Quality of life and functional evaluation after supracricoid partial laryngectomy with cricohyoidoepiglottopexy in Mexican patients

Partial Horizontal Supracricoid Laryngectomy: Which Factors Impact on Post-decannulation Swallowing Outcomes? A Prospective Single-Center Experience

Early decannulation, performed within the first ten days after supracricoid partial laryngectomy, can result in a more rapid recovery of swallowing function with a semisolid bolus in the short term, about 30 days. We selected 20 patients with squamous cell carcinoma of larynx, who underwent supracricoid laryngectomies: 10 cricohyoidopexy (CHP) and 10 cricohyoidoepiglottopexy (CHEP). Staging was pT2 (10 pts), and pT3 (10 pts). Fiberoptic endoscopic evaluation of swallowing was used to assess postoperative swallowing function after a mean of 12 and 22 days from surgery. A modified PAS score (penetration-aspiration scale) was assigned for subtotal laryngectomies. Decannulation occurred after 6.7 ± 2.1 days. Univariate analysis showed that the type of surgery (CHP or CHEP), pT, resection of one arytenoid, and decannulation time are significantly associated with the 12-day PAS score. The 22-day PAS score is significantly associated with only 3 variables: type of surgery, pT, and resection of one arytenoid. From the data presented, the factors that most delay an effective recovery of swallowing are T3 and the resection of one arytenoid. Early decannulation has been shown statistically to improve PAS score in the short term, but not in the long term.

The Safety and Efficacy of Expiratory Muscle Strength Training for Rehabilitation After Supracricoid Partial Laryngectomy: A Pilot Investigation

OBJECTIVES

Expiratory muscle strength training (EMST) is a safe, effective intervention that can be performed at home and may be beneficial for individuals with voice and swallowing disorders. To date there have been few studies of EMST in the head and neck cancer population, and there are no previous reports of its use after supracricoid partial laryngectomy (SCPL). The current prospective clinical pilot study was undertaken to determine the safety and efficacy of a 4-week treatment program.

METHODS

Six participants were recruited who had previously undergone SCPL, were medically stable, and had no contraindications for use of the device. At baseline, objective respiratory measurements were collected, dietary status was recorded, and participants were asked to complete a series of validated self-report instruments relating to voice, swallowing, breathing, and cough. Following the completion of treatment, baseline measures were repeated, and participant feedback was solicited.

RESULTS

The majority of individuals found the device easy to use (83%) and beneficial (83%). The side effects of treatment were relatively minor and included dizziness, muscle inflammation, and vocal fatigue. There were improvements in 2 measures from before to after treatment, namely, an average 21% increase in peak cough flow (from 371.67 to 451.33 L/min) and a 38% decrease on the Dyspnea Index (from 6.17 to 3.83). Other measures showed inconsistent changes.

CONCLUSIONS

EMST appeared to improve cough strength and reduce dyspnea symptoms after SCPL. Further study of the relative efficacy of EMST compared to other rehabilitation protocols after SCPL is needed.

[Supracricoid partial laryngectomy (SCPL) with either cricohyoidoepiglottopexy (CHEP): our experience with 16 cases]

La chirurgie partielle du larynx avec reconstruction par crico-hyoïdo-épiglottopexie (CHEP) s’adresse essentiellement aux cancers du plan glottique permettant une préservation satisfaisante des rôles physiologiques et un contrôle carcinologique local également satisfaisant. L’objectif de notre étude est d’analyser les résultats fonctionnels et carcinologiques de cette chirurgie. Il s’agit d’une étude rétrospective incluant l’ensemble des patients ayant bénéficié d’une chirurgie partielle du larynx avec reconstruction CHEP entre 2011 et 2014 dans notre institution. Nous avons analysé les données épidémiologiques, les particularités chirurgicales, les suites fonctionnels et le contrôle carcinologique de la maladie. Au total, 16 patients ont été inclus dans cette étude. Tous nos patients avaient un carcinome épidermoïde du plan glottique classé T1 ou T2. Les suites fonctionnels étaient généralement simples surtout dans les cas où La conservation des 2 unités cricoaryténoïdiennes était possible (75% des cas) mais avec toutefois des complications post-opératoires notées dans 31,25%. Le contrôle carcinologique était satisfaisant, une seule récidive locale a été objectivée dans notre étude. La chirurgie partielle du larynx avec reconstruction par crico-hyoïdo-épiglottopexie (CHEP) est une chirurgie sure avec une préservation des rôles physiologiques et une qualité de vie satisfaisante, elle permet également un bon contrôle carcinologique sous réserve de bien cerner les indications.

Supracricoid Partial Laryngectomy with Cricohyoidoepiglottopexy for Recurrent Laryngeal Cancer

Objectives:

Recurrent laryngeal cancer can be treated either with total laryngectomy or in selected cases with supracricoid laryngectomy with cricohyoidoepiglottopexy (CHEP). We performed a retrospective study to analyze the functional and oncological results of supracricoid laryngectomy with CHEP.

Methods:

Fourteen patients were treated with supracricoid laryngectomy with CHEP. In 8 patients, flexible endoscopic evaluation of swallowing was performed. Preoperative and postoperative voice evaluation was performed in 5 patients. Oncological and functional follow-up, postoperative complications, and data concerning rehabilitation were recorded on standard forms.

Results:

After the supracricoid laryngectomy with CHEP, 11 of the 14 patients were alive and disease-free. No local recurrences were found, but 2 patients had regional recurrences. The voice was worse after the operation; however, most patients were satisfied. Swallowing was uncompromised.

Conclusions:

Supracricoid laryngectomy with CHEP for recurrent glottic laryngeal cancer after radiotherapy appears to be oncologically safe and functional.

Quality of Life After Conservation Surgery for Laryngeal Cancer

Quality of life preservation has become an essential goal of treatment in the management of laryngeal carcinoma. Although established treatments of reference such as total laryngectomy and chemoradiation protocols have focused on survival and anatomic preservation of the larynx, they still generate considerable functional morbidity with detrimental effects on quality of life. Transoral and transcervical partial laryngectomy techniques can offer significant advantages when used prudently after proper patient selection. The growing relevance of those techniques in the management of advanced and recurrent laryngeal carcinoma deserves particular attention, with potential for improved quality of life without compromising oncologic outcomes.

Factors associated with supracricoid laryngectomy functional outcomes

BACKGROUND

Supracricoid partial laryngectomy (SCPL) is an option for laryngeal cancer resection that preserves laryngeal function; however, little information exists regarding factors that are associated with functional outcomes.

METHODS

A medical chart review was performed on patients that underwent SCPL at our institution between 2006 and 2011. Data were collected on surgical, voice, and swallowing outcomes.

RESULTS

Eighteen patients were identified. Thirteen underwent cricohyoidoepiglottopexy (CHEP) and 5 had a cricohyoidopexy (CHP). Mean follow-up was 737 days. On average, decannulation occurred at 27.4 days and feeding tube removal at 87.9 days postoperatively. Sixty-seven percent of patients tolerated an unrestricted diet at follow-up. Increased age and a CHP procedure were associated with negative outcomes. Age may be a proxy for more extensive disease and prior treatments.

CONCLUSION

Patients who undergo an SCPL require extensive rehabilitation after surgery. Those who have undergone multiple cancer interventions and have more extensive surgery may be at risk for poorer outcomes.

High-speed digital imaging laryngoscopy of the neoglottis following supracricoid laryngectomy with cricohyoidoepiglottopexy

OBJECTIVES

This study aimed to analyse vocal performance and to investigate the nature of the neoglottal sound source in patients who had undergone supracricoid laryngectomy with cricohyoidoepiglottopexy, using a high-speed digital imaging system.

METHODS

High-speed digital imaging analysis of neoglottal kinetics was performed in two patients who had undergone supracricoid laryngectomy with cricohyoidoepiglottopexy; laryngotopography, inverse filtering analysis and multiline kymography were also undertaken.

RESULTS

In case one, laryngotopography demonstrated two vibrating areas: one matched with the primary (i.e. fundamental) frequency (75 Hz) and the other with the secondary frequency (150 Hz) at the neoglottis. In case two, laryngotopography showed two vibrating areas matched with the fundamental frequency (172 Hz) at the neoglottis. The interaction between the two areas was considered to be the sound source in both patients. The waveform of the estimated volume flow at the neoglottis, obtained by inverse filtering analysis, corresponded well to the neoglottal vibration patterns derived by multiline kymography. These findings indicated that the specific sites identified at the neoglottis by the present method were likely to be the sound source in each patient.

CONCLUSIONS

High-speed digital imaging analysis is effective in locating the sites responsible for voice production in patients who have undergone supracricoid laryngectomy with cricohyoidoepiglottopexy. This is the first study to clearly identify the neoglottal sound source in such patients, using a high-speed digital imaging system.

Voice after supracricoid laryngectomy: Subjective, objective and self-assessment data

Supracricoid laryngectomy (SCL) is an efficient surgical procedure for the treatment of selected laryngeal carcinoma, presently being performed not only in Europe but also in North America. The functional goals of the technique are voice and swallowing without a permanent tracheostoma. Perceptual and acoustic voice characteristics after SCL have been reported by different authors, but self-assessment data together with subjective and objective data have only been reported for a small number of subjects. Twenty male subjects, with a mean age of 71 years (range: 51-82 years) who underwent a SCL at least one year before our observation, were included in the study. Each subject underwent a flexible laryngoscopy and his voice was perceptually rated using the GRBAS scale. Objective examination included: maximum phonation time (MPT), voice spectrograms and syllable diadochokinesis on a single breath. Finally, each subject assessed his own voice using the Voice Handicap Index (VHI). The mean values of the GRBAS scale were respectively 2.4, 2.6, 2.4, 0.8, 0.5, 0.8. Mean MPT was 7.5 s, while for voice spectrograms the mean value of the Yanagihara scale was 3.7. Mean syllable diadochokinesis appeared as 3.3 syllables/s. Mean value of the VHI was 29.9. Subjective and objective data show a severely dysphonic voice after SCL; self-assessment data, on the contrary, reveal only moderate functional and emotional consequences. While perceptual, aerodynamic and acoustic data are in line with previous reports, self-assessment data were less severe in our subjects compared to what appears in the literature. It is concluded that self-assessment explores a different dimension of the patient's voice and that even if a severe dysphonia is present the consequences on everyday oral communication are only moderate.

Supracricoid laryngectomy: age influence on long-term functional results

OBJECTIVES/HYPOTHESIS

: Supracricoid laryngectomies (SCL) are conservative surgical techniques for the treatment of selected laryngeal carcinomas, currently adopted also in old patients. Long-term functional results have not been reported in elderly patients. The aim of this study is to compare voice and swallowing in elderly and younger patients following SCL.

STUDY DESIGN

: Cross-sectional study.

METHODS

: Twenty male patients who underwent SCL were recruited in the study; 10 were younger than 65 years at the time of surgery and 10 were older. Video-endoscopic ratings were taken of neoglottic vibration patterns and bolus transit. Voices were perceptually rated using the GIRBAS scale. The maximum phonation time (MPT) and the syllables diadochokinesis were measured. Spectrograms were recorded. All of the patients completed a self-assessment questionnaire for both voice and swallowing. The data obtained from the two groups were compared through the Mann-Whitney test.

RESULTS

: Video-endoscopic ratings of neoglottal vibration and bolus transit showed no difference between the two groups. The perceptual assessment showed a harsh voice in both groups. No significant difference was found for mean syllable diadochokinesis and the mean MPT was 6.3 seconds and 8.8 seconds, respectively in the younger and older group. The mean value of the Yanagihara scale of voice spectrogram was 3.8 and 3.7. Voice and swallowing quality-of-life questionnaires revealed satisfied patients in both age groups.

CONCLUSIONS

: Age by itself does not have a significant impact on long-term functional results following SCL. Meticulous selection of the candidate to SCL allows the application of this surgical technique with adequate long-term functional results. Laryngoscope, 2009.

Quality of life in patients treated with PDMS injection for swallowing disorders

Objective: To document the efficacy of polydimethylsiloxane (PDMS) injections in patients with swallowing disorders after partial supracricoid laryngectomy; to assess the importance of quality-of-life (QOL) outcome in oncologic patients.

Subjects and Methods: The study included 11 patients with swallowing disorders after partial laryngectomy and appropriate rehabilitation. They were treated with endoscopic injection of PDMS; QOL was investigated with four questionnaires (M.D. Anderson Dysphagia Inventory, Performance Status Scale for Head and Neck Cancer, Performance Karnofsky Scale, and Voice Handicap Index-10) before and after surgical treatment and further rehabilitation.

Results: A significant improvement in QOL of all 11 patients was seen after endoscopic injection. The impact of this treatment on the social life of patients was considerable.

Conclusion: Swallowing disorders and speech problems are quite common complications of partial laryngectomy. QOL in oncologic patients is a mandatory outcome measure. PDMS injection showed an improvement in the everyday life of selected patients.

Laryngeal function after supracricoid laryngectomy

Objective: The purpose of this study was to assess laryngeal function after supracricoid laryngectomy.

Study Design: Case series.

Subjects and Methods: Supracricoid laryngectomy (SCL) has been performed in our institution for 24 selected patients with laryngeal cancer since December 2000. Reconstruction was performed through cricohyoidoepiglottopexy for 23 patients and cricohyoidopexy for 1 patient. Seven patients had ipsilateral arytenoid removal, and 15 patients underwent SCL as salvage surgery. A retrospective chart review was performed to assess postoperative speech and swallowing function. Stroboscopy and/or fiberscopy of the neoglottis were used to assess postoperative speech kinetics. Acoustic parameters were measured to evaluate vocal function, and several questionnaires were used to evaluate postoperative quality of life (QOL).

Results: In the absence of postoperative complications, stoma closure and normal diet intake were achieved 1 month after surgery. The neoglottis comprises the arytenoid(s), epiglottis, and pyriform sinus mucosa. Several different combinations of vibrating regions were observed among patients during phonation. Although vocalization sounded rough and breathy, vocal communication was possible with little inconvenience.

Conclusion: Acceptable functional recovery and tolerable QOL can be achieved after SCL.

The CT evaluation of neoarytenoid soft tissue after an arytenoidectomy during a supracricoid partial laryngectomy

Objective

To evaluate the postoperative laryngeal CT findings of neoarytenoid soft tissue at an arytenoidectomy site during a supracricoid partial laryngectomy, and to compare its thickness to the mucosa over the spared arytenoid cartilage.

Materials and Methods

Thirty-one patients underwent a supracricoid partial laryngectomy with (n = 14) or without (n = 17) an arytenoidectomy. A postoperative laryngeal CT examination was performed to statistically compare the thickness of the neoarytenoid soft tissue to the mucosa over the spared arytenoids.

Results

The neoarytenoid soft tissue revealed an eccentric prominence in all 14 arytenoidectomy sites. Further, the neoarytenoid soft tissue was consistently thicker than the mucosa over spared arytenoids cartilage (p < 0.01), however did not exceed 11 mm.

Conclusion

The eccentric prominence of neoarytenoid soft tissue at the arytenoidectomy site during a supracricoid partial laryngectomy should be identified and distinguished from a recurrent mass when compared to spared arytenoid cartilage on a postoperative laryngeal CT.

Long-term voice and swallowing modifications after supracricoid laryngectomy: objective, subjective, and self-assessment data

PURPOSE

The supracricoid laryngectomies (SCLs) are conservative surgical techniques for the treatment of selected laryngeal carcinomas. The advantage of SCL is that a permanent tracheostoma is not required, thus, maintaining the principal laryngeal functions. The aim of the study is to report objective, subjective, and self-assessment long-term results of voice and swallowing in a large group of patients who underwent SCL at least 2 years before this study was undertaken.

METHODS

Twenty male subjects who underwent SCL with a mean age of 71 years (range, 51-82) were involved in a retrospective study on swallowing and vocal function. Videoendoscopic ratings were taken of neoglottic vibration patterns and bolus transit. The maximum phonation time and the syllable diadochokinesis were measured. Spectrograms were recorded. Voices were perceptually rated using the Grade, Instability, Roughness, Breathiness, Asthenicity, Strain (GIRBAS) scale. All of the subjects completed a self-assessment questionnaire for both voice and swallowing.

RESULTS

Videoendoscopic ratings showed moderate to severe impairment of neoglottal vibration, whereas bolus transit appeared only mildly impaired. The mean values of the GIRBAS scale were 2.4, 2.6, 2.4, 0.8, 0.5, and 0.8. The mean maximum phonation time was 7.5 seconds, whereas the mean value of the Yanagihara scale was 3.7 for voice spectrograms. Mean syllable diadochokinesis appeared as 3.3 syllables per second. Voice and swallowing quality of life questionnaires revealed satisfied patients.

CONCLUSIONS

Swallowing after SCL was satisfactory; on the contrary, endoscopic, aerodynamic, perceptual, and acoustic data showed a highly dysphonic voice after SCL. However, self-assessment results revealed relatively satisfied speakers on the emotional, physical, and functional levels.

Supracricoid Partial Laryngectomy as a Primary Treatment for Carcinosarcoma of the Larynx

Carcinosarcoma of the larynx is uncommon. When it does occur, its clinical features resemble those of sarcomatoid carcinoma, and its biologic behavior is similar to that of malignant mesenchymal neoplasms. We describe 2 cases of carcinosarcoma of the glottis. The tumors were staged as T3N0M0 and T2N0M0. Both patients were treated with supracricoid partial laryngectomy with cricohyoidoepiglottopexy. Eight months postoperatively, 1 of the 2 patients experienced a recurrence of the sarcomatous component of the tumor, and he underwent a total laryngectomy. The other patient remained free of disease at 12 months of follow-up. We conclude that supracricoid partial laryngectomy may be offered as an organ-preserving measure even in patients with sarcomatous disease; total laryngectomy can be held in reserve as a rescue measure. Patients must be closely monitored for early detection of recurrence. The role of adjuvant therapy for sarcomatous neoplasms in this area has not yet been clearly established.