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Ambrosch P, Fazel A, Dietz A, Fietkau R, Tostmann R, Borzikowsky C. Multicenter clinical trial on functional evaluation of transoral laser microsurgery for supraglottic laryngeal carcinomas. Laryngorhinootologie 2024. [PMID: 38885651 DOI: 10.1055/a-2321-5968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
BACKGROUND Transoral laser microsurgery (TLM) is an accepted and effective treatment strategy for supraglottic carcinomas. Data on oncologic and to a lesser extent functional outcomes have been published by mainly European specialized single institutions. TLM for supraglottic carcinomas has never been tested in a multicenter trial on its applicability as surgical standard at every hospital. OBJECTIVES To test the efficacy of TLM supraglottic laryngectomy (TLM-SGL) in terms of swallowing function, oncologic outcome parameters, morbidity, complications of treatment, and quality of life in a multicenter setting. METHODS The study is designed as a multicenter (approximately 25 centers), non-randomized, single-arm study with a targeted number of 200 previously untreated patients with squamous cell carcinomas (SCC) of the supraglottic larynx T2/T3 N0-3 M0; UICC stage II-IVa. The surgical treatment consists of TLM-SGL and elective or therapeutic uni- or bilateral selective neck dissection (SND). After pathologic risk stratification adjuvant radio- (RT) or radiochemotherapy (RCT) is indicated. Patients are followed-up for 2 years post surgically. Swallowing function is assessed by fibreoptic endoscopic evaluation of swallowing (FEES). The primary endpoint is aspiration-free swallowing at 12 months as established using FEES and defined as grade < 6 of penetration-aspiration scale (PAS). Secondary endpoints include local control, larynx preservation, overall and disease-free survival, complications and side effects of treatment, prevalence of tracheostomy and percutaneous endoscopic gastrostomy (PEG)-tube-feeding, and dysphagia-specific quality of life (QoL) assessed by the MD Anderson Dysphagia Inventory (MDADI) as well as voice-related QoL assessed by the Voice Handicap Index (VHI).
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Affiliation(s)
- Petra Ambrosch
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, and Christian-Albrechts-University Kiel, Kiel, Germany
| | - Asita Fazel
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, and Christian-Albrechts-University Kiel, Kiel, Germany
| | - Andreas Dietz
- Clinic of Otorhinolaryngology, University of Leipzig, Leipzig, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Ralf Tostmann
- Clinical Trial Unit, UMG, University of Göttingen, Göttingen, Germany
| | - Christoph Borzikowsky
- Institute of Medical Informatics and Statistics, Christian-Albrechts-University Kiel, Germany
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Chung HR, Reddy NK, Smith AF, Chhetri DK. Videofluoroscopic Measures of Swallowing After Partial Epiglottidectomy for Dysphagia. Otolaryngol Head Neck Surg 2023; 169:317-324. [PMID: 36939459 DOI: 10.1002/ohn.294] [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: 08/29/2022] [Revised: 12/06/2022] [Accepted: 12/30/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Partial epiglottidectomy has a role in improving dysphagia due to epiglottic obstruction. This study evaluates objective parameters of swallow function in patients who underwent partial epiglottidectomy. STUDY DESIGN Retrospective study design. SETTING Tertiary Care University Academic Medical Center. METHODS A review was performed of patients who underwent CO2 laser partial epiglottidectomy for the treatment of dysphagia at a single tertiary care academic center over a 4-year period. Objective swallowing parameters were evaluated from pre- and postoperative modified barium swallow studies using SwallowTail Advanced Measurement software using blinded reviewers. The postswallow pharyngeal residue (bolus clearance ratio or BCR), spatiotemporal swallowing variables (oropharyngeal [OPT], hypopharyngeal [HPT], and total pharyngeal transit times [TPT]), and airway protection (Penetration-Aspiration Scale [PAS]) were analyzed. Student paired t test was used to determine significant changes in outcome parameters pre- and postsurgery. RESULTS Forty-three patients (age range 45-92 years, median 70) met the inclusion criteria. A majority (69.8%) had a history of external beam radiation therapy for head and neck cancer. BCR decreased significantly from a mean of 31.7% presurgery to 24.2% (p = .01) postsurgery. OPT, HPT, and TPT did not differ significantly postsurgery. The mean Eating Assessment Tool-10 score improved from 25.1 to 20.2 after treatment (p = .03). PAS score improved by 15.4% and remained stable at 66.2% after surgery. CONCLUSION Partial epiglottidectomy improves pharyngeal bolus clearance in properly selected patients with dysphagia due to epiglottic obstruction. Patients demonstrated stable swallow function with the benefit of reduced postswallow residue following surgical intervention.
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Affiliation(s)
- Hye R Chung
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Neha K Reddy
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Alden F Smith
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Dinesh K Chhetri
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Doazan M, Hans S, Morinière S, Lallemant B, Vergez S, Aubry K, De Monès E, Espitalier F, Jegoux F, Pradat P, Céruse P. Oncologic outcomes with transoral robotic surgery for supraglottic squamous cell carcinoma: Results of the French Robotic Surgery Group of GETTEC. Head Neck 2018; 40:2050-2059. [DOI: 10.1002/hed.25199] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 09/22/2017] [Accepted: 03/15/2018] [Indexed: 12/24/2022] Open
Affiliation(s)
- Marianne Doazan
- Department of Head and Neck Surgery, Hospices Civils de Lyon; University Hospital Lyon-Nord; Lyon France
| | - Stéphane Hans
- Department of Head and Neck Surgery, Assistance Publique Hôpitaux de Paris; Hôpital Européen Georges Pompidou; Paris France
| | - Sylvain Morinière
- Department of Head and Neck Surgery; University Hospital Bretonneau; Tours France
| | - Benjamin Lallemant
- Department of Head and Neck Surgery; University Hospital Carémeau; Nîmes France
| | - Sébastien Vergez
- Department of Head and Neck Surgery; University Hospital Rangueil-Larrey; Toulouse France
| | - Karine Aubry
- Department of Head and Neck Surgery; University Hospital Dupuytren; Limoges France
| | - Erwan De Monès
- Department of Head and Neck Surgery; University Hospital Pellegrin; Bordeaux France
| | - Florent Espitalier
- Department of Head and Neck Surgery; University Hospital Hôtel-Dieu; Nantes France
| | - Franck Jegoux
- Department of Head and Neck Surgery; University hospital Pontchaillou; Rennes France
| | - Pierre Pradat
- Clinical Research Committee, Hospices Civils de Lyon; University Hospital Lyon-Nord; France
| | - Philippe Céruse
- Department of Head and Neck Surgery, Hospices Civils de Lyon; University Hospital Lyon-Nord; Lyon France
- Université Claude Bernard; Lyon France
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A systematic review of current and emerging approaches in the field of larynx preservation. Radiother Oncol 2013; 110:16-24. [PMID: 24139733 DOI: 10.1016/j.radonc.2013.08.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 08/11/2013] [Accepted: 08/12/2013] [Indexed: 11/20/2022]
Abstract
Treatment options targeting laryngeal preservation include conservative surgery, concurrent chemo-radiotherapy, induction chemotherapy (IC) followed by radiotherapy (RT), and alternating chemo-radiation. The goal of this paper was to perform a systematic review of randomized clinical trials (RCTs) on current and emerging approaches in the field of larynx preservation. The search identified 36 papers of which 27 did not fall within the inclusion criteria (i.e. non-RCTs). IC followed by RT has been shown to allow laryngeal preservation in about two-thirds of pts with locally advanced laryngeal or hypopharyngeal cancer without compromising survival. IC is regarded as the landmark treatment of non-surgical larynx preservation approaches. Concomitant and alternating chemoradiotherapy treatments are also acceptable in larynx preservation.
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Management of oropharyngeal Dysphagia in laryngeal and hypopharyngeal cancer. Int J Otolaryngol 2012; 2012:157630. [PMID: 23346112 PMCID: PMC3549351 DOI: 10.1155/2012/157630] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 12/08/2012] [Accepted: 12/10/2012] [Indexed: 11/17/2022] Open
Abstract
On considering a function-preserving treatment for laryngeal and hypopharyngeal cancer, swallowing is a capital issue. For most of the patients, achieving an effective and safe deglutition will mark the difference between a functional and a dysfunctional outcome. We present an overview of the management of dysphagia in head and neck cancer patients. A brief review on the normal physiology of swallowing is mandatory to analyze next the impact of head and neck cancer and its treatment on the anatomic and functional foundations of deglutition. The approach proposed underlines two leading principles: a transversal one, that is, the multidisciplinary approach, as clinical aspects to be managed in the oncologic patient with oropharyngeal dysphagia are diverse, and a longitudinal one; that is, the concern for preserving a functional swallow permeates the whole process of the diagnosis and treatment, with interventions required at multiple levels.
We further discuss the clinical reports of two patients who underwent a supracricoid laryngectomy, a function-preserving surgical technique that particularly disturbs the laryngeal mechanics, and in which swallowing rehabilitation dramatically conditions the functional results.
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Hutcheson KA, Jantharapattana K, Barringer DA, Lewin JS, Holsinger FC. Functional and oncological outcomes of primary versus salvage transoral laser microsurgery for supraglottic carcinoma. Ann Otol Rhinol Laryngol 2012; 121:664-70. [PMID: 23130541 DOI: 10.1177/000348941212101007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We evaluated the functional and oncological outcomes of transoral laser microsurgery (TLM) in patients with previously untreated supraglottic carcinoma compared with the outcomes in salvage cases after radiation-based treatment. METHODS We conducted a retrospective case-control study at a single academic tertiary care institution. The functional outcomes were stratified by prior irradiation and were assessed at baseline, less than 1 week after operation, and at last follow-up. RESULTS Five patients underwent TLM for previously untreated disease, and 5 previously irradiated patients underwent salvage TLM for local failure. No patient required tracheostomy. There was no local recurrence after TLM as primary therapy, and none of those patients required radiotherapy. One salvage patient developed local recurrence. The duration of feeding tube dependence (p = 0.049) and the rates of chronic aspiration (more than 1 month after operation; p = 0.048) were significantly higher in the salvage TLM cases than in the previously untreated cases. The median scores on the PSS-HN Understandability of Speech were 75 ("usually understandable") in the salvage group and 100 ("always understandable") in the previously untreated group. CONCLUSIONS Both local control and function were better in the previously untreated patients than in the salvage patients. Our findings provide support for the use of TLM as a primary treatment modality for selected supraglottic carcinomas, but also suggest a potential for functional recovery in both previously untreated and salvage cases.
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Affiliation(s)
- Katherine A Hutcheson
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77230, USA
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Ambrosch P, Fazel A. Functional organ preservation in laryngeal and hypopharyngeal cancer. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2012; 10:Doc02. [PMID: 22558052 PMCID: PMC3341579 DOI: 10.3205/cto000075] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The principles of open versus laser microsurgical approaches for partial resections of the larynx are described, oncologic as well as functional results discussed and corresponding outcomes following primary radiotherapy are opposed. Over the last decade, the endoscopic partial resection of the larynx has developed to an accepted approach in the treatment of early glottic and supraglottic carcinomas thus leading to a remarkable decline in the use of open surgery. Comparing the various surgical approaches of laryngeal partial resections, the oncological outcome of the patients, as far as survival and organ preservation are concerned, are comparable, whereas functional results of the endoscopic procedures are superior with less morbidity. The surgical procedures put together, are all superior to radiotherapy concerning organ preservation. Transoral laser microsurgery has been used successfully for vocal cord carcinomas with impaired mobility or fixation of the vocal cord, supraglottic carcinomas with infiltration of the pre- and/or paraglottic space as well as for selected hypopharyngeal carcinomas. It has been well documented that laser microsurgery achieves good oncological as well as functional results with reasonable morbidity. However, patients with those tumours have been successfully treated by open partial resections of the larynx at medical centres with appropriate expertise. The initially enthusiastic assessment of study results concerning the efficacy of various protocols of chemoradiation with the intent of organ preservation for laryngeal and hypopharyngeal carcinomas are judged more cautious, today, due to recent reports of rather high rates of late toxicity complications.
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Affiliation(s)
- Petra Ambrosch
- Department of Otorhinolaryngology - Head and Neck Surgery, Christian-Albrechts-University of Kiel, Kiel, Germany
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Transoral minimally invasive robotic surgery for carcinoma of the pharynx and the larynx. Anticancer Drugs 2011; 22:591-5. [DOI: 10.1097/cad.0b013e3283421868] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Injection augmentation of arytenoids after partial laryngectomy: case series. The Journal of Laryngology & Otology 2010; 125:65-9. [DOI: 10.1017/s002221511000160x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractBackground:We undertook collagen injection laryngoplasty to achieve arytenoid augmentation in patients with dysphagia and persistent aspiration following partial laryngectomy, and we evaluated the efficacy of arytenoid augmentation in aiding neoglottic closure and ensuring airway safety.Methods:Two patients with persistent swallowing impairment after partial laryngectomy were studied. Swallowing was evaluated using fibre-optic endoscopy, and modified barium swallow study. Collagen was then injected into the arytenoid mucosa to achieve neoglottic competence.Results:The patients were followed up for up to two years. Both patients showed a marked improvement in neoglottic competence, as evaluated by fibre-optic and flexible endoscopy at three-month and one-year follow-up appointments.Conclusion:Arytenoid augmentation by injection laryngoplasty can be considered a safe and effective surgical tool for the treatment of dysphagia with persistent aspiration following partial laryngectomy.
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Simonelli M, Ruoppolo G, de Vincentiis M, Di Mario M, Calcagno P, Vitiello C, Manciocco V, Pagliuca G, Gallo A. Swallowing ability and chronic aspiration after supracricoid partial laryngectomy. Otolaryngol Head Neck Surg 2010; 142:873-8. [PMID: 20493361 DOI: 10.1016/j.otohns.2010.01.035] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Revised: 01/02/2010] [Accepted: 01/28/2010] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Sporadic episodes of aspiration may occur after supracricoid partial laryngectomy. To prevent risks of pulmonary consequences, a limitation of oral intake of food or a "nothing by mouth" regimen has been suggested. The objective of this study was to evaluate the long-term swallowing and pulmonary status of patients after supracricoid partial laryngectomy. STUDY DESIGN Case series with chart review. SETTING Tertiary University Hospital Policlinico "Umberto I" and Santa Lucia Foundation, Rome, Italy. SUBJECTS AND METHODS The swallowing status of a selected group of 116 patients who recovered functional deglutition after supracricoid partial laryngectomy was analyzed during follow-up consultation. Swallowing evaluation included clinical observation, fiberoptic endoscopic evaluation of swallowing, and a videofluoroscopy. When aspiration was confirmed by videofluoroscopy, a high-resolution computed tomography (CT) of the chest was performed in order to assess the radiological manifestations of aspiration. A group of 45 patients with chronic obstructive pulmonary disease and normal deglutition was used as a control. RESULTS Seventy-nine patients out of 116 showed a fiberoptic endoscopic evaluation of swallowing suggestive for aspiration; only 45 patients had aspiration confirmed by videofluoroscopy. No significant differences in radiological findings were noted in the patients affected by postoperative chronic aspiration compared to the control group. CONCLUSION Patients with functional deglutition after supracricoid partial laryngectomy show a mild and well-tolerated degree of chronic aspiration and do not require a limitation of oral intake of food.
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Affiliation(s)
- Marilia Simonelli
- The Speech and Swallowing Rehabilitation Service, Santa Lucia Foundation, Rome, Italy
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Chawla S, Carney AS. Organ preservation surgery for laryngeal cancer. HEAD & NECK ONCOLOGY 2009; 1:12. [PMID: 19442314 PMCID: PMC2686690 DOI: 10.1186/1758-3284-1-12] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Accepted: 05/15/2009] [Indexed: 11/04/2022]
Abstract
The principles of management of the laryngeal cancer have evolved over the recent past with emphasis on organ preservation. These developments have paralleled technological advancements as well as refinement in the surgical technique. The surgeons are able to maintain physiological functions of larynx namely speech, respiration and swallowing without compromising the loco-regional control of cancer in comparison to the more radical treatment modalities. A large number of organ preservation surgeries are available to the surgeon; however, careful assessment of the stage of the cancer and selection of the patient is paramount to a successful outcome. A comprehensive review of various organ preservation techniques in vogue for the management of laryngeal cancer is presented.
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Affiliation(s)
- Sharad Chawla
- Department of Otolaryngology, Head and Neck Surgery, Flinders Medical Centre, South Australia, Australia
| | - Andrew Simon Carney
- Department of Otolaryngology, Head and Neck Surgery, Flinders Medical Centre, South Australia, Australia
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Petrović Z, Dordević V, Nesić V. Surgical treatment of the supraglottic laryngeal carcinoma. MEDICINSKI PREGLED 2008; 61:242-6. [PMID: 19102069 DOI: 10.2298/mpns0806242p] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This is a retrospective analysis of 439 patients with supraglottic laryngeal cancer primary surgically treated in the period 1976-1999. The objectives of our study were to analyze the localizations as well as local and regional tumor spread, frequency of occult and palpable cervical metastases, the incidence of local and regional recurrences, five-year survival rate and functional results of supraglottic partial horizontal laryngectomies. A retrospective analysis of operated patients was carried out. T1 tumor was prevalent in 184 (42%) patients, T2 in 228 (52%) patients, and T3 tumor in 27 (6%) of cases. Clinically negative finding of the neck was found in 369 (84%) patients, and metastasis N1 was established in 70 (16%) patients. The patients with clinically negative cervical finding underwent selective neck dissection, while N1 metastasis patients were subjected to a selective or modified radical neck dissection. Five-year disease-free survival rate was 76% (334/439).
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Affiliation(s)
- Zeljko Petrović
- Institut za otorinolaringologiju i maksilofacijalnu hirurgiju, Klinicki centar Srbije, Beograd.
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Roh JL, Kim DH, Park CI. Voice, swallowing and quality of life in patients after transoral laser surgery for supraglottic carcinoma. J Surg Oncol 2008; 98:184-9. [DOI: 10.1002/jso.21101] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Clavé P, Arreola V, Velasco M, Quer M, Castellví JM, Almirall J, García Peris P, Carrau R. [Diagnosis and treatment of functional oropharyngeal dysphagia. Features of interest to the digestive surgeon]. Cir Esp 2007; 82:62-76. [PMID: 17785140 DOI: 10.1016/s0009-739x(07)71672-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Digestive surgeons should form part of the multidisciplinary team managing patients with oropharyngeal dysphagia. These patients can be diagnosed through clinical methods and complementary investigations such as videofluoroscopy and pharyngoesophageal manometry. These techniques also allow specific treatment to be selected. Up to one-third of patients with dysphagia suffer from malnutrition as a result of alterations in food bolus transport. Furthermore, up to two-thirds show alterations in swallowing safety (penetrations and aspirations, especially when swallowing liquids), as well as a high risk of respiratory infections and aspiration pneumonia. Increasing food bolus viscosity to 3500-4000 mPas (pudding viscosity) improves the effectiveness of swallowing and reduces the risk of aspirations. Botulinic toxin injection in the upper esophageal sphincter is indicated in patients with spasticity of neuromuscular origin. Cricopharyngeal myotomy is the basis of treatment for Zenker's diverticulum and is also indicated in patients with alterations in the upper esophageal sphincter and preserved oropharyngeal motor response.
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Affiliation(s)
- Pere Clavé
- Unidad de Exploraciones Funcionales Digestivas, Servicio de Cirugía, Hospital de Mataró, Universidad Autónoma de Barcelona, Carretera Cirera s/n, 08304 Mataró, Barcelona, España.
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Yeager LB, Grillone GA. Organ preservation surgery for intermediate size (T2 and T3) laryngeal cancer. Otolaryngol Clin North Am 2005; 38:11-20, vii. [PMID: 15649495 DOI: 10.1016/j.otc.2004.10.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article discusses the surgical options, both open and endoscopic,developed to preserve voice, maintain swallowing, and avoid permanent tracheotomy in patients with intermediate-sized laryngeal lesions.
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Affiliation(s)
- Lauren B Yeager
- Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine, 88 East Newton Street, Boston, MA 02118, USA
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Petrović Z, Djukić V, Mikić A, Stanković P, Jesić S, Dimitrijević M, Djordević V, Milovanović J, Pendjer I. [Extended supra glottic laryngectomies]. ACTA CHIRURGICA IUGOSLAVICA 2005; 51:17-9. [PMID: 15756781 DOI: 10.2298/aci0401017p] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In the period 1976-1998, 408 patients with supraglottic laryngeal cancer were primarily treated by surgery using the method of supraglottic laryngectomy. Classical supraglottic laryngectomy was performed in 355 patients, while 53 underwent extended supraglottic laryngectomy. The objective of the study was to analyze the success of the extended supraglottic laryngectomy in relation to classical supraglottic laryngectomy in indicated cases. T1 tumor was found in 171 (42%) patients, T2 in 212 (52%), while T3 was found in 25 (6%) cases. Local recurrence developed in 3 out of 53 patients operated by the extended supraglottic laryngectomy technique, and in 17 out of 355 operated by classical supraglottic laryngectomy (chi2=0.075, DF=1, p=0.784; Yates=0.00, p=1.00). Five-year survival of patients operated by the extended supraglottic laryngectomy was reported in 40 out of 53 patients, while survival of patients operated by classical supraglottic laryngectomy was noted in 270 out of 355 cases (chi2=0.004, DF=1, p=0.926; Yates=0.00, p=1.00). There was no significant difference of local recurrence and five-year survival between patients treated by classical and extended supraglottic laryngectomy.
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Affiliation(s)
- Z Petrović
- Institut za otorinolaringologiju i maksilofacijalnu hirurgiju, Klinickog centra Srbije
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Yücetürk AV, Tarhan S, Günhan K, Pabuşçu Y. Videofluoroscopic evaluation of the swallowing function after supracricoid laryngectomy. Eur Arch Otorhinolaryngol 2004; 262:198-203. [PMID: 15821909 DOI: 10.1007/s00405-004-0790-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2003] [Accepted: 02/26/2004] [Indexed: 10/26/2022]
Abstract
This study was designed to evaluate the swallowing function in patients with supracricoid laryngectomy (SCL) compared to normal subjects and to search for the factors affecting postoperative aspiration. Ten patients who underwent SCL with cricohyoidopexy (CHP) for primary laryngeal squamous cell carcinoma were included in the study. The control group consisted of 13 normal adult volunteer men with similar ages. The swallowing act of the subjects was evaluated by using videofluoroscopy (VFS) and videolaryngostroboscopy (VLS). The movements of the larynx were measured with regard to the hyoid bone, mandible and vertebral spine. The patients with SCL-CHP, except for two who had slight aspiration, had effective and near normal swallowing regarding the measurements of the movements of the hyoid bone. They could tolerate a near-normal oral diet. We have observed that the preventive precautions for aspiration are preserving the superior laryngeal nerves, suturing and positioning the cricoarytenoid unit as anterosuperiorly as possible, early decannulation and early onset of swallowing rehabilitation; the risk factors for aspiration are advanced stage of cancer, postoperative radiation and shortening of bolus transit time. VFS is useful for the patients with postoperative aspiration, because it is the definitive technique for anatomical and physiological evaluation of swallowing. We consider that the parameters of VLS and VFS, such as tongue base-arytenoid contact, presence of bolus splitting, pseudoepiglottis function, maximal opening of the pharyngoeosophageal sphincter and total movement of hyoid bone are important criteria to evaluate swallowing.
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Petrović Z. [Results of supraglottic partial horizontal laryngectomy]. MEDICINSKI PREGLED 2004; 56:568-70. [PMID: 15080052 DOI: 10.2298/mpns0312568p] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Supraglottis is a part of larynx comprising two subregions: epilarynx (suprahyoid epiglottis--including lingual and laryngeal surface, aryepiglottic folds--laryngeal surface, and arytenoids) and supraglottis without epilarynx (infrahyioid epiglottis and ventricular folds). MATERIALS AND METHODS A total of 234 patients with supraglottic squamous cell carcinoma undergoing primary surgery were analyzed in the period 1976-1996. The tumor was localized in epilarynx in 84 (25%) patients, and in supraglottis without epilarynx in 261 (75%) cases. RESULTS T1 tumor was present in 145 (42%) patients, T2 tumor was found in 178 (52%) patients, while T3 was reported in 22 (6%) cases. Clinically negative neck (N0) was found in 290 (84%) patients, and palpable metastases (N1) manifested in 55 (16%) cases. Local recurrences were established in 18 (5%) patients, and subsequent postoperative cervical metastases were found in 45 (13%) cases. Five-year disease-free survival was reported in 76% (262/345) of patients. Nasogastric tubes were removed in all patients approximately 12 days following surgery. 27 patients developed laryngeal stenosis and only 2 patients were not decannulated. Voice and speech functions were satisfactory. DISCUSSION Supraglottic laryngectomy, extended supraglottic laryngectomy is fully justified from oncological and functional aspects. Selective neck dissection in N0 cervical findings provides detection of occult metastases and indicates need for postoperative radiotherapy. CONCLUSION Oncological and functional results of supraglottic laryngeal surgery, along with simultaneous treatment of neck by selective, modified radical neck dissection and postoperative radiotherapy offer hope for treatment of supraglottic laryngeal cancer.
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Affiliation(s)
- Zeljko Petrović
- Institut za otorinolaringologiju i maksilofacijalnu hirurgiju, Klinicki centar Srbije, Beograd.
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Bernal-Sprekelsen M, Vilaseca-González I, Blanch-Alejandro JL. Predictive values for aspiration after endoscopic laser resections of malignant tumors of the hypopharynx and larynx. Head Neck 2003; 26:103-10. [PMID: 14762878 DOI: 10.1002/hed.10363] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND CO2-laser surgery is a relatively new treatment for selected carcinomas of the upper aerodigestive tract. The purpose of our study was to evaluate prospectively the functional results for swallowing after CO2-laser resections. METHODS The sample was composed of 210 consecutive patients with malignancies of the larynx and hypopharynx treated with CO2 laser between February 1998 and January 2002. Endoscopic resections included all T1 and T2 tumors and selected T3 and T4 tumors. T1 glottic tumors were not included in the analysis. We assessed the need for a feeding tube and the period the tube remained in place, aspiration pneumonia, tracheotomy secondary to aspiration, the need for a permanent or temporary gastrostomy, and total laryngectomy secondary to aspiration. RESULTS The nasogastric feeding tube was used in 23.2% of small tumors (2.5 +/- 8.04 days) and in 63% of locally advanced tumors (13.95 +/- 22.55 days). Frequency and period of storage of the feeding tube were higher in locally advanced tumors (p=.0001). Twelve patients (5.7%) had postoperative pneumonia and 59 (28.1%) had temporary postoperative cough during oral intake. Aspiration symptoms correlated with location (p=.001) and locally advanced tumors (p=.016). Eight patients (3.8%) needed a postoperative tracheotomy for severe swallowing difficulties; six (2.9%) of them were definitive and two (0.95%) temporary. Thirteen gastrostomies (6.2%) were performed to avoid severe aspirations; five of them were definitive. The need for gastrostomy correlated significantly with location (p=.002), pT3 and pT4 tumors (p=.002), age (p=.02), and postoperative radiotherapy (p=.04). No correlation was found with the period of feeding tube (p=.38), or aspiration pneumonia (p=.24). CONCLUSIONS Endoscopic resection of laryngeal and hypopharyngeal tumors is associated with good recovery of deglutition. Many tracheotomies are avoided, the need for a feeding tube is usually reduced, and organ preservation is often feasible even in locally advanced tumors.
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Affiliation(s)
- Manuel Bernal-Sprekelsen
- Servicio de ORL, Hospital Clinic Universitari, Villarroel, 170, Esc 8, 2 degrees A, 08036 Barcelona, Spain.
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