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Abstract Introduction: Laryngeal cancer is the most common cancer of the upper respiratory tract. The main methods of treatment included surgery (partial laryngectomy and total laryngectomy) and radiation therapy. Laryngeal dysfunction is seen after both treatment modalities. Objective: The aim of the study is to compare postoperative functional results of the standard supracricoid partial laryngectomy technique and a modified supracricoid partial laryngectomy technique using the sternohyoid muscle. Methods: In total, 29 male patients (average years 58.20 ± 9.00 years; range 41-79 years) with laryngeal squamous cell carcinoma who underwent supra cricoid partial laryngectomy were included. The patients were divided into two groups in terms of the surgical techniques. In Group A, all patients underwent standard supracricoid partial laryngectomy technique between January 2007 and November 2011. In Group B, all patients underwent modified supracricoid partial laryngectomy between August 2010 and November 2011. Fiberoptic endoscopic evaluation of swallowing test, short version of the voice handicap index scores, and the MD Anderson dysphagia inventory, the time of oral feeding and the decanulation of the patients after surgery of each groups were compared. Results: The mean maximum phonation time was 8.68 ± 4.21 s in Group A and 15.24 ± 6.16 s in Group B (p > 0.05). The S/Z (s/s) ratio was 1.23 ± 0.35 in Group A and 1.08 ± 0.26 in Group B (p > 0.05); the voice handicap index averages were 9.86 ± 4.77 in Group A and 12.42 ± 12.54 in Group B (p > 0.05); the fiberoptic endoscopic evaluation of swallowing test averages were calculated as 12.73 ± 3.08 in Group A and 13.64 ± 1.49 in Group B (p > 0.05). In the MD Anderson dysphagia inventory, evaluation of swallowing, the emotional, physical, and functional scores were 29.21 ± 4.11, 32.21 ± 6.85, and 20.14 ± 2.17 in the Group B, and 29.20 ± 2.54, 32.4 ± 4.79, and 19 ± 1.92 in Group A, respectively. Conclusion: Although there is no statistical difference in functional outcome comparisons, if rules are adhered to in preoperative patient selection, modified supracricoid partial laryngectomy can be applied safely and meaningful gains can be achieved in functional outcomes.
Resumo Introdução: O câncer laríngeo é o câncer mais comum do trato respiratório superior. Os principais métodos de tratamento incluem cirurgia (laringectomia parcial e laringectomia total) e radioterapia. A disfunção laríngea é observada em ambas as modalidades de tratamento. Objetivos: Comparar os resultados funcionais pós-operatórios da técnica de laringectomia padrão supracricoide e a técnica de laringectomia supracricoide modificada com o uso do músculo esterno-hióideo. Método: Foram incluídos 29 pacientes do sexo masculino (média de 58,20 ± 9,00 anos, intervalo de 41 a 79) com carcinoma espinocelular de laringe submetidos à laringectomia supracricoide parcial. Os pacientes foram divididos em dois grupos em termos de técnicas cirúrgicas. Todos os pacientes do Grupo A foram submetidos à laringectomia padrão supracricoide entre janeiro de 2007 e novembro de 2011. No Grupo B, todos os pacientes foram submetidos à laringectomia supracricoide modificada entre agosto de 2010 e novembro de 2011. A avaliação endoscópica da deglutição por fibra ótica, os escores da versão curta do Voice Handicap Index e do MD Anderson Dysphagia Inventory, o tempo de alimentação oral e a decanulação dos pacientes foram comparados após a cirurgia em cada grupo. Resultados: A média do tempo máximo de fonação foi de 8,68 ± 4,21 segundos no Grupo A e 15,24 ± 6,16 segundos no Grupo B (p > 0,05). A razão S/Z (seg/seg) foi de 1,23 ± 0,35 no Grupo A e 1,08 ± 0,26 no Grupo B (p > 0,05); as médias do Voice Handicap Index foram 9,86 ± 4,77 no Grupo A e 12,42 ± 12,54 no Grupo B (p > 0,05); as médias da avaliação endoscópica da deglutição por fibra ótica foram calculadas como 12,73 ± 3,08 no Grupo A e 13,64 ± 1,49 no Grupo B (p > 0,05). Na avaliação da deglutição pelo MD Anderson Dysphagia Inventory, os escores emocional, físico e funcional foram 29,21 ± 4,11, 32,21 ± 6,85 e 20,14 ± 2,17 no Grupo B e 29,20 ± 2,54, 32,4 ± 4,79 e 19 ± 1,92 no Grupo A, respectivamente. Conclusão: Embora não haja diferença estatística nas comparações de resultados funcionais, se as regras forem respeitadas na seleção pré-operatória do paciente, a laringectomia supracricoide parcial modificada pode ser aplicada com segurança e ganhos significativos podem ser alcançados em termos de resultados funcionais.
Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Idoso , Carcinoma de Células Escamosas/cirurgia , Neoplasias Laríngeas/cirurgia , Recuperação de Função Fisiológica/fisiologia , Cartilagem Cricoide/cirurgia , Laringectomia/métodos , Carcinoma de Células Escamosas/fisiopatologia , Neoplasias Laríngeas/fisiopatologia , Estudos Retrospectivos , Resultado do Tratamento , Laringe/fisiopatologiaRESUMO
OBJECTIVE To evaluate the survival and functional outcomes of advanced laryngeal squamous cell carcinoma after modified supracricoid partial laryngectomy(SCPL).METHODS We selected 65 laryngeal cancer patients treated with modified supracricoid partial laryngectomy from 2002 to 2015 in our hospital.Among them,62 cases were males,3 cases were females with an age ranged from 35 to 80 years(median age 58 years)There were 26 cases with T2 stage,32 cases with T3 stage and 7 cases with T4 stage.We selected 120 laryngeal cancer patients treated with vertical partial laryngectomy at the same period as control.Then we evaluated the functional outcomes of modified supracricoid partial laryngectomy group compared with vertical partial hemilaryngectomy group.RESULTS The 5-year cumulative survival rate and decannulation rate were 82.3％ and 98.3％ for supracricoid laryngectomy group respectively.Decannulation ratewas 86.1％ for vertical partial hemilaryngectomy group(P＜0.05).However,there was no significant difference between supracricoid partial laryngectomy group and vertical partial laryngectomy group in pronunciation evaluation and abnormal deglutition.CONCLUSION Modified supracricoid partial laryngectomy is a good choice for local advanced laryngeal squamous cell carcinoma.
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A laringectomia parcial horizontal supracricoidea é indicada para o tratamento do câncer da laringe que não invade a subglote e preserva ao menos uma das aritenoides. Esta cirurgia possibilita a manutenção das funções respiratória e esfinctérica da laringe e permite a fonação com característica predominantemente rugosa. O trabalho fonoaudiológico visa promover a aproximação das estruturas remanescentes para reabilitar a deglutição e fonação do paciente. A técnica de firmeza glótica é um exercício indicado para melhorar a coaptação das pregas vocais, sendo realizado por meio da oclusão quase total da boca com a mão em concha, durante a emissão de fricativo sonoro sustentado. Para compreender como esta técnica atua nas estruturas supraglóticas, foi avaliada a configuração laríngea e a qualidade vocal de pacientes submetidos à laringectomia supracricoide, com voz supraglótica estável, após dois minutos de realização da técnica de firmeza glótica. Foram avaliados seis pacientes, com gravação das amostras de voz em programa computadorizado e nasolaringofibroscopia, antes e após dois minutos de realização da técnica. Para a avaliação perceptivo-auditiva das vozes foi utilizada a escala GRBASI. O tipo de constrição da laringe remanescente, grau de aproximação e amplitude de vibração das estruturas foram avaliados nos exames de nasolaringofibroscopia. Houve aumento da amplitude de vibração das estruturas remanescentes em cinco pacientes, redução da soprosidade em três e da tensão vocal em dois pacientes. Neste estudo inicial com seis indivíduos, observamos que a técnica de firmeza glótica pode ser utilizada como exercício complementar para melhorar a qualidade vocal supraglótica e ampliar a vibração das estruturas remanescentes.
Supracricoid horizontal partial laryngectomy is a surgical technique used to treat laryngeal tumors restricted to glottic and supraglottic regions, preserving at least one of the arytenoids. This surgery allows for maintenance of the sphincter and respiratory functions, as well as phonation, with rough vocal quality. Rehabilitation aims to promote sphincter contraction of the remaining structures to improve swallowing and phonation. The hands-over-mouth exercise is usually employed to improve glottic closure: one cupped hand gently covers the half-open mouth to almost completely obstruct the airway during sustained emission of a voiced fricative phoneme. To understand the effect of this technique in patients submitted to supracricoid laryngectomy, we evaluated the configuration of the laryngeal remaining structures and vocal quality during supraglottic phonation, after a hands-over-mouth exercising period of two-minutes, by comparing digitizing voice samples and nasolaryngoscopic images of six patients, before and after the task. We used the GRBASI scale to access vocal quality and analyzed the pattern of constriction, the degree of approximation and the vibratory amplitude to evaluate the images. In this pilot, we observed an increase in vibratory amplitude of the remaining structures of five patients and concluded that the hands-over-mouth exercise can be used as a complementary exercise to improve supraglottic voice quality.
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OBJETIVOS: Com a intenção de se avaliar os resultados funcionais e terapêuticos da laringectomia supracricóide com crico-hióide-epiglote-pexia (CHEP) foram estudados 50 casos de pacientes com carcinoma epidermóide da glote classificados como T2/T3 submetidos a esta técnica em nossa instituição. MÉTODOS: Foi realizada uma análise retrospectiva entre 1996 e 1999. Classificamos 18 pacientes como T2N0M0 e 32 pacientes como T3N0M0. Quarenta e um pacientes foram submetidos a esvaziamento cervical seletivo lateral bilateralmente, quatro foram submetidos ao mesmo esvaziamento unilateralmente, e cinco não foram esvaziados. Analisamos as complicações e a sobrevida livre de doença pelo método de Kaplan-Meyer. RESULTADOS: Dez pacientes tiveram complicações pós-operatórias, dois foram tratados com complementação da laringectomia. Os 48 pacientes restantes mantiveram a via aérea normal, deglutição e a voz. Três pacientes no grupo submetido a esvaziamento cervical apresentaram linfonodo metastático. Quatro pacientes tiveram recidiva da doença, três com recidiva local, sendo dois tratados com laringectomia total e estão vivos e sem doença, o outro com doença avançada alcançou o óbito pela doença. O paciente que teve recidiva no pescoço foi tratado com esvaziamento cervical mais radioterapia e morreu com doença. Dois pacientes tiveram um segundo tumor primário em orofaringe, sendo um tratado com radioterapia paliativa e morreu com doença e o outro tratado com cirurgia está vivo e sem doença. A sobrevida livre de doença em três anos foi de 88 por cento para pacientes T2 e 72 por cento para pacientes T3. CONCLUSÕES: Esta técnica é útil no tratamento de casos selecionados de carcinoma epidermóide da glote T2/T3 sempre se considerando a extensão da doença. A incidência de complicações necessitando laringectomia total de resgate não compromete a funcionalidade desta técnica. A sobrevivência é comparável aos pacientes submetidos a laringectomia total e laringectomia ...
BACKGROUND: Our objective was to assess whether Supracricoid Laryngectomy with CricoHiodoEpiglottoPexy (CHEP) could successfully achive cure preserving voice in the treatment of glottic laryngeal cancer. METHODS: A retrospective analysis has been carried out between 1996 through 1999. We classified 18 patients as T2N0M0 and 32 patients as T3N0M0. Fourty one patients underwent selective bilateral lateral neck dissection, four had unilateral neck dissection and five patients had the neck undissected. Survival was analyzed under the Kaplan-Meyer method. RESULTS: Ten patients had postoperative complications, two treated with total laryngectomy. The remained 48 patients maintained normal airway, swallowing and speech. Three patients in the neck dissection group presented occult neck metastasis. Four patients had recurrences, three of them were local. Two patients treated with total laryngectomy are alive without disease, and another had advanced recurrence and died. One patient had neck recurrence and was treated with radical neck dissection plus radiotherapy and died from the disease. Two patients presented a second tumor in the oropharynx. One of them was treated with palliative radiotherapy and died and the other had surgical resection and is alive without disease. Three years disease free survival was 88 percent for T2 and 72 percent for T3. CONCLUSIONS: This technique is useful in the treatment of selected cases of T3/T2 glottic cancer, regarding the extension of the disease. The incidence of complications required completion laryngectomy which did not compromise the functionality of this technique. Survival is comparable to patients submitted to total laryngectomy and near-total laryngectomy, regarding the extension of the lesion.
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BACKGROUND AND OBJECTIVES: Advanced or recurrent laryngeal cancers after chemoradiotherapy were mainly treated by total laryngectomy because of inadequate surgical margin, multifocal recurrent site, and delayed diagnosis. Recently, voice preservation through conservative laryngeal surgery in case of advanced or recurrent laryngeal cancer with strict application of surgical indication became possible. In this study, authors studied the usefulness of surpracricoid partial laryngectomy (SCPL) for advanced or recurrent laryngeal cancers is discussed. MATERIALS AND METHOD: Twenty-five laryngeal cancer cases of cricohyoido-epiglottopexy (CHEP) or cricohyoidopexy (CHP) from May 1996 through April 2001 were analysed retrospectively. In recurrent cases after radiotherapy, there were 8 cases with glottic T1, 6 with T2, 3 with T3, one with T4, one with supraglottic T2 and T3. In advanced cases without radiotherapy, there were 3 cases with glottic T3 and 2 with supraglottic T3. Evaluation of oncological and functional results were conducted. The mean follow-up period was 29.1 months. RESULTS: Local recurrence occurred in 1 patient (4.3%) and cricoid perichondritis in 5 patients (21.7%), laryngocutaneous fistula in 1 patient (4.3%) after the operation. Four patients (17.3%) had to be treated with completion laryngectomy. Voice function was preserved in 19 patients (82.7%). CONCLUSION: Our experience with supracricoid partial laryngectomy with CHEP or CHP suggests that this technique can be a valuable alternative to the total laryngectomy in the recurrent or advanced laryngeal cancer.
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Humanos , Quimiorradioterapia , Diagnóstico Tardio , Fístula , Seguimentos , Neoplasias Laríngeas , Laringectomia , Radioterapia , Recidiva , Estudos Retrospectivos , VozRESUMO
BACKGROUND AND OBJECTIVES: Conservation laryngeal surgery is designed to remove the cancer mass completely while preserving the physiologic functions of the larynx. Recently, the supracricoid partial laryngectomy (SCPL) has broadened the spectrum of reliable techniques available to conservation laryngeal surgeons. Much research has been devoted to the surgical technique and oncological results of SCPL, but only a few signi6cant objective reports of the phonatory results are available presently. This study was designed to analyze the phonatory results achieved after SCPL for laryngeal cancer. MATERIALS AND METHODS: Selected characteristics of the speech and voice were compared in 25 patients who had undergone SCPL and 10 normal adult laryngeal (NAL) speakers. Durational and frequency features were analyzed with the CSL and the MDVP. RESULTS: SCPL speech proved comparable to NAL speech at the average fundamental frequency. SCPL spech and voice were statistically less efficient than NAL speech in jitter, shimmer, harmonics-to-noise ratio, mean airflow rate, maximal phonation time, and subglottic pressure (p<0.01). The completion of an arytenoid cartilage resection and/or anterior cricoid cartilage removal did not statistically modify the durational and frequency features of SCPL speakers (p <0.01). CONCLUSION: The voice parameters of SCPL speakers were different from those of the NAL speakers, but patients were thought to be allowed social interaction.
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Adulto , Humanos , Cartilagem Aritenoide , Cartilagem Cricoide , Relações Interpessoais , Neoplasias Laríngeas , Laringectomia , Laringe , Fonação , VozRESUMO
BACKGROUND AND OBJECTIVES: Supracricoid partial laryngectomy is popular due to its satisfactory oncological and functional outcomes in selected laryngeal cancers. Their postoperative management is now well codified, but functional failures still persist. The aims of this study were to analyze the deglutition modification induced by these intervention and to plan a better rehabilitation program of swallowing. MATERIALS AND METHOD: For the evaluation of swallowing function, the swallowing analysis was performed by following the videofluoroscopic evaluation using the modified barium swallow (Logemann, 1983) in 14 laryngeal cancer patients. RESULTS: Asymptomatic aspiration was observed in 4 patients (28.6%), especially in patients with the extended procedures (p=0.032) and delayed decannulation (p=0.035). Aspiration was associated with faulty backward tilting of epiglottis and inadequate movement of the base of tongue (p<0.05). CONCLUSIONS: In planning the swallowing rehabilitation program after supracricoid partial laryngectomy, recuperation of proper epiglottic movement, which is promoted by exercise of backward tongue movement, is the most important concern.
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Humanos , Bário , Deglutição , Epiglote , Neoplasias Laríngeas , Laringectomia , Reabilitação , LínguaRESUMO
BACKGROUND AND OBJECTIVES: Supracricoid partial laryngectomy (SCPL), one of the conservative techniques for supraglottic laryngectomy, can be used to control advanced laryngeal cancers extending to paraglottic space, thyroid cartilage with or without epiglottis and preepiglottic space. This procedure can preserve physiologically phonatory and swallowing function, and achieve similar local control rates as total laryngectomy but voice quality is somewhat less efficient than that of normal speakers. Authors evaluated prospectively speech and voice parameters for efficiency of phonation in patients treated with SCPL for recurrent laryngeal carcinoma after primary radiotherapy. MATERIALS AND METHODS: Authors compared 5 male patients who underwent SCPL with 8 normal subjects of the same age. RESULTS: No significant difference of phonatory function was found between subjects before or 3 to 6 months after the operation. However, MPT, C/B, jitter and shimmer were significantly different between the normal and post-operative 3 months group (p<0.05) and jitter and shimmer between the normal and post-operative 6 months group (p<0.05). CONCLUSION: All patients complained of breathy voice but could not breathe through the oro-nasal airway and swallow without aspiration within 2 to 3 months after SCPL. In conclusion, SCPL is a recommendable procedure in selected cases of laryngeal cancer which can not be controlled by vertical partial laryngectomy or supraglottic laryngectomy.