Indications and complications prevention and management of phaseⅡ implantation of Provox Vega voice prosthesis after total laryngectomy / 中华耳鼻咽喉头颈外科杂志

Objective: To explore the indications and management of common postoperative complications of phase II tracheoesophageal puncture (TEP) for Provox Vega voice prosthesis after total laryngectomy. Methods: The clinical data of 20 patients undergoing phase II TEP for Provox Vega voice prosthesis in our hospital between May 2021 and January 2022 were analyzed. Among them, there were 19 males and 1 female, aged from 37 to 76 years, with an average age of (60.0±8.4)years. The surgical indications and the prevention and treatment of common postoperative complications were summarized. Descriptive analysis was used in this research. Results: The basic surgical indications were as following: after total laryngectomy, there was no stenosis of the stoma and esophagus entrance, no scar constitution, no mouth opening restriction, no stiffness and backward restraint of the neck after radiotherapy, and more than half a year apart surgery or radiotherapy. Among the 20 patients, 18 underwent implantation successfuly, 1 failed in the operation, and for 1 patient, the prosthesis was removed due to bleeding 1 week after implantation. The common postoperative complications included TEP fistula infection (2 cases), the TEP fistula bleeding(1 case), deep neck (prevertebral) abscess (1 case), granulation at the inner side of the TEP fistula (1 case), invagination of the prosthesis (2 cases) and leakage around the prosthesis (2 cases). All patients were cured with different interventions. Conclusions: The Provox Vega voice prosthesis is generally safe for phase Ⅱ implantatione, but implantation indications need to be established. Common postoperative complications can be solved through preventive and remedial interventions.

Treatment of large persistent tracheoesophageal peristomal fistulas using silicon rings / Tratamento de fístula periestomal traqueoesofágica grande e persistente com anéis de silicone

Abstract Introduction: Tracheoesophageal peristomal fistulae can often be solved by reducing the size of the fistula or replacing the prosthesis; however, even with conservative techniques, leakage around the fistula may continue in total laryngectomy patients. Also, several techniques have been developed to overcome this problem, including injections around the fistula, fistula closure with local flaps, myofascial flaps, or free flaps and fistula closure using a septal perforation silicon button. Objective: To present the results of the application of silicon ring expanding the voice prosthesis in patients with large and persistent peri-prosthetic fistula. Methods: A voice prosthesis was fitted to 42 patients after total laryngectomy. Leakage was detected around the prosthesis in 18 of these 42 patients. Four patients demonstrated improvement with conservative methods. Eight of 18 patients who couldn't be cured with conservative methods were treated by using primary suture closure and 4 patients were treated with local flaps. As silicon ring was applied as a primary treatment in the 2 remaining patients and also, applied to 2 patients who had recurrence after suture repair and to 2 patients who had recurrence after local flap implementation. Silicon rings were used in a total of 6 patients due to the secondary trachea-esophageal fistula. Patients were treated with provox-1 initially and later with provox-2. At the time of leakage around the fistula, 6 patients had provox-2. Results: Fistulae were treated successfully in 6 patients, and effective speech of patients was preserved. Patients experienced no adaptation problem. Prosthesis changing time was not different between silicon rings expanded and normal prosthesis applied patients. Silicon ring combined voice prosthesis was used 26 times; there was no recurrence in fistula complication during 29 ± 6 months follow up. Conclusion: Silicon rings for modified expanded voice prosthesis seems to be an effective treatment for persistent peri-prosthetic leakage, for both, fistula closure and preserving the patients speech.

Resumo Introdução: Fístulas traqueoesofágicas persistentes podem ser resolvidas através da redução do tamanho da fístula ou substituição da prótese; no entanto, mesmo com técnicas conservadoras, o pertuito em torno da fístula pode continuar em pacientes com laringectomia total. Além disso, várias técnicas têm sido desenvolvidas para superar esse problema, inclusive injeções ao redor da fístula, fechamento da fístula com retalhos locais, retalhos miofasciais ou retalhos livres e fechamento da fístula com um botão septal de silicone. Objetivo: Apresentar os resultados da aplicação de anel de silicone para expansão da prótese vocal em pacientes com grandes fístulas periprotéticas persistentes. Método: Prótese vocal foi colocada em 42 pacientes após laringectomia total, e fístula foi detectada ao redor da prótese em 18 desses 42 pacientes. Quatro pacientes obtiveram melhora com métodos conservadores. Oito dos 18 pacientes que não obtiveram sucesso com métodos conservadores foram tratados usando sutura primária e quatro pacientes foram tratados com retalhos locais. Um anel de silicone foi aplicado inicialmente nos dois pacientes restantes e, também, aplicado a dois pacientes que tiveram recorrência após a técnica de sutura e a dois pacientes que tiveram recorrência após a utilização de retalho local. No total, seis pacientes receberam anéis de silicone em decorrência da fístula traqueoesofágica secundária. Os pacientes haviam sido tratados com provox-1 inicialmente e posteriormente com provox-2. No momento da detecção da fístula em torno do estoma, seis pacientes haviam recebido provox-2. Resultados: A fístula foi tratada com sucesso em seis pacientes. Além disso, após o tratamento a fala foi mantida de forma eficaz. Não houve problema de adaptação. O tempo de troca da prótese expandida com os anéis de silicone não foi diferente do tempo que se leva para a colocação da prótese normal. O anel de silicone combinado com a prótese vocal foi usado 26 vezes em pacientes na época da troca de prótese e não houve recorrência da fístula durante os 29 ± 6 meses de acompanhamento. Conclusão: Os resultados sugerem que em casos de grandes fístulas peri-prostéticas persistentes, anéis expandidos de silicone e prótese vocal modificada são eficazes tanto para o fechamento da fístula como para a manutenção da fala do paciente.

Alternative technique in secondary tracheoesophageal puncture using flexible endoscope and overtube in patients with difficult post-laryngectomy abnormalities

Background: Functional speech rehabilitation after total laryngectomy remains one of the most challenging issues in head and neck multidisciplinary care. Tracheoesophageal puncture for voice prosthesis insertion performed as a secondary procedure with a rigid esophagoscope and trocar can be technically difficult in certain patients due to post-treatment cervical abnormalities, such as reduced hyperextension, stenosis, and trismus. Methods: This study presents an improved method of secondary tracheoesophageal prosthesis insertion using a flexible endoscope in association with a plastic pliable overtube to keep the virtual esophageal lumen open. By this method, the puncture can be performed easily and safely with the avoidance of unexpected lesions. Results: From 2005 to 2015, 12 (16,9%) out of 71 patients who underwent secondary voice prosthesis placement at our institution required this alternative technique due to anatomical alterations that hindered the execution of the procedure following the standard technique. Conclusion: The procedure was successfully performed in all patients with no related complications (AU)

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>

Surgical management of refractory dysphagia and aspiration / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the methods and results of surgical management for refractory dysphagia and aspiration.</p><p><b>METHODS</b>The clinical data of 24 refractory dysphagia and aspiration patients who accepted surgical management were retrospectively analysed.</p><p><b>RESULTS</b>Twenty-four refractory dysphagia and aspiration patients accepted 26 operations between 2001 and 2014. Of the 26 operations, 17 were cricopharyngeal myectomy (CPM), 6 were scarectomy, 3 were laryngeal-tracheal separation. No severe complications occurred. Assessments of dysphagia were completed in 18 operations before and after operation. Aspiration scores of videofluoroscopic swallowing study (VFSS) were 4.50 [4.00;7.00] vs 2.00 [1.00; 3.25], P = 0.000; swallow dysfunction scroes of VFSS were 5.00 [4.00; 12.00] vs 1.00 [1.50; 10.00], P = 0.001; aspiration scores of fibroptic endoscopic evaluation of swallowing (FEES) were 4.00 [5.00; 7.00] vs 2.00 [1.75; 3.00], P = 0.000. But the surgical results for post radiotherapy dysphagia were not successful (n = 5): aspiration scores of VFSS were 7.00 [6.50; 8.00] vs 6.00 [2.00; 7.50], P = 0.109;swallow dysfunction scroes of VFSS were 12.00 [10.50; 12.00] vs 12.00 [7.50; 12.00], P = 0.180;aspiration scores of FEES were 7.00 [6.50; 8.00] vs 6.00 [2.00; 7.50], P = 0.109.</p><p><b>CONCLUSION</b>Surgical management was effective for refractory dysphagia and aspiration, but the surgical indication selection should be strict.</p>

Microbial colonization of Provox voice prosthesis in the Indian scenario.

INTRODUCTION: Tracheoesophageal speech using the voice prosthesis is considered to be the “gold standard” with success rates as high as 90%. Despite significant developments, majority eventually develop dysfunction due to microbial deterioration. We did a pilot study of 58 laryngectomy patients who developed prosthesis dysfunction. MATERIALS AND METHODS: A total of 58 laryngectomy patients who had their dysfunctional prosthesis removed were included in this study. Dysfunctional prostheses were removed and examined. Esophageal and tracheal flanges were examined separately. After obtaining pure fungal and bacterial cultures, the yeast strains were identified. Bacteria were identified with the light microscope and gram staining. We analyzed prosthesis lifespan and probable factors affecting it. RESULTS: Central leak was found in 43% cases while in 57% peri‑prosthetic leakage was the most common reason for prosthesis replacement. Microbial analysis revealed a combination of yeast and bacteria in approximately 55% culture samples. Out of these, almost 90% had the presence of single yeast species with bacteria. Pure fungal culture was identified in rest of the 45% cultures while none detected pure bacterial forms. Candida tropicalis was the solitary yeast in 81% while Candida albicans was seen in 10% as the solitary yeast. Bacterial isolates revealed Klebsiella pneumonia in 19%, Escherichia coli in 8% while Staphylococcus aureus was grown in 1% cultures. The consumption of curd (P = 0.036, 95% confidence intervals [CI]: 2.292‑64.285) to have a significant correlation of the mean prosthesis lifespan. Consumption of curd (P = 0.001, 95% CI: 0.564‑2.008) and history of prior radiotherapy (P = 0.015, 95% CI: 0.104‑0.909) had a significant bearing on the Provox prosthesis lifespan. CONCLUSIONS: Candida is the most common organism grown on voice prosthesis in Indian scenario. Consumption of curd and history of prior radiotherapy significantly affect Provox prosthesis lifespan.

Surgical treatment of differentiated thyroid carcinoma with laryngeal or tracheal invasion / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To analyze the clinical characters, surgical treatments and prognosis of differentiated thyroid carcinoma (DTC) with laryngeal or tracheal invasion.@*METHOD@#Forty-six cases including 33 papillary and 13 follicular were retrospectively reviewed. Thirty-four cases with tracheal invasion received conservative resection (17), window resection (11) and sleeve resection (6). One case with subglottic invasion was performed subglottic partial laryngectomy. Eleven cases with trachea-laryngeal invasion received total laryngectomy(4), 3 shave technique and 4 preservative laryngectomy.@*RESULT@#Complications included infections and hypocalcaemia, 15 patients got permanent fistula. 5-year survival rate in cases of tracheal shave resection was 88.2%, while 63.6% in those of window resection and 83.3% in those of sleeve resection. Survival rate within 5 years of patients received preservative laryngectomy was 62. 5%. Conclusion: With meticulous preoperative examination and positive surgical treatment, both survival rate and quality of life could be improved in patients of DTC with laryngeal or tracheal invasion.

Inhibitory effect of full-length spleen tyrosine kinase on invasion and metastasis of human laryngeal squamous cells / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the effect of gene transfection of full length spleen tyrosine kinase (Syk (L)) on the biological behavior of malignant cancer cells.</p><p><b>METHODS</b>Eukaryotic expression vector pIRES2-EGFP-Syk (L) was constrauted and sequenc. Laryngeal carcinoma cell line Hep-2 were transfected with pIRES2-EGFP-Syk (L) vectors or blank vectors. The expressions of mRNA and protein were examined by real time fluorescence quantitative polymerase chain reaction (Q-RT-PCR) and Western blot analysis. CCK-8 method was used for evaluating cell proliferation, Transwell for cell invasion capacity in vitro, and tumor formation in nude mice for in vivo tumorigenicity.</p><p><b>RESULTS</b>pIRES2-EGFP-Syk (L) vectors were successfully construct and transfected to Hep-2 cells. Q-PCR showed that mRNA expression level in Hep-2 cells transfected with Sky (L) (28.395 ± 0.067) was higher than those in Hep-2-neo cells transfected with blank vectors (3.891 ± 0.021) and Hep-2 cells with no transfection (1.005 ± 0.012), with statistically significant difference (F = 104.02, P < 0.01). Western blot showed that protein expression level of transfected-Sky (L) cells (0.821 ± 0.047) was significantly higher than those of Hep-2-neo cells (0.558 ± 0.031) and Hep-2 cells (0.468 ± 0.031), and the difference was statistically significant (F = 112.32, P < 0.01) ; CCK-8 assay showed OD value (1.390 ± 0.067) of transfected-Sky (L) cells was lower than those of Hep-2-neo cells (1.830 ± 0.067) and Hep-2 cells (1.920 ± 0.040), and the difference was statistically significant (F = 107.64, P < 0.01). Transwell assay showed average cell number per field of transfected-Sky (L) cells (176.04 ± 22.32) was higher than those of Hep-2-neo cells (301.02 ± 21.45) and Hep-2 cells (336.04 ± 26.01) with statistically significant difference (F = 123.46, P < 0.01). The volume (250.77 ± 34.83) mm(3) tumor formed from transfected-Sky (L) cells in nude mice, was less than those from Hep-2-neo cells (750.77 ± 40.83) mm(3) and Hep-2 cells (770.77 ± 30.83) mm(3), with statistically significant difference (F = 165.78, P < 0.01).</p><p><b>CONCLUSION</b>Down-regulation of Syk in Hep-2 cells is associated with the malignant biological behaviors of the cells. Syk (L) may be a potential target in gene therapy for laryngeal squamous cell carcinoma.</p>

Prognostic factors affecting results of comprehensive treatment of hypopharyngeal carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the efficacy of surgery followed by adjuvant radiotherapy and the prognostic factors affecting the results of treatment in hypopharyngeal carcinoma.</p><p><b>METHODS</b>A retrospective review of 149 patients with hypopharyngeal carcinoma that received surgical treatment from Jun 2003 to Jun 2010 was accomplished. In the 149 patients, the site of origin were pyriform sinus (n = 121), posterior pharyngeal wall (n = 21) and postcricoid (n = 7). According to UICC 2002 criteria, there were 3 in stage I, 15 in stage II, 29 in stage III and 102 in stage IV. Surgical methods for primary tumor were: pyriform sinus resection or posterior pharyngeal wall resection in 22 cases, partial pharyngectomy and partial laryngectomy in 29 cases, partial pharyngectomy and total laryngectomy in 67 cases, total pharyngectomy and total laryngectomy in 16 cases, total pharyngolaryngectomy and partial esophagus resection in 12 cases, and total esophagus resection in 3 cases. All the patients received elective and/or radical neck dissection. Unilateral or bilateral thyroid lobectomy was performed in 98 cases. Eighty-seven patients received intensity modulation radiated therapy (IMRT) postoperatively in the cancer center of Provincial Hospital Affiliated to Shandong University. Individualized adjustment of the radiation field was made according to the surgical condition. Forty-nine cases received radiotherapy in other hospitals (dose 50-70 Gy). Laryngeal function was restored in 51 patients (34.2%). The risk clinicopathological factors of survival and the causes of death were analyzed.</p><p><b>RESULTS</b>The survival rate was calculated with Kaplan-Meier method. The overall 3- and 5- year survival rates were 47.7% and 38.7%, respectively. There were no significant differences in 3-year survival between T1-2 and T3-4 groups, N0 and N+ groups, stage I-II and III-IV groups, laryngeal function preserved and unpreserved groups. The overall 3 years survival rate of patients received surgery and adjuvant radiotherapy was higher than those just received surgery alone (χ² = 6.851, P < 0.05). The 3-year survival rate in patients treated in comprehensive treatment group has showed a good trend, although still no statistical significance (χ² = 0.176, P > 0.05). The cause of death in 86 patients, including regional lymph nodes recurrence in 25 cases (29.1%). Of them, one was stoma recurrence and 9 were retropharyngeal lymph nodes metastasis; distant metastasis in 19 cases (22.1%); local recurrence in 13 cases, local or regional recurrence with distant metastasis in 8 cases (9.3%), and second primary cancer in 6 cases (7.0%).</p><p><b>CONCLUSIONS</b>The overall prognosis of hypopharyngeal carcinoma was poor and dismal. In accordance with specific conditions of surgery, active adjustment of the personalized protocol of IMRT was the key of improving the efficacy of hypopharyngeal carcinoma.</p>

Surgical treatment for advanced carcinoma of hypopharynx and laryngeal function preservation / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the treatment outcome advanced hypopharyngeal carcinoma by surgery with laryngeal function preservation.</p><p><b>METHODS</b>Twenty cases with squamous cell carcinoma of the hypopharynx who were treated by the function preserved surgery between January 2000 and March 2012 were reviewed. Of the patients 19 were males and 1 female, and their median age was 62.0 years. Eight cases were only applied with total or subtotal hypopharyngectomy, and others received total or subtotal hypopharyngectomy with partial-laryngectomy. Postoperative functional training was performed. Radiotherapy was used in all cases from 2 to 4 weeks after surgery.</p><p><b>RESULTS</b>Speech intelligibility remained in all 20 patients and 80.0% of the patients were extracted the trachea tube in the average 60 days.</p><p><b>CONCLUSIONS</b>Laryngeal functions of larynx can be preserved in advanced hypopharyngeal carcinoma by total or subtotal hypopharyngectomy alone or plus partial laryngectomy with functional reconstruction, and the patients can maintain their rational speech and swallowing functions.</p>

Free jejunum reconstruction and laryngeal preservation for squamous cell carcinoma in the pharyngoesophageal junction / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>Try to use free jejunum flaps reconstruction and laryngeal preservation for squamous cell carcinoma (SCC) in the pharyngoesophageal junction.</p><p><b>METHODS</b>Thirteen patients who underwent resections of SCC in the pharyngoesophageal junction with free jejunal interposition from August 2007 to December 2012 were reviewed. Of them, 8 had T3 lesions, 4 had T4 lesions, and one had radiation failure with rT2 lesion. Ten patients were treated with postoperative radiotherapy with a average dosage of 56 Gy.</p><p><b>RESULTS</b>The 3 year over all survival rate was 47.9% and disease-specific survival rate was 34.2%. The surgical complications occurred in 9 patients (9/13), including one death and one flap failure. Five patients (5/13) had permanent tracheal canulation, 10 patients (10/13) resumed oral feeding and all patients achieved reasonable speech.</p><p><b>CONCLUSION</b>Free jejunum interposition can be used to reconstruct surgical defect of SCC in the pharyngoesophageal junction, thus preserving the larynx and ensuring a better quality of life for the patients.</p>

Non-surgical combined modality treatments for laryngeal organ preservation in advanced hypopharyngeal carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the treatment outcome, laryngeal preservation and side-effect in locally advanced hypopharyngeal carcinoma treated with combined Hilical tomotherapy (HT) or intensity-modulated radiotherapy (IMRT) and chemotherapy and/or EGFR inhibitor (Cetuximab or Nimotuzumab).</p><p><b>METHODS</b>A total of 68 patients (20 cases with T1-2N1-3M0 and 48 cases with T3-4N1-3M0) with locally advanced hypopharyngeal cancer were treated individualy with non-surgical combined modality treatments including induction chemotherapy followed by concurrent chemoradiotherapy, induction chemotherapy followed by concurrent radiotherapy and EGFR inhibitor, concurrent chemoradiotherapy and EGFR inhibitor, and concurrent radiotherapy and EGFR inhibitor. HT was used in 40 patients and IMRT in 28 patients. Side-effects were evaluated with the established Common Terminology Criteria for Adverse Events (CTCAE) version 3.0 criteria.</p><p><b>RESULTS</b>The average follow-up time was 25.7 months (range 3-69 months). All patients completed the planned radiotherapy without treatment breaks, and 66 (97.0%) of 68 patients completed the planned chemotherapy. The 2-year and 3-year overall survival rates were 78.8% and 64.7% respectively, with an organ preservation rate of 84.2%. The most common side-effect greater than or equal to grade 3 was oropharyngeal mucositis. No patient dependent on a percutaneous gastrostomy and tracheostomy tube.</p><p><b>CONCLUSION</b>Hypopharyngeal carcinoma can be treated with non-surgical combined modality treatment including HT or IMRT, with a high laryngeal organ preservation rate and minimal toxicities.</p>

Application of narrow-band imaging endoscopy in laryngeal malignant lesion biopsy / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the guiding role of narrow-band imaging endoscopy in laryngeal malignant lesion biopsy.</p><p><b>METHODS</b>From February 2013 to January 2014, 113 patients suspected of laryngeal malignant lesions after electronic nasopharyngolaryngoscope screening were included in the study. The patients were randomly divided into two groups, 58 cases in group A underwent laryngeal tumor biopsies in the white light mode and 55 cases in group B did in NBI mode. The patients were applied with corresponding surgery treatment according to the biopsy results. Postoperative pathologic examination result was as a gold standard for identifing the laryngeal diseases.</p><p><b>RESULTS</b>The positive rate of malignant lesions in group A (71.1%, 32/45) was significantly lower than that in group B (95.4%, 42/44) (χ² = 7.75, P < 0.05); the accurate rate of biopsy in group A (77.6%, 45/58) was significantly lower than that in group B (96.4%, 53/55, χ² = 7.09, P < 0.05) .</p><p><b>CONCLUSION</b>Narrow-band imaging endoscopy can obviously improve in the detection of laryngeal malignant lesion by biopsy.</p>

A new proposal for evaluation of the pharyngoesophageal segment and its relation with the narrow-band spectrogram in tracheoesophageal speakers / Uma nova proposta de avaliacao do segmento faringoesofagico e sua relacao com a espectrografia acustica na voz traqueoesofagica

PURPOSE: The primary purpose of this study was to assess the relationship between pharyngoesophageal segment (PES) configuration and narrow-band spectrogram of tracheoesophageal voices. METHODS: This study included 30 total laryngectomees tracheoesophageal speakers. Patients were assessed by videofluoroscopy (VF), during deglutition and voicing, and the vowel /a/ was recorded for spectrographic analysis. The evaluation of VF recording consisted of visual perceptual rating of degree of contact between the prominence of PES and its anterior wall, defined as absent/mild (hypo contact), moderate (normo contact) and intense (hyper contact); and quantitative measures of PES: anteroposterior distance (APD) and length of the PES (lenPES); PES surface area in swallowing (areaSw), and phonation (areaPh), and the area of the air reservoir (areaAir). Visual inspection of a narrow-band spectrogram was made and four different acoustic signal typing were defined as Type I, II, III or IV. RESULTS: Type I-II is correlated with moderate contact; Type III, with intense and Type IV, with absent/mild contact. Type I-II has bigger APD and PES with lower length than Type IV. There is a correlation between bigger APD and shorter PES. CONCLUSION: The group with I-II signal typing has PES with normo contact; Type III with hyper contact and Type IV has PES with hypo contact. The best tracheoesophageal voices are achieved by PES with moderate contact of the prominence and with shorter and larger anteroposterior PES distances. What differentiates the PES with hyper contact from PES with normal one is only the degree of contact between the prominence of the PES and its anterior wall. .

OBJETIVO: Avaliar a relação entre a configuração do segmento faringoesofágico (SFE) e a espectrografia acústica nas vozes traqueoesofágicas (TE). Métodos: Participaram 30 sujeitos laringectomizados totais com fonação TE, que se submeteram à gravação da vogal /a/, para análise espectrográfica acústica, e ao exame videofluoroscópico (VF), durante a deglutição e a fonação. A análise espectrográfica foi feita pela avaliação visual do tipo do traçado e classificado como Tipo I, II, III ou IV. No exame, foi avaliado o grau de contato da proeminência do SFE com sua parede anterior, definido como ausente/leve (hipocontato), moderado (contato normal) e intenso (hipercontato); e mensurados: distância anteroposterior (DAP), comprimento do SFE (cSFE); área do reservatório de ar (área AR); área do SFE na deglutição (área DE) e na fonação (área FO). RESULTADOS: O tipo de sinal espectrográfico I-II caracteriza-se por contato normal; Tipo III, hipercontato; e Tipo IV, hipocontato. O grupo com sinal Tipo I-II apresenta DAP maior e cSFE menor do que o Tipo IV. Há correlação entre DAP maior e cSFE menor. CONCLUSÃO: Os sinais espectrográficos Tipo I e II caracterizam o SFE com contato normal; Tipo III, com hipercontato e Tipo IV, com hipocontato. SFE com contato normal, curtos e com DAP maior caracterizam as melhores vozes TE. Somente o grau de contato da proeminência do SFE com sua parede anterior diferencia SFE com contato normal de segmentos com hipercontato. .

Correlation of intraluminal esophageal pressure with the dynamic extension of tracheoesophageal voice in total laryngectomees

PURPOSE: To evaluate and correlate the amplitude of esophageal contractions triggered by swallowing water with dynamic extension and habitual, strong and weak sound intensity in total laryngectomees wearing a tracheoesophageal prosthesis. METHODS: Thirty total laryngectomees using tracheoesophageal voice with a phonatory prosthesis were evaluated by measuring the amplitude of contractions in the proximal, middle and distal esophagus and the pressure of the pharyngoesophageal transition by manometry. In order to measure vocal intensity the subject was asked to emit phonation of the vowel /a/ at habitual, strong and weak intensity which was captured with a sound pressure meter. Dynamic extension was calculated by subtracting strong intensity from weak intensity. RESULTS: A positive correlation was observed between contraction amplitude and dynamic extension in the proximal (rho: 0.45; p=0.01) and distal (rho: 0.41; p=0.02) esophagus There was no correlation with other parameters.. Total laryngectomees wearing a phonatory prosthesis with a dynamic extension above 21 dBNPS had greater contraction amplitude than laryngectomees with a dynamic extension below this value. CONCLUSIONS: There was a positive correlation between pressure amplitude in the proximal and distal esophagus and increased dynamic extension. The individuals with normal dynamic extension had greater contraction amplitude in the proximal esophagus than individuals with dynamic extension lower than the expected values for age.

Effect of singing training on total laryngectomees wearing a tracheoesophageal voice prosthesis

PURPOSE: To assess the effect of a program of singing training on the voice of total laryngectomees wearing tracheoesophageal voice prosthesis, considering the quality of alaryngeal phonation, vocal extension and the musical elements of tunning and legato. METHODS: Five laryngectomees wearing tracheoesophageal voice prosthesis completed the singing training program over a period of three months, with exploration of the strengthening of the respiratory muscles and vocalization and with evaluation of perceptive-auditory and singing voice being performed before and after 12 sessions of singing therapy. RESULTS: After the program of singing voice training, the quality of tracheoesophageal voice showed improvement or the persistence of the general degree of dysphonia for the emitted vowels and for the parameters of roughness and breathiness. For the vowel "a", the pitch was displaced to grave in two participants and to acute in one, and remained adequate in the others. A similar situation was observed also for the vowel "i". After the singing program, all participants presented tunning and most of them showed a greater presence of legato. The vocal extension improved in all participants. CONCLUSION: Singing training seems to have a favorable effect on the quality of tracheoesophageal phonation and on singing voice.

MicroRNAs regulate epithelial-mesenchymal transition of supraglottic laryngeal cancer / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study microRNAs (miRNAs) expression profiles associated with epithelial-mesenchymal transition (EMT) in lymph node metastasis of supraglottic laryngeal squamous cell carcinomas(SGLSCC).</p><p><b>METHODS</b>Primary tumor tissue samples of 12 SGLSCC patients were collected, including 6 patients clinically diagnosed with lymph nodes metastasis (N(+)) and 6 patients with lymph nodes metastasis-free (N0), for miRNA microarray gene-expression profiling to identify the differences between N(+) and N0 groups. Differentially expressed miRNAs was verified using quantitative real-time PCR in 20 patients with N(+) and 20 patients with N0. Target genes for the miRNAs associated with EMT in SGLSCC metastasis were analyzed.</p><p><b>RESULTS</b>Ten miRNAs differentially expressed between N(+) group and N0 group were determined. Comparing with N0 group, nine miRNAs were over-expressed and one miRNA was expressed at lower level in N(+) group. The genes for miR-192, miR-143, miR-409 and miR-634 were predicted as target genes that could promote EMT of laryngeal cancer cells by targeted inhibiting Krüppel-like factor 17(KLF17), E-cadherin and phosphatidylinositol 3 kinase (PI3K).</p><p><b>CONCLUSIONS</b>The miRNAs over-expressed in group N(+) can be used to predict cervical lymph node metastasis in SGLSCC. The miRNAs as new markers could improve the diagnosis and treatment of SGLSCC.</p>

Study on decellularized laryngeal scaffold in dogs / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the survivorship and character of decellularized laryngeal scaffold in pectoralis major muscle flap in canine.</p><p><b>METHODS</b>Eighteen donor larynx in experimental group were decellularized by perfusing sodium dodecyl sulphate. Three of them were used to detect the character of histology. The other fifteen ones were embedded in right pectoralis major muscle flap of acceptor canine. Donor larynx in control group were not perfused. Other experimental procedure was the same as experimental group. The specimens were harvested at two weeks, one month and two months after operation, respectively. Macroscopic view, histological examination and trypan blue staining were performed in the experimental group and control group.</p><p><b>RESULTS</b>The size of the specimens decreased remarkably into disappearance in control group, there was statistical significance between the experimental group and the control group (which used least significant difference t test P < 0.05). There was only little neutrophils and lymphocytes infiltrating around the laryngeal scaffold at 2 weeks in the experimental group. One month after operation, loose connective tissue begin to form around the laryngeal scaffold. After two months of transplantation, the connective tissue became thicker and the number of blood vessels increased than before. There was a large number of lymphocytes and neutrophil infiltration around the laryngeal specimens in the control group at 2nd week. The perichondrium in the control group was damaged at one month post operation. The cartilage cells could not be detected two months after surgery. The survival rate of cartilage cell between experimental group (86.8% ± 3.2%) and the control group (88.6% ± 3.1%) did not show statistical significance before implantation (χ(2) = 0.19, P > 0.05). The survival rate of cartilage cell decreased insignificantly in experimental group while the survival rate declined obviously in the control group at two weeks and one month after operation, the difference had statistical significance (χ(2) were respectively 5.52 and 20.55, P were respectively < 0.05 and < 0.01), the survival rate of cartilage cell in experimental group was (65.8% ± 2.6%) at two months after operation, while the cartilage cell all disappeared in control group.</p><p><b>CONCLUSIONS</b>Perfused decellularation technique can construct a low immunogenicity laryngeal cartilage scaffold which can survive in the chest muscle package and establish a good blood supplement. The decellularized laryngeal scaffold could be used as a biological scaffold for whole laryngeal reconstruction.</p>

Clinical significance of reducing cricopharyngeal dysfunction on voice restoration / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To discuss the effect of reducing the cricopharyngeal dysfunction on the Groningen prosthesis voice restoration following total laryngectomy and the effect of different methods.@*METHOD@#Fifty-six patients were implanted with Groningen voice prostheses to rebuild voice after total laryngectomy. The clinical data were analyzed retrospectively.@*RESULT@#Of 56 patients, 412 patients successes in voice restoration. The success rate of amputating pharynx plexus nerves group was 60.0%, amputating cricopharyngeal muscle group was 62.5%, and the amputating pharynx plexus nerves and cricopharyngeal muscle group was 96.0%.@*CONCLUSION@#The combination of pharynx plexus nerves resection and cricopharyngeal myotomy can make higher success rate of voice restoration.

Fabrication of larynx-shape tissue engineered cartilage by means of filling together with wrapping with pedicle myofascial flap / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the method of fabricating larynx-shape tissue engineered cartilage by means of filling together with wrapping with pedicle myofascial flap.</p><p><b>METHODS</b>Serial steps of solution casting, extrusion molding and particulate leaching were used to make larynx-shape [poly (3-hydroxybutyrate-co-3-hydroxyhexanoate), PHBHH] biomaterial models. The chondrocytes were seeded onto PHBHH models to form cell-PHBHH composites for culture in vitro for one week and then to fill and wrap larynx-shape composites with pedicle myofascial flap. After that to implant larynx-shape composites in situ on the back of adult New Zealand white rabbits (experimental groups n = 9). Control groups (n = 3) were the same measure as experimental groups but without chondrocytes on PHBHH models. Finally, morphological observation, HE & special staining and immunohistochemical test were conducted to evaluate the cartilage regeneration and its shape at 6, 8 and 12 weeks following implantation.</p><p><b>RESULTS</b>The PHBHH models appeared to be hollow half-trumpet with edges and corners of larynx-shape and its porosity > 90%. Pedicle myofascial flap using fascia as lining presented rich blood supply and had enough to fill and wrap larynx-shape composites. Tissue engineered larynx-shape cartilage specimens could be harvested at different period. It was demonstrated that the cartilaginous tissue formed in 6 weeks after implantation through histological and immunohistochemical examination and further maturity in 12 weeks and 18 weeks. But no cartilaginous tissue showed without chondrocytes on PHBHH as control groups to implant at the same time.</p><p><b>CONCLUSION</b>It seems that pedicled myofascial flap showed sufficient blood supply and that the filling together with wrapping method with pedicled myofascial flap is appropriate for fabricating larynx-shape tissue engineered cartilage.</p>