RESUMO
Total laryngectomy is potentially a debilitative surgery resulting in compromise of some of the most basic functions of life including speech and swallowing. This may have a profound adverse effect on the patient's physical, functional, and emotional health, and may result in a decreased quality of life (QOL). Until the 1980s, total laryngectomy was regarded as a dreadful, but often, life-saving procedure for which there was little alternative, and was used as a last resort. At that time survival at any cost in terms of QOL was paramount and many laryngectomies were forced into an isolated life as a mute and dysphasic recluse. Most attempts at voice restoration produced inconsistent results and often techniques were laborious, expensive, and ineffective, particularly when carried out as a salvage procedure after failed radiotherapy. Progress in voice rehabilitation, following total laryngectomy, over the last 30 years, has made an enormous difference in the whole concept of the management of laryngeal cancers. Currently there are several options available for these patients, namely, esophageal speech, artificial larynx, and tracheoesophageal speech. The choice of speech rehabilitation varies from patient to patient, but tracheoesophageal voice has become the preferred method. This article provides a brief account of surgical voice restoration after total laryngectomy. Special emphasis has been given to the surgical technique, special considerations, complications, and the prevention / treatment of tracheoesophageal voice restoration.
Assuntos
Afonia/etiologia , Afonia/prevenção & controle , Humanos , Neoplasias Laríngeas/psicologia , Neoplasias Laríngeas/reabilitação , Neoplasias Laríngeas/cirurgia , Laringectomia/efeitos adversos , Laringectomia/reabilitação , Laringe Artificial/estatística & dados numéricos , Implantação de Prótese/efeitos adversos , Implantação de Prótese/métodos , Qualidade de Vida , Recuperação de Função Fisiológica , Fala , Voz Esofágica/instrumentação , Voz Esofágica/métodosRESUMO
Two cases of Wilson's disease with unusual features are reported. In one case neurological abnormality was the presenting feature without any clinical involvement of the liver. In the other case, neurologic manifestations were associated with rickets and cholelithiasis, a result of chronic hemolytic state. Apart from clinical profile both the cases were diagnosed by grossly reduced serum ceruloplasmin level. However, Kayser-Fleischer rings were found in each case.
Assuntos
Afonia/etiologia , Criança , Colelitíase/etiologia , Doenças da Córnea/etiologia , Distúrbios Distônicos/etiologia , Feminino , Degeneração Hepatolenticular/diagnóstico , Humanos , Raquitismo/etiologiaRESUMO
Se analizan las características de seis pacientes disfónicas de sexo femenino que presentan fenómenos histéricos en el curso del estudio diagnóstico o de su seguimiento. Se destaca la alta deserción y pobre respuesta al tratamiento a pesar de la buena evaluación y control por el equipo multidisciplinario. En esta muestra se incluye un caso de una paciente portadora de nódulos vocales, sin rasgos caracterológicos de histeria, quien presenta una crisis histérica que pudo alterar su diagnóstico. Se concluye la necesidad de un estudio detallado en cada caso