Voice-related quality of life in patients after total and partial laryngectomy

Objective

To assess the voice-related quality of life (V-RQOL) in patients after total and partial laryngectomy.

Materials and methods

96 patients treated for laryngeal cancer were enrolled in the study. The cohort of patients was divided into three groups depending on the surgical procedure carried out: total laryngectomy (TL), supracricoid partial laryngectomy (SCL) and/or horizontal glottectomy (HG). The maximum phonation time (MPT) and syllable diadochokinesis, were used for the aerodynamic assessment; Yanagihara score was used for acoustic analysis of the sustained /a/ and the GRBAS scale was used for perceptual assessment. Each of the patients completed the VHI. The Kruskal–Wallis and Mann–Whitney tests were used to analyse the mean difference among the three groups of patients.

Results

A comparison with the values found between groups noted that the TL group showed significantly higher scores of G, R and Yanagihara score, while the HG group showed a significantly higher score of B. No differences were found in the aerodynamic and acoustic measures among the 3 groups. The mean ± standard deviations of VHI total score were 35.3 ± 24.5 for TL group, 30.1 ± 21.6 for SCL group, 35.8 ± 9.6 for HG group. No significant difference was found across the three groups.

Conclusions

V-RQOL seems to be similar in patients who underwent significantly different surgical procedures even if the voice characteristics were different. These findings need to be considered in patient's counselling together with other data on general quality of life after total and partial laryngectomy.     

喉全切除后气管造瘘口复发癌缺损外科修复比较

目的探索喉全切除后气管造瘘口复发癌缺损外科修复的治疗效果。方法对18例喉全切除后气管造瘘口复发癌实施外科治疗。其中Ⅰ型7例,颈部单纯切口,胸大肌肌皮瓣修复颈部皮肤气管造瘘口缺损;Ⅱ型6例,颈肢或胸联合切口,前臂皮瓣或胸大肌肌皮瓣(游离前臂皮瓣5例,胸大肌肌皮瓣1例)修复部分喉咽切除;Ⅲ型3例,颈腹联合切口,游离空肠修复全喉咽、颈段食管;Ⅳ型2例,颈胸腹联合切口,胃上拉修复全喉咽、全食管。Ⅱ、Ⅲ、Ⅳ型的颈部皮肤气管造瘘口缺损均用胸大肌肌皮瓣修复。结果颈部缺损胸大肌肌皮瓣均成活;咽瘘4例(其中游离空肠1例,前臂皮瓣2例,胃上拉咽瘘出血1例);全部病例术后均能进食;随访6～74个月,3例出现不同程度吞咽梗阻。结论喉全切除后气管造瘘口复发癌外科治疗缺损,修复选择应根据原发肿瘤治疗的经过及气管造瘘口复发癌侵及范围来确定修复方法。     

喉癌喉部分切除术切缘状况与患者预后的相关性研究

目的回顾性研究喉鳞状细胞癌患者喉部分切除术后切缘状况与患者预后的相关性。方法回顾性研究2001年8月～2006年9月135例喉部分切除术患者的情况,所有切缘标本行常规病理检查,局部复发及淋巴结转移率与切缘情况进行相关性研究。结果 26例阳性切缘中,9例不典型增生,17例切缘有癌细胞浸润,其余109例切缘常规病理阴性。对患者随访3年发现135例中17例局部复发,其中10例来自切缘阳性患者,7例来自阴性切缘患者。无局部复发患者3年生存率明显高于局部复发者。结论阳性切缘患者导致局部复发或淋巴结转移率明显高于阴性切缘患者,术后切缘的病理检查为阳性切缘患者随后的治疗起指导作用。     

Comparison of the state of acceptance by patients after total and partial laryngectomy

In this study authors asked about 400 patients (or their families) after surgery procedures because of larynx carcinoma. The questions was connected with acceptance the postoperative state. We collected 170 answers on the question, 137 from patients after total laryngectomy and 33 after partial laryngectomy. On of the question exactly sounded: how patients accepted their postoperative state? They had 3 answers: not content, agreed with the injury or content with the treatment. The results was very astonished: from extreme discontent patients to very satisfied. The most acceptable from the patients point of view is the partial laryngectomy. Even if that sparing operation is enough for some time patient is more satisfied than after total laryngectomy. The acceptance for the total operation is lower, but grows together with a time alive's. The important conditions of acceptance the injuries after the total operations are the awareness of the threats because of the condition, the possibilities of the treatment and it's choice and the knowledge about a rehabilitations after surgery and possibilities to achieve it. The acceptance of the injuries depends on the acceptance this patients by society.     

Life after total laryngectomy

This work relates the observation conducted in our outpatient clinic with fourteen patients who underwent a total laryngectomy due to a laryngeal and hypo pharyngeal cancer. The aims of our study were to analyse identity transformations and sociability modifications for these patients. It confirmed the social inequalities when a cancer occurs. Total laryngectomy upset or staggers the patients by impairing their appearance. Relations with other people are limited to the dearest because the tracheostomy and the deprivation of the original voice are regarded as disability that excludes them from the society. The physicians should be aware of the profound psychologic trouble and social changes attached to laryngeal cancer surgery to allow optimal care for the patients.     

Dysphagia after total laryngectomy

Quantitative analysis of swallowing after total laryngectomy has been compared with the data obtained in normal subjects. Lack of negative pressure production in the PE segment has been related to the dysphagia and prolonged bolus transit times. High pressures in the oropharynx may be a cause of fistulas.     

喉部分切除术后喉囊肿

目的探讨喉部分切除术后喉囊肿的发病率、病因、临床特点、诊断及治疗方法。方法回顾性分析2003年1月～2009年6月北京同仁医院收治的228例颈外入路喉部分切除术患者的诊疗及随访情况,并对喉部分切除术后喉囊肿进行分析报道。结果随访中发现2例喉囊肿,均为喉部分切除会厌成形术后。1例于术后20个月发现囊肿位于会厌舌面,行支撑喉镜下CO2激光切除囊肿。另1例术后19个月发现囊肿位于声门下区,经颈外入路切除。结论喉部分切除术后喉囊肿并不常见,可能与会厌前间隙分离过程中黏膜上皮种植有关。CT或MRI有助于诊断。囊肿可于支撑喉镜下或经颈外入路行手术切除。     

Endoscopic laser cricopharyngeal myotomy to salvage tracheoesophageal voice after total laryngectomy

Development of voice after tracheoesophageal puncture, following laryngectomy, is sometimes hampered by spasm of the cricopharyngeal muscle. This problem has been addressed by various means, including bougienage, botulinum toxin injection, and open surgical division of the muscle. We believe that endoscopic carbon dioxide laser cricopharyngeal myotomy represents a direct, simple, and effective solution.     

Voice and swallowing after total laryngectomy

Background: Voice and swallowing problems are often seen in patients with advanced larynx cancer, after total laryngectomy (TL) and chemo/radiotherapy.

The aim of this study was to determine the occurrence of voice and swallowing problems in patients who have been laryngectomised and investigate if these symptoms were related to age, time after TL, radiotherapy and TNM-classification. In addition, we studied how often the patients changed their voice prostheses and the need of therapeutic interventions after TL.

Methods: Forty-five patients were included in the study and completed the Swedish version of the Sydney Swallow Questionnaire and the Voice Handicap Index-T.

Results: Swallowing problems were reported by 89% of the patients and moderate-to-severe voice handicap was reported by 66%. Most of the subjects who had dysphagia also presented voice problems (r_s?=?0.67 p?≤?.01). Additional therapeutic interventions to manage problems with voice and/or swallowing after TL were required in 62% of the patients.

Conclusions: Swallowing and voice problems after TL are common. Thus, the preoperative information and assessment of these functions, as well as the treatment and the post-operative rehabilitation should be evaluated and optimised to provide better functional results after treatment of advanced larynx cancer.     

Speech rehabilitation after total laryngectomy

The outcome of speech therapy for 65 laryngectomees at Kitasato University Hospital is reported and what needs to be done in order to establish a better system for laryngectomee rehabilitation in Japan is discussed. Of the 65 patients, 53 were trained for both esophageal and electrolarynx speech, 8 for electrolarynx speech only and 4 for esophageal speech only. Of the 57 patients who were trained for esophageal speech, 38 continued the training for a period of > 6 months. Of these 38, 36 (94.7%) could produce one-syllable sounds at the first session. For the production of 5-6 syllables, a median of 6 sessions was necessary for the total laryngectomee group and 10 sessions were necessary for the pharyngo-laryngo-esophagectomee group but the difference was not significant. The study showed that for the production of a single esophageal sound the training period in our hospital was much shorter than that reported in other Japanese studies. Of the 65 patients, 27 (41.5%) acquired practical esophageal speech and 59 (90.8%) acquired either esophageal or electrolarynx speech. Six (9.2%) could not acquire any alaryngeal speech and this percentage was lower than that reported in other studies from Japan (12.5-33%) and from other countries (8.5-40%).     

Videofluoroscopy of the swallowing act after partial supraglottic laryngectomy by CO2 laser

The evaluation of functional deglutition in patients after partial supraglottic laryngectomy by CO(2) laser was performed by videofluoroscopy of the swallowing act. We studied 20 patients in PA and LL projections, and the swallowing act, at 25 frames per s, was captured on videotape. Aspiration was found in six patients, four of whom had manifest clinical symptoms of aspiration. Four patients had post-deglutitive, one intra-deglutitive and one both intra- and post-deglutitive aspiration. Other swallowing disturbances or structural deformities were not detected. Dynamic radiological studies of swallowing, such as videofluoroscopy of the swallowing act, can provide valuable information regarding functional results after surgical procedures in the upper aerodigestive tract. Our encouraging results prove the validity of partial supraglottic laryngectomy by CO(2) laser as a method of treatment for carcinoma of the larynx.     

Hyperthyreosis as a cause of postoperative disorders after partial CO2 laser laryngectomy

In a case of 66 years old man after partial laryngectomy psychiatric disorders with anorectic symptoms and significant loss of weight were observed. Psychiatric treatment was unsuccessful. Further examination and labour data revealed hyperthyreosis. Specific treatment was successful and caused complete recovery.