The qualitative study of effectiveness of expressive writing intervention on patients with laryngeal cancer post total laryngectomy / 中国实用护理杂志

Objective:The aim of this study was to explore the perception and cognition of patients with laryngeal cancer post total laryngectomy accepted expressive writing intervention, analyze the intervention effect from the perspective of patients, and provide a basis for psychological intervention of these patients.Methods:From July to August 2021, the descriptive research method was applied to 13 patients with laryngeal cancer post total laryngectomy who had participated in the expressive writing intervention hosted in the General Hospital of Ningxia Medical University, in order to understand the patients′ perception and cognition of the intervention, and the data were analyzed by using content analysis method.Results:A total of 2 themes and 9 sub themes were extracted. Theme 1: the positive feedback of expressive writing intervention: relieve related physical symptoms and improve sleep; reduce anxiety and regulate emotions effectively; reduce psychological stress and promote positive coping; reduce stigma and improve social withdrawal; make up for lost pronunciation and clear mind. Theme 2: Difficulties and challenges in the application of expressive writing intervention: physical discomfort affects the compliance of patients, poor economic status affects the enthusiasm of patients to participate, poor social and family support affects the willingness of patients to participate, and literacy and writing habits affect the completion of participation.Conclusions:The application of expressive writing intervention promotes the psychological and social functional rehabilitation of patients with laryngeal cancer post total laryngectomy and has satisfactory effects and certain feasibility. The researchers should fully consider the influencing factors of intervention and optimize the plan in the future.

Influence of ADOPT mode nursing intervention on airway self-care ability in patients after total laryngectomy / 中国实用护理杂志

Objective:To explore the effect of ADOPT mode nursing intervention on airway self-care ability in patients with total laryngectomy.Methods:50 patients who received total laryngectomy were randomly divided into control group (25 cases) and observation group (25 cases). The control group received routine nursing, while the observation group received ADOPT mode nursing intervention on the basis of routine nursing. The Exercise of Self-Care Agency Scale and self-made airway self-care knowledge questionnaire were used to evaluate the airway self-care ability and the incidence of airway related complications was also evaluated.Results:On discharge and 3 months after discharge, total scores about self-care knowledge of airway were 83.80 ± 5.06 and 89.40 ± 4.86 in the experimental group, which were significantly higher than those in the control group (68.75 ± 5.57, 72.50 ± 6.76), the differences were statistically significant ( t = -9.91, -10.09, both P<0.05). On discharge and 3 months after discharge, total scores in ESCA were 126.88 ± 9.77 and 133.60 ± 8.10 in the experimental group, which were significantly higher than those in the control group (113.29 ± 17.06 and 119.13 ± 15.30). The differences were significant ( t = -3.42, -4.12, both P<0.05). The incidence of airway complications was 41.67% (10/24) in the control group and 12.00%(3/25) in the observation group, which was statistically significant ( χ2 = 5.53, P<0.05). Conclusions:ADOPT mode nursing intervention can significantly improve the airway self-care ability of patients with total laryngectomy, reduce the incidence of airway complications, and is beneficial to patients′ physical and mental recovery.

Rehabilitación olfatoria en pacientes laringectomizados: maniobra de inducción del flujo aéreo nasal / Olfactory rehabilitation in laryngectomized patients: nasal airflow inducing maneuver

Resumen Introducción: La laringectomía total (LT) tiene como secuela la perdida de la voz, pero otra consecuencia no estudiada es la pérdida del olfato. Objetivo: Demostrar que la "maniobra de inducción del flujo aéreo nasal" (MIFAN) rehabilita el olfato en pacientes con LT. Material y Método: Estudio cuasiexperimental antes-después en pacientes laringectomizados por cáncer de laringe del Servicio de Otorrinolaringología del Hospital Barros Luco Trudeau (HBLT) de Santiago de Chile. Evaluación a través de encuesta, examen físico, nasofibroscopía y test olfatométrico. Pacientes con alteración del olfato por transmisión serán enrolados y se enseñará la MIFAN. Resultados: Se estudiaron 12 pacientes: 10 hombres, 2 mujeres. Edad promedio 66,3 años, todos autovalentes. 66,6% presentó anosmia y 33,3% hiposmia. Todos lograron realizar la maniobra. Posrehabilitación el 100% presentó presencia de olfato valorada por olfatometría. Población intervenida similar a otras series en cuanto a sexo y edad. La erigmofonación facilita la rehabilitación con MIFAN. La rehabilitación del olfato se logró en todos y paralelamente mejoró el sentido del gusto. Conclusión: La MIFAN es una técnica sencilla, barata y asequible para lograr rehabilitar el sentido del olfato en pacientes laringectomizados.

Abstract Introduction: Total laryngectomy (TL) has as a consequence the loss of voice, but another not studied consequence is the loss of smell. Aim: To demonstrate that the "nasal airflow inducing maneuver" (NAIM) rehabilitates smell in patients with TL. Material and Method: A quasi-experimental before-after study in laryngectomized patients for laryngeal cancer from the Otorhinolaryngology Service (ENT) of the Barros Luco Trudeau Hospital (BLTH) at Santiago, Chile. Evaluation through survey, physical examination, nasofibroscopy and olfactory test. Patients with transmission impairment of smell were enrolled and NAIM was performed. Results: 12 patients were studied: 10 men, 2 women. Average age 66.3 years. All self-supporting. 66.6% presented anosmia and 33.3% hyposmia. They all managed to perform the maneuver. Post-rehabilitation, 100% presented the presence of smell assessed by olfactometry. Intervened population similar to other series in terms of sex and age. Esophageal speech facilitates NAIM rehabilitation. Rehabilitation of smell was achieved in all of them and in parallel, the sense of taste improved. Conclusion: NAIM is a simple, cheap and affordable technique to rehabilitate the sense of smell in laryngectomized patients.

Comparación de sutura mecánica con sutura manual de la faringe en laringectomía total / Comparison of mechanical suture with manual suture of the pharynx in total laryngectomy

Introducción: La sutura mecánica es una opción para el cierre de la faringorrafia en laringectomía total por cáncer de laringe. Objetivo: Comparar el uso de sutura mecánica lineal con sutura manual de la faringe durante la laringectomía total por cáncer de laringe. Material y Método: Se realizó un estudio de tipo experimental prospectivo. Se compararon dos grupos pacientes: Los pacientes con sutura mecánica desde 2018 a marzo de 2020 y los pacientes con sutura manual previa a enero de 2018 en el Servicio de Otorrinolaringología del Hospital Barros Luco. Se analizaron fístula faringo-cutánea posoperatoria (FFC), tiempo operatorio, estadía hospitalaria y costo. Resultados: El estudio incluyó a 14 pacientes, cada grupo con n = 7. El grupo con sutura mecánica presento 0% de FFC y el grupo sutura manual 28%. El grupo con sutura mecánica reinicio alimentación a los 7 días y el grupo con sutura manual en promedio a los 11,5 (7-23) días. (p = 0,0023). El tiempo promedio de cirugía para el grupo experimental es de 288 ± 37,4 minutos y con sutura manual 311 ± 32,4 minutos. (p = 0,0176). El promedio de hospitalización para el grupo experimental fue de 11 ± 2,6 días (9 a 16), y para el grupo control fue de 21 ± 14 días (10 a 49) (p < 0,0001). Conclusión: La sutura mecánica es un procedimiento fácil de usar y seguro. Existiría un beneficio en el uso de sutura mecánica para el cierre faríngeo al compararlo con la sutura manual al disminuir el número de FFC, el tiempo operatorio y los días de hospitalización.

Introduction: Mechanical suture is an option for the closure of the pharyngorrhaphy in total laryngectomy due to laryngeal cancer. Aim: To compare the use of linear mechanical suture with manual pharyngeal suture during total laryngectomy for laryngeal cancer. Material and Method: A prospective experimental study was carried out. Two patient groups were compared: patients with mechanical suture from 2018 to March 2020 and patients with manual suture prior to January 2018 at the otorhinolaryngology service of the Barros Luco Hospital. Postoperative pharyngocutaneous fistula (FFC), operative time, hospital stay and cost were analyzed. Results: The study included 14 patients, each group with n = 7. The group with mechanical suture presented 0% of FFC and the group with manual suture 28%. The group with mechanical suture restarted feeding at 7 days and the group with manual suture on average at 11.5 (7-23) days (p = 0.0023). The average surgery time for the experimental group was 288 ± 37.4 minutes, while for the group with manual suture was 311 ± 32.4 minutes (p = 0.0176). The mean hospitalization for the experimental group was 11 ± 2.6 days (9 to 16), and for the control group it was 21 ± 14 days (10 to 49) (p < 0.0001). Conclusion: The mechanical suture is an easy to use and safe procedure. There would be a benefit in the use of mechanical suture for pharyngeal closure when buying it with manual suture by reducing the number of FFCs, operative time and days of hospitalization.

Análisis de factores predictivos en la aparición de fístulas faringocutáneas poslaringectomía total / Analysis or predictive factors associated with pharingocutaneous fistulas after total laryngectomy

RESUMEN Antecedentes: la fístula faringocutánea es la complicación más común luego de una laringectomía total. Los factores implicados en su aparición son estudiados por numerosos autores sin obtener resultados concluyentes. Objetivo: Evaluar las causas de aparición de fístula faringocutánea y describir los factores de riesgo implicados en la aparición de fístulas faringocutáneas en la población estudiada. Material y métodos: estudio retrospectivo, observacional, con análisis estadístico de variables. Se consideraron 55 pacientes a quienes se les realizó una laringectomía total inicialmente o como rescate, desde enero de 2000 hasta diciembre de 2019, con una proporción hombre/mujer de 48/7. La edad media fue de 61,3 años. El 96,36% con diagnóstico anatomopatológico de carcinoma epidermoide. Análisis estadístico (prueba de chi cuadrado-prueba de Mann-Whitney) de variables relacionadas con la aparición de fístula faringocutánea. Resultados: la incidencia de fístulas alcanzó el 20% de los pacientes laringectomizados. Cerraron espontáneamente el 72,73% de las fístulas y requirieron el uso de colgajos, 3 (27,27%) pacientes. De los pacientes fistulizados, el 63,64% tenían radioterapia previa. El uso de sonda nasogástrica para alimentación se prolongó en dichos pacientes por más de 15 días. El tiempo de internación promedio de los pacientes fistulizados fue de 23 días. Conclusión: en nuestro medio, el factor más asociado a la aparición de fístulas tras laringectomía fue el uso de radioterapia previa. La fístula en estos pacientes tardó más tiempo en cerrarse y requirió en algunos casos reconstrucciones más complejas.

ABSTRACT Background: Pharyngocutaneous fistula is the most common complication after total laryngectomy. The factors associated with its development have been studied by several authors without conclusive results. Objective: To evaluate the causes for the development of PCF and to describe the risk factors associated with PCF in the population studied. Material and methods: We conducted a retrospective and observational study with statistical analysis of the variables. A total of 55 patients undergoing initial or salvage total laryngectomy from January 2000 to December 2019 were included. Male-to-female ratio was 48/7. Mean age was 61.3 years. The pathological diagnosis was epidermoid carcinoma in 96.36% of the cases. Statistical analysis: (chi square test and Mann-Whitney test) of the variables related with the development of pharyngocutaneous fistula. Results: The incidence of fistula in patients with laryngectomy was 20%. Spontaneous closure occurred in 72.73% and 3 patients (27.27%) required the use of flaps. In patients with fistula, 63.64% had previous radiotherapy. In these patients, the use of nasogastric tube feeding lasted > 15 days. Mean length of hospital stay in patients with fistula with 23 days. Conclusion: In our environment, previous radiotherapy was the most significant factor associated with the development of fistula. In these patients, fistula took longer to close and required more complex reconstructions in some cases.

Laringectomía total en el adulto mayor, Guantánamo 2015-2019 / Laringectomia total em idosos, Guantánamo 2015-2019 / Total laryngectomy in older adult, Guantanamo 2015-2019

Introducción: El cáncer laríngeo en el adulto mayor tiene una incidencia elevada por múltiples factores que se incrementan con la edad, pero con un tratamiento específico adecuado como la laringectomía total permiten mejorar y elevar la calidad de vida de estos pacientes. Objetivo: Caracterizar el resultado de las intervenciones por laringectomía total realizadas en pacientes adultos mayores en el servicio de Otorrinolaringología del Hospital General Docente "Dr. Agostinho Neto", provincia Guantánamo, en el período de enero de 2015 a diciembre de 2019. Método: Se realizó un estudio descriptivo, retrospectivo de corte transversal en el total de pacientes (n=32) de 60 años y más a los que se les realizó laringectomía total durante el periodo estudiado. Las variables estudiadas fueron: edad, sexo, hábitos tóxicos, condicionantes prequirúrgicas, técnica quirúrgica y complicaciones más frecuentes. Los datos se obtuvieron de las historias clínicas. Resultados: La mayoría de los pacientes correspondió al sexo masculino (90,6 porciento) entre 70-74 años; el 71,8 porciento de los pacientes fumaba. La laringectomía total combinada con tiroidectomía unilateral o bilateral y vaciamiento cervical selectivo fue la técnica quirúrgica más empleada y el faringostoma la complicación predominante. Conclusiones: La caracterización de los resultados de la laringectomía total en el adulto mayor portador de carcinoma epidermoide laríngeo aporta datos que permiten una mejor atención integral a este grupo poblacional(AU).

Introduction: Laryngeal cancer has a high incidence in older adult due to various factors which has been increasing in frequency with age. However, assuming an adecuated and specific treatment like total laryngectomy, allows improving and enhancing the patient's quality of life. Objective: To characterize the outcomes of total laryngectomy in older adult patients treated in the otorhinolaryngology service at the Hospital General Docente "Dr. Agostinho Neto" in Guantánamo, from January 2015 to December 2019. Method: A descriptive, retrospective, and cross-sectional study was conducted on the total of patients (n=32) 60 and older, who underwent total laryngectomy during the mentioned period. Variables used were as follow: age, sex, toxic habits, preoperative conditions, surgical technique and, most frequent complications. Data was gathered from medical records. Results: Male patients 70 to 74 years were predominant (90.6 percent) and most of them smoked (71.8 percent). Total laryngectomy combined with unilateral or bilateral thyroidectomy and selective neck dissection was the most common surgical technique used and pharyngostoma was the predominant complication. Conclusions: The characterization of total laryngectomy outcomes in older adult with laryngeal squamous cell carcinoma provides important data for better comprehensive care in this population group(AU).

Introdução: O câncer de laringe em idosos apresenta alta incidência devido a múltiplos fatores que aumentam com a idade, mas com um tratamento específico adequado como a laringectomia total, melhoram e melhoram a qualidade de vida desses pacientes. Objetivo: Caracterizar o resultado da laringectomia total realizada em pacientes idosos no serviço de Otorrinolaringologia do Hospital General Docente "Dr. Agostinho Neto", província de Guantánamo, no período de janeiro de 2015 a dezembro de 2019. Método: Estudo descritivo, retrospectivo e transversal em todos os pacientes (n=32) com 60 anos ou mais que realizaram laringectomia total. durante o período estudado. As variáveis estudadas foram: idade, sexo, hábitos tóxicos, condições pré-cirúrgicas, técnica cirúrgica e complicações mais frequentes. Os dados foram obtidos dos prontuários médicos. Resultados: A maioria dos pacientes era do sexo masculino (90,6 porcento) entre 70-74 anos; 71,8 porcento dos pacientes fumavam. A laringectomia total combinada com tireoidectomia unilateral ou bilateral e dissecção cervical seletiva foi a técnica cirúrgica mais utilizada e a faringostomia a complicação predominante. Conclusões: A caracterização dos resultados da laringectomia total em idosos com carcinoma espinocelular de laringe fornece dados que permitem uma melhor assistência integral a este grupo populacional(AU).

Tradução e adaptação transcultural do Swallow Outcomes After Laryngectomy Questionnaire (SOAL) para o português brasileiro / Translation and cross-cultural adaptation of the Swallow Outcomes After Laryngectomy (SOAL) Questionnaire for Brazilian Portuguese

RESUMO Objetivo desenvolver a adaptação do questionário Swallow Outcomes After Laryngectomy Questionnaire - SOAL para a cultura brasileira. Método estudo de validação restrito à tradução e adaptação transcultural. Foram seguidas as seguintes etapas: discussão sobre a necessidade do instrumento no contexto brasileiro, duas traduções independentes, síntese das traduções, análise por comitê de 12 juízes especialistas nas áreas de Disfagia e Oncologia, análise dos comentários dos juízes e dos Índices de Validade de Conteúdo por item e do questionário, aplicação do questionário numa amostra de 10 laringectomizados totais, retradução e síntese final. Resultados foi necessário realizar equivalências semântica, sintática/gramatical, experiencial, idiomática e de conteúdo, principalmente após análise dos especialistas. O Índice de Validade de Conteúdo por item e do questionário foram aceitáveis em todos os aspectos avaliados. A retradução foi equivalente à versão original. A comparação entre as versões original, traduzida e retraduzida viabilizou a versão final do instrumento. Conclusão foi desenvolvida a adaptação do SOAL para a cultura brasileira. O processo de validação continuará a partir da versão apresentada neste estudo.

ABSTRACT Purpose To adapt the Swallow Outcomes After Laryngectomy (SOAL) Questionnaire for the Brazilian culture. Method Validation study restricted to translation and cross-cultural adaptation. The following steps were taken: discussion of the need for the instrument in the Brazilian context, two independent translations, summary of the translations, analysis by a committee of 12 expert judges in dysphagia and oncology, analysis of the judges' comments and of the content validity indexes of each item and of the questionnaire as a whole, application of the questionnaire in a sample of 10 total laryngectomy patients, back translation and final summary. Results It was necessary to perform semantic, syntactic/grammatical, experiential, idiomatic and content equivalences, mainly after the analysis by experts. The content validity indexes of each item and of the questionnaire were acceptable for all evaluated aspects. The back translation was equivalent to the original version. The comparison of the original, translated and back-translated versions indicated that the final version of the instrument was viable. Conclusion The SOAL was adapted to the Brazilian culture was developed. The validation process will continue using the version presented in this study.

Which risk factors are associated with stomal recurrence after total laryngectomy for laryngeal cancer? A meta-analysis of the last 30 years / Quais fatores de risco estão associados à recorrência estomal após laringectomia total para câncer de laringe? Uma meta-análise dos últimos 30 anos

Abstract Introduction Stomal recurrence is a troublesome complication after total laryngectomy. Despite a large number of studies having been performed, there is still controversy about which risk factors are most significant for the development of stomal recurrence. Objective The objective of the present meta-analysis was to analyze the potential factors leading to stomal recurrence after total laryngectomy. Methods PubMed, Web of Science, Cochrane Library, and Ovid databases were systematically searched using multiple search terms. Eighteen studies with 6462 patients were identified. The quality of evidence was assessed by The National Institute for Health and Clinical Excellence. Results The results showed that, tumor subsite (supraglottic vs. subglottic, RR = 0.292, 95% CI 0.142-0.600, p = 0.001; glottic vs. subglottic, RR = 0.344, 95% CI 0.175-0.676, p = 0.002), T stage (RR = 0.461, 95% CI 0.286-0.742, p = 0.001), preoperative tracheotomy (RR = 1.959, 95% CI 1.500-2.558, p < 0.001) were the high-risk factors associated with the development of stomal recurrence. Conclusion From the results of our study, tumor subsite, T stage and preoperative tracheotomy were the significant risk factors for stomal recurrence. Methodologically high-quality comparative investigations are needed for further evaluation.

Resumo Introdução A recorrência estomal pós-laringectomia total e é uma complicação de difícil manejo. Apesar de um grande número de estudos ter sido feito, ainda há controvérsias sobre quais fatores de risco são mais significativos para o seu desenvolvimento. Objetivo O objetivo da presente meta-análise foi analisar os fatores potenciais para recorrência estomal após a laringectomia total. Método As bases de dados PubMed, Web of Science, Cochrane Library e Ovid foram sistematicamente pesquisadas com vários termos de busca. Dezoito estudos com 6.462 pacientes foram identificados. A qualidade da evidência foi avaliada pelo National Institute for Health and Clinical Excellence. Resultados Os resultados mostraram que o subsítio tumoral (supraglótico vs. subglótico, RR = 0,292, IC 95% 0,142 ± 0,600, p = 0,001; glótico vs. subglótico, RR = 0,344, IC 95% 0,175 ± 0,676, p = 0,002), estágio T (RR = 0,461, IC 95% 0,286 ± 0,742, p = 0,001), traqueotomia pré-operatória (RR = 1,959, IC 95% 1.500 ± 2.558, p < 0,001) foram os fatores de alto risco associados ao desenvolvimento de recorrência estomal. Conclusão Com base nos resultados de nosso estudo, o subsítio do tumor, o estágio T e a traqueotomia pré-operatória foram fatores de risco significativos para recorrência estomal. São necessárias investigações comparativas metodologicamente de alta qualidade para maior avaliação.

Salvage total laryngectomy: is a flap necessary? / Laringectomia total de resgate: o uso de retalho é necessário?

Abstract Introduction: Pharyngocutaneous fistula is the most significant complication after salvage total laryngectomy in patients who have received previous treatment with radiotherapy with or without chemotherapy. Objective: Our purpose is to review the fistula rate in radiated patients undergoing salvage total laryngectomy, to determine if the use of pectoralis major flap interposition reduces the incidence and duration of fistula and to examine other risk factors. Methods: We made a retrospective review of patients undergoing salvage total laryngectomy for exclusively larynx cancer after failure of primary curative radiotherapy between 2000 and 2017. General data from patients, risk factors and other complications were analyzed. Results: We identified 27 patients whose mean age was 66.4 years, mainly male (92.5%). The primary closure group without pectoralis major flap included 14 patients, and the group with pectoralis major flap closure included 13 patients. Pharyngocutaneous fistula was present in 15 patients (55.5%). Global pharyngocutaneous fistula rate was higher in the group of patients without pectoralis major flap comparing with those were the flap was interposed (78.6% versus 30.8%, p = 0.047). Also the pharyngocutaneous fistulas which need to be repaired with surgery (64.3% versus 7.7%, p = 0.03) and large pharyngostomes (64.3% versus 0%, p = 0.0004) were present in a higher rate in the group closed primary without pectoralis major flap. We did not find other risk factors with statistical significance. Oral diet initiation (84 days versus 21.5 days, p = 0.039) and the duration of hospitalization (98.3 days versus 27.2 days, p = 0.0041) were much lower in patients with a preventive pectoralis major flap. Two patients died as a consequence of complications of large pharyngostomes. Conclusions: Prophylactic pectoralis major flap reduced the incidence, severity and duration of fistula and should be considered during salvage total laryngectomy.

Resumo Introdução: A fístula faringocutânea é a complicação mais significativa após laringectomia total de resgate em pacientes que receberam tratamento prévio com radioterapia com ou sem quimioterapia. Objetivo: Revisar a taxa de fístula em pacientes irradiados submetidos a laringectomia total de resgate, para determinar se o uso de interposição de retalho do peitoral maior reduz a incidência e a duração da fístula e examinar outros fatores de risco. Método: Fizemos uma revisão retrospectiva de pacientes submetidos à laringectomia total de resgate para câncer exclusivamente laríngeo após falha da radioterapia curativa primária entre 2000 e 2017. Dados gerais dos pacientes, fatores de risco e outras complicações foram analisados. Resultados: Foram identificados 27 pacientes com média de 66,4 anos, principalmente do sexo masculino (92,5%). O grupo de fechamento primário sem retalho de peitoral maior incluiu 14 pacientes e o grupo de fechamento com retalho de peitoral maior incluiu 13 pacientes. Fístula faringocutânea esteve presente em 15 pacientes (55,5%). A taxa global de fístula faringocutânea foi maior no grupo de pacientes sem retalho de peitoral maior em comparação com aqueles que receberam o retalho (78,6% vs. 30,8%, p = 0,047). Além disso, as fístulas faringocutâneas que precisaram ser reparadas através de cirurgia (64,3% vs. 7,7%, p = 0,03) e grandes faringostomias (64,3% vs. 0%, p = 0,0004) apresentaram uma taxa mais alta no grupo fechado primariamente sem retalho do peitoral maior. Não encontramos outros fatores de risco com significância estatística. O início da dieta oral (84 dias vs. 21,5 dias, p = 0,039) e a duração da internação (98,3 dias vs. 27,2 dias, p = 0,0041) foram muito menores nos pacientes com uso preventivo do retalho do peitoral maior. Dois pacientes morreram em consequência de complicações de grandes faringostomias. Conclusões: O uso profilático do retalho do peitoral maior reduziu a incidência, a gravidade e a duração da fístula e deve ser considerado durante a laringectomia total de resgate.

The applicability of high resolution manometry in total laryngectomy / Aplicabilidade da manometria de alta resolução na laringectomia total

Abstract: Purpose: This study aims to measure the pressure of the pharynx and the pharyngoesophageal segment (PES) at rest and during phonation in total laryngectomized patients, with different levels of voice production. Methods: four total laryngectomized individuals participated in the study, All patients underwent High Resolution Manometry (MAR) at rest and during phonation. After this process, a descriptive analysis of the results was performed. Results: we observed that during rest the patients had PES pressure below normal and this data may be related to changes in the muscular connections at the level of the upper esophageal sphincter (UES) especially the interruption of the cricopharyngeal plexus. During phonation, two patients presented higher UES pressure values during phonation, when compared to the values found at rest, suggesting that introduction of air into the esophagus is followed by pharyngoesophageal contraction and that during phonation the patients with good esophageal speech may develop more pressure in this region. Conclusion: Studies with a greater number of participants may help define, for example, subjects who may benefit from procedures such as cricopharyngeal myotomy or other medical conduct in order to facilitate the acquisition of esophageal voice in these patients.

Resumo: Objetivo: medir a pressão da faringe e do segmento faringo-esofágico (SFE), no repouso e durante a sua vibração (na produção de voz esofágica) em pacientes laringectomizados totais com diferentes níveis de produção de voz. Método: participaram do estudo quatro indivíduos laringectomizados totais, todos submetidos à Manometria de Alta Resolução (MAR) no repouso e durante a fonação. Após esse processo, foi realizada uma análise descritiva dos resultados. Resultados: em nosso estudo, observamos que, durante o repouso, os pacientes apresentaram pressão do esfíncter esofágico superior (EES) abaixo da normalidade, e este dado pode estar relacionado a alterações das conexões musculares, ao nível do EES, especialmente, a interrupção do plexo cricofaríngeo. Durante a fonação, dois pacientes apresentaram maiores valores de pressão do EES, em todas as fonações, quando comparado com os valores encontrados no repouso, sugerindo que a introdução de ar no esôfago é seguida de contração faringo-esofágica e que, durante a fonação, os pacientes bons falantes esofágicos, podem desenvolver maior pressão nesta região. Conclusão: estudos com maior número de participantes podem ajudar a definir, por exemplo, sujeitos que poderão se beneficiar de procedimentos como a miotomia do cricofaríngeo ou outra conduta médica, a fim de facilitar a aquisição de voz esofágica nesses pacientes.

Total Laryngectomy with Horizontal Mechanical Closure of the Pharyngoesophagectomy: Evaluation of the Effectiveness in Elderly Patients

Abstract Introduction The main modalities of surgical treatment for laryngeal cancer include transoral laser microsurgery (TLM), open preservation surgery, and total laryngectomy (TL). In the elderly, for the presence of comorbidities, the surgical approach more appropriate in many cases remains TL. The use of a stapler for the closure of the esophagus has been introduced to reduce surgical time and postoperative complications such as pharyngocutaneous fistula (PCF). Objective In the present study, we have evaluated the effectiveness of the use of the horizontal mechanical pharyngoesophageal closure in patients who underwent TL. Methods This nonrandomized study was performed on consecutive patients with histopathologically proven squamous cell endolaryngeal carcinoma. The TLwas performed using a linear stapler to mechanically suture the pharyngotomy using the semiclosed technique. Results A total of 33 patients underwent TL, and 13 of themunderwent neck dissection. A total of 15 patients (45.4%) were ≤70 years old, and 18 were > 70 years old. Analyzing the results in relation to age, patients > 70 years old showed tumors at an earlier stage than those aged ≤70 years old. Furthermore, in this group there was a greater number of patients who had comorbidities (p = 0.014). In total, we had 2 (6%) cases of PCF in 6.6% in the group ≤70 years old, and in 5.5% of the group > 70 years old (p = 1.00). Conclusions The use of the stapler for the horizontal closure of the pharyngoesophagectomy in the patients subjected to TL is proven to be useful and safe even when used in elderly patients.

Repair of post-laryngectomy pharyngocutaneous fistulas using a pectoralis major flap / Reparo de fístulas faringocutâneas pós-laringectomia utilizando retalho do músculo peitoral maior

Abstract Introduction: The pectoralis major flap is a reconstructive option to consider in the treatment of pharyngocutaneous fistula after a total laryngectomy. There are not large studies assessing variables related to pharyngocutaneous fistula recurrence after removal of the larynx. Our objectives were to review the results obtained with this type of treatment when pharyngocutaneous fistula appears in laryngectomized patients, and to evaluate variables related to the results. Methods: We retrospectively reviewed our results using either a myocutaneous or fasciomuscular pectoralis major flap to repair pharyngocutaneous fistula in 50 patients. Results: There were no cases of flap necrosis. Oral intake after fistula repair with a pectoralis major flap was restored in 94% of cases. Fistula recurrence occurred in 22 cases (44%), and it was associated with a lengthening of the hospital stay. Performing the flap as an emergency procedure was associated with a significantly higher risk of fistula recurrence. Hospital stay was significantly shorter when a salivary tube was placed. Conclusions: The pectoralis major flap is a useful approach to repair pharyngocutaneous fistula. Placing salivary tubes during fistula repair significantly reduces hospital stay and complication severity in case of pharyngocutaneous fistula recurrence.

Resumo Introdução: O retalho do músculo peitoral maior é uma opção a ser considerada no fechamento de fístula faringocutânea pós-laringectomia total. Não há grandes estudos que avaliem as variáveis relacionadas à recorrência da fístula faringocutânea após esse procedimento. Nossos objetivos foram avaliar os resultados obtidos com esse tipo de tratamento em pacientes laringectomizados com fístula faringocutânea e as variáveis relacionadas aos resultados. Método: Revisamos retrospectivamente os nossos resultados em 50 pacientes nos quais um retalho miocutâneo ou fasciomuscular do músculo peitoral maior foram utilizados para reparar a fístula faringocutânea. Resultados: Não houve casos de necrose de retalho. Após o reparo da fístula com um retalho do músculo peitoral maior, a ingestão oral foi restaurada em 94% dos casos. Houve recorrência da fístula em 22 casos (44%), a qual foi associada à duração da hospitalização. O uso do retalho como procedimento de emergência foi associado a um risco significativamente maior de recorrência da fístula. A permanência hospitalar foi significativamente menor quando utilizado um tubo de derivação salivar. Conclusões: O uso do retalho do músculo peitoral maior é uma abordagem útil para reparar a fístula faringocutânea. A colocação de tubos de derivação salivar durante o reparo da fístula reduz significativamente o tempo de hospitalização e a gravidade das complicações em caso de recorrência da fístula faringocutânea.

Factores de riesgo en la aparición de fístula faringocutánea / Risk factors in the apparition of pharyngocutaneous fistula

RESUMEN Introducción: la fístula faringocutánea es la complicación postoperatoria más frecuente de la laringectomía total. Incrementa la morbimortalidad, demora la administración del tratamiento oncológico y repercute en la esfera psicológica del paciente. Objetivo: conocer el comportamiento de la fístula faringocutánea en pacientes con laringectomía total. Materiales y métodos: se realizó un estudio observacional, descriptivo, retrosprospectivo en el Hospital Universitario "Comandante Faustino Pérez", en el período comprendido entre enero 2010 a diciembre 2015. El universo lo constituyó 143 pacientes laringectomizados. Se estudiaron las variables: edad, sexo, estado nutricional previo a la cirugía, estadio del tumor, radiaciones, traqueostomía; manejo del cuello, previo a la cirugía, y evolución de la fístula. Resultados: presentó fístula postoperatoria el 28 %, predominando el sexo masculino, en un 92.3 %; y los normopesos en un 56,6 %. Se encontraban en estadio IV, el 70 %. Fueron irradiados 72,5 % y se les practicó traqueostomía, previa a la cirugía, al 95 % de los pacientes. Vaciamiento cervical se realizó al 37,5 %. En el 70 % de los pacientes, la fístula apareció entre los 8 y 14 días. Conclusiones: la incidencia de la fístula faringocutánea es mayor en el sexo masculino entre los 60-69 años. La mayor incidencia ocurrió en el año 2015. El estadio avanzado del tumor, la presencia de traqueostomía, el estado nutricional e irradiación previa, fueron los factores que más incidieron en la aparición de fístula faringocutánea. En la mayoría de los pacientes el cierre fue espontáneo con buena su evolución (AU).

ABSTRACT Introduction: pharyngocutaneous fistula is the most frequent post-surgery complication of the total laryngectomy. It increases morbimortality, delays the administration of the oncological treatment and rebounds in the patient's psychological sphere. Objective: to know the behavior of the pharyngocutaneous fistula in patients with total laryngectomy. Materials and methods: a retrospective, descriptive, observational study was carried out in the University Hospital "Comandante Faustino Pérez", in the period from January 2010 until December 2015. The universe were 143 patients who undergone a laryngectomy. The studied variables were age, sex, nutritional status before the surgery, tumor stage, radiations, tracheotomy, neck management before surgery, and fistula evolution. Results: 28 % of the patients presented post-surgery fistula, predominantly among males (92.3 %). Normal weight patients were 56.6 %; 70 % were in the IV stage. 72.5 % of the patients were irradiated and 95 % undergone tracheotomy before the surgery. 37.5 % of them undergone cervical resection. In 70 % of the patients, the fistula appeared after 8-14 days. Conclusions: the incidence of the pharyngocutaneous fistula is higher in the male sex and the 60-69 years age-group. The highest incidence occurred in 2015. The advanced stage of the tumor, the presence of tracheotomy, the nutritional status and previous irradiation were the factors that had more incidences on pharyngocutaneous fistulae. The closure of the fistula was spontaneous in most of the patients, with a good evolution (AU).

Relation between Anxiety and Depression and Personal Attributes or Difficulties in Daily Life in Patients after Total Laryngectomy

Objective: This study aimed to reveal the relationship between anxiety and depression and personal attributes or difficulties in daily life in patients after total laryngectomy. Methods: An anonymous questionnaire was mailed to 135 members of a self-help patient group. The questionnaire included the following items: personal attributes, difficulties in daily life, and anxiety and depression (according to the Nottingham Adjustment Scale-Japanese Laryngectomy Version). Multiple regression analysis was conducted with anxiety-depression score as the dependent variable and personal attributes and difficulties in daily life as independent variables. Results: Among the 57 patient respondents, 43 provided valid answers and were selected for analysis (valid response rate: 36.8%, 41 men and 2 women, mean age: 67.5±10.6 years). Results revealed that presence of anxiety and depression were significantly associated with patient age (β=−0.369, p=0.004) and difficulties pertaining to speech/performance during outings and engaging in hobbies (β=0.419, p=0.002). Conclusions: Our findings indicate that there is an increased risk of anxiety and depression in patients are young or middle aged and have difficulties in outings and engaging hobbies. Therefore, in clinical practice, nurses should carefully assess the mental state and difficulties in daily life in these patients after total laryngectomy. Moreover, nurses should continuously provide psychosocial support to patients and their families in order to help patients prevent psychological problems even after they are discharged from hospital.

A Preliminary Study of Office-Based Transnasal Endoscopic Balloon Dilatation of Pharyngoesophageal Stricture after Total Laryngectomy / 대한연하장애학회지

OBJECTIVE: Pharyngoesophageal stricture formation and dysphagia following total laryngectomy negatively affect quality of life and result in nutritional compromise that can be successfully managed with various techniques. This study was conducted to describe our experiences of office-based balloon dilatation by transnasal endoscopy, which can be performed by an otolaryngologist. METHOD: The present study investigated three patients who underwent transnasal endoscopy guided balloon dilatation of pharyngoesophageal stricture. The assessment was performed based on the number of procedures and recurrences, final subjective outcomes, and complications. RESULT: There were no post-procedural complications. In one patient, a scarric band was found after the procedure; therefore, steroids were injected into the stricture site. There were 2–3 balloon dilatations and the interval between dilatations was 3–6 months. All patients were able to tolerate solid diet after 2 or 3 sessions. CONCLUSION: Transnasal endoscopic balloon dilatation, which can be easily performed by an otolaryngologist in an office setting without sedation or general anesthesia, can be a useful modality for treating pharyngoesophageal stricture after total laryngectomy.

A Case of Subglottic Cancer with Saber Trachea

“Saber-sheath” trachea is a deformity of lower cervical or intrathoracic trachea. The configuration of the deformity is marked coronal narrowing associated with sagittal widening. This deformity is associated with chronic obstructive pulmonary disease. We report a case of patient with saber-sheath who underwent total laryngectomy. Although the patient had no tracheal collapse after the total laryngectomy, crusted discharge was increased. Diagnosis of the saber-sheath trachea, possible causes, and clinical implications are discussed.

Voice Rehabilitation after Total Laryngectomy

Total laryngectomy remains as an important treatment option in selected patients with laryngopharyngeal cancers, which inevitably sacrifices naturally produced voice. Much effort has been devoted to voice restoration for these laryngectomized patients. Several ways of voice rehabilitation after total laryngectomy have been developed and utilized thus far, including tracheoesophageal shunt speech, esophageal speech, pneumatic speech aid, and electrolarynx. Of these, tracheoesophageal shunt speech appears to be the most effective voice restoration method, while other trials might also be useful in special situations. Nevertheless, each method has its own unique mechanisms of voice production, thus has its advantages and drawbacks in clinical setting. In this review, we discuss the currently available management options for the rehabilitation of laryngectomized voice.

Self-knotting of Nasogastric Tube: Case Report and Review of Literature.

Naso-Gastric (NG) tube use is very common in patients’ care at all levels of healthcare service delivery Worldwide. However, it is not without its complications. Naso-Gastric tube self-knotting is an unusual complication associated with its insertion and removal. A review of literature shows that no such case has been documented in our environment. Therefore, we thought it necessary to report this first case of self-knotting of NG tube encountered in the management of a 60 year old male post laryngectomy patient in the University of Port-Harcourt Teaching Hospital (UPTH), Port Harcourt, Nigeria. We want colleagues and other healthcare providers to be conversant with this unusual complication.

Factors influencing the longevity and replacement frequency of Provox voice prostheses

<p><b>INTRODUCTION</b>This study aimed to assess the factors that influence the longevity and replacement frequency of Provox voice prostheses following their placement.</p><p><b>METHODS</b>The medical records of 27 patients who received Provox voice prostheses after total laryngectomy and attended follow-up regularly between 1998 and 2012 were retrospectively reviewed. The success rate of the Provox voice prostheses (i.e. whether speech was achieved), quality of speech achieved, number and type of complications encountered, frequency of prostheses replacement and reasons for prostheses replacements were evaluated.</p><p><b>RESULTS</b>All 27 patients were men and their mean age was 63.0 (range 43-78) years. The mean follow-up period was 60.3 (range 1-168) months. Fluent and understandable speech was achieved in 85.0% of the patients. The mean duration before prosthesis replacement had to be performed was 17.1 (range 1-36) months. The most frequent complication was fluid leakage through the prosthesis. There was a strong positive correlation of 77.1% between the longevity of prostheses and postoperative follow-up duration (r = 0.771; p < 0.01).</p><p><b>CONCLUSION</b>The voice prosthesis is a tool that can be delivered in a practical fashion and replaced easily with no serious complications. It is a means by which speech can be restored, with a high success rate, after total laryngectomy. In the present study, we found that postoperative follow-up duration was the most important factor influencing the longevity of the Provox voice prosthesis.</p>

The relationship between acceptance of disability and hope level in patients with total laryngectomy / 中国实用护理杂志

Objective To explore the relationship between acceptance of disability and hope level in patients with total laryngectomy.Methods Totally 84 patients with total laryngectomy were recruited and investigated with the general information questionnaire,Acceptance of Disability Scale (ADS)and Herth Hope Index (HHI).Results The total score of ADS was (85.82±12.64),which showed medium level acceptance of disability.The total score of Herth Hope Index (HHI) was (35.50±8.12),which showed high level HHI.Significantly positive correlation was found between acceptance of disability and HHI.Conclusions Nurses should pay more attention to the acceptance of disability in patients with total laryngectomy,and provide effective psychological intervention to improve the patients' menial health and quality of life.