radiated group (p = 0.02). Reasons for removal included patient preference, persistent leakage, recurrence of disease, enlarging tracheoesophageal fistula, poor voice, and dysphagia. Eleven percent of once-radiated patients required surgical intervention for TEP-related complications (p = 0.057). CONCLUSION In the twice-radiated patient cohort, there is a higher rate of TEP removal and need for surgical intervention for a voice prosthesis-related complication as compared to a once-radiated cohort.
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Britt CJ, Russell JO. Tyrosine Kinase Inhibitor Use and Wound Healing in Tracheoesophageal Punctures. EAR, NOSE & THROAT JOURNAL 2019; 98:510-512. [PMID: 30974994 DOI: 10.1177/0145561319839805] [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: 11/17/2022] Open
Abstract
Tyrosine kinase inhibitors (TKIs) aid in prolonging life in patients with advanced locoregional thyroid malignancy. Such patients may undergo total laryngectomy for local disease control and tracheoesophageal puncture (TEP) for speech rehabilitation. Enlargement of TEP fistulas is usually attributed to wound healing issues and leads to major complications. Four laryngectomies with TEP were performed between 2015 and 2016 and subsequently placed on a TKI. Three patients developed a complication after TKI treatment, and 2 patients had a tracheoesophageal fistula. Patients should be counseled about possible wound healing risks associated with TKIs.
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Affiliation(s)
- Christopher J Britt
- Department of Otolaryngology, Loyola University Medical Center, Chicago, IL, USA
| | - Jonathon O Russell
- Department of Otolaryngology, Johns Hopkins University, Baltimore, MD, USA
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Zenga J, Goldsmith T, Bunting G, Deschler DG. State of the art: Rehabilitation of speech and swallowing after total laryngectomy. Oral Oncol 2018; 86:38-47. [DOI: 10.1016/j.oraloncology.2018.08.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 08/22/2018] [Accepted: 08/31/2018] [Indexed: 10/28/2022]
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