Surgical Laryngeal Preservation in Early-Staged Hypopharyngeal Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Hypopharyngeal cancer is aggressive, grows rapidly and often tends to spread through the submucosa combined with multiple "skip lesions" or tumor satellites. Therefore, even in the early stages, most patients require wide resection, usually including total laryngectomy followed by radiotherapy. However, it is obvious that, with consideration of quality of life, the laryngeal function and cancer control are equally important. The purpose of this study is to evaluate the oncologic and functional results of laryngeal conservation surgery for early-staged hypopharyngeal cancer. SUBJECTS AND METHOD: Fourteen patients with T1 or T2 carcinoma of the various subsites of the hypopharynx, including the medial wall of pyriform sinus (four patients), lateral wall of pyriform sinus (four patients), and posterior pharyngeal wall (six patients), who were treated surgically between 1992 and 2000, were studied. All except one patient who had skin graft underwent surgical resection of the primary tumor with laryngeal preservation and immediate reconstruction with forearm free flap transfer or primary closure. Follow-up period was 6-54 months. RESULTS: One patient died in the immediate postoperative period due to myocardial infarction. However, other postoperative complications were minimal. There was no evidence of disease for at least 1 postoperative year in 7of 13 patients (53.8%) with hypopharyngeal cancer who have been performed the conservation surgery. All patients except one who died of myocardial infarction, were decannulated. All but 2 patients achieved oral intake without continuous aspiration. Of these 2 patients, one patient had severe dysphagia due to the bulkiness of the reconstructed flap and he was fed through a gastrostomy tube. The other patient died of myocardial infarction before the trial of oral diet. CONCLUSION: Our data suggest that if the precise evaluation of the extent of the tumor and a careful selection of the well adjustable patients are done preoperatively, the laryngeal conservation surgery in early hypopharyngeal cancer may be valuable in terms of oncologic and functional aspect.

The Effect of MAC (Monitored Anesthesia Care) on Perioperative Pain in Endoscopic Sinus Surgery

BACKGROUND AND OBJECTIVES: Pain and anxiety control is the most important factor for patients that have undergone endoscopic sinus surgery under local anesthesia. Monitored anesthesia care (MAC) technique has been applied to local anesthetic patients for anxiolysis and analgesia. This technique encompasses the use of sedatives, tranquilizers and analgesics in combination to local supplements. This study was performed to evaluate the effectiveness of MAC for intraoperative pain control in patients who have undergone endoscopic sinus surgery. MATERIALS AND METHODS: We studied 83 patients undergoing ambulatory endoscopic sinus surgery. Patients were randomly allocated into 2 groups of MAC (n=49) and placebo (n=34). We administrated alfentani1 and propofol intravenously at 2-3 minutes before local anesthesia for endoscopic sinus surgery. We evaluated the intraoperative pain with visual analogue pain score (VAS) and satisfactory score to pain control. RESULTS: Overall, MAC cases showed statistically significant better VAS than placebo cases. Satisfactory score to pain control was also higher in MAC cases than placebo cases. CONCLUSION: We conclude that MAC is an effective method using intravenous sedatives and analgesics for intraoperative sedation and pain control in patients undergoing endoscopic sinus surgery under local anesthesia.

Vocal Analysis after Vertical Partial Laryngectomy

It is generally believed that a reconstruction of the glottic region after a vertical partial laryngectomy (VPL) can improve the glottic and supraglottic function. However, there is a paucity of reports on secondary healing without a glottic reconstruction after a VPL. The aim of this study was to obtain objective phonatory data after a VPL without a glottic reconstruction. From 1993 to 2001, 13 patients, who had been treated with VPL without a glottic reconstruction, were enrolled in this study. Patients with a postoperative follow up of less than 12 months were excluded. Seven lesions were classified as T1 glottic cancer and six as T2 glottic cancer- standard VPL (11 cases) and frontolateral VPL (2 cases). Acoustic ( (fundamental frequency, Fo), jitter, shimmer, the noise to harmonic ratio (NHR) ), aerodynamic (maximal phonation time (MPT), mean flow rate (MFR) ) analysis and videostroboscopy were performed to evaluate the voice. There were significant differences in the Fo, jitter, shimmer, NHR, MPT and MFR between the VPL group and normal control group. In videostroboscopy, the following tendencies were observed in many cases: incomplete glottic closure, a decreased and irregular mucosal wave and amplitude, supraglottic voicing, abnormal arytenoid movement and anterior commissure blunting. Objective phonatory data after VPL without a glottic reconstruction was obtained. The voice quality after a VPL without a glottic reconstruction was somewhat unsatisfactory. A further comparison with other different surgical techniques of a VPL would help determine a better way of improving the voice quality in these patients.