ABSTRACT
The anatomical grounds of and surgical technique for functional neck dissection are described in detail in order to demonstrate that the radicalism of this procedure, from the viewpoint of surgical anatomy, is by no means less than that of the classical (so-called radical) neck dissection. From 1972 to 1978, 476 operations were performed (211 patients treated bilaterally and 54 unilaterally). The percentage of false negatives (ie, histologically proven metastases in clinically unsuspected nodes) was 14%, while the percentage of false positives (histological negativity in clinically suspected nodes) reached 53%. The total number of local recurrences in a three-year follow-up was nine (3.5%).
Subject(s)
Head and Neck Neoplasms/surgery , Lymph Node Excision/methods , Fascia/anatomy & histology , Follow-Up Studies , Humans , Lymph Node Excision/mortality , Lymph Nodes/pathology , Lymphatic Metastasis , Neck/anatomy & histology , Neck Muscles/anatomy & histology , Neoplasm Recurrence, Local/epidemiology , Postoperative ComplicationsABSTRACT
Our experience with the so-called "neoglottis" (according to Staffieri) after total laryngectomy is presented. The technique, described in detail, aims at giving the patient good speech by creating a tracheoesophageal fistula through which air passes. In the period from 1973-1979, 63 patients underwent the procedure. The functional results were satisfactory in 68% of the cases. The patient's voice is much more agreeable than the esophageal voice and sounds louder and less monotonous than a laryngophone voice. The spectrographic analyses confirm its resemblance to natural voice. An occasional passage of liquids into the trachea may occur, but is not prejudicial to either speech or swallowing. Some dysfunctional problems may arise early or late after the operation: they are continuous aspiration during swallowing and lack of phonatory function. In most cases, these problems are due to incorrect surgical technique; the possibilities and procedures of correction are described. In conclusion, we maintain that the "neoglottis" which may be applied to nearly all cases of total laryngectomy, represents a worthwhile "phonatory" innovation in the field of mutilating surgery of laryngeal cancer.
Subject(s)
Laryngectomy/methods , Pharynx/surgery , Trachea/surgery , Adult , Aged , Female , Humans , Laryngectomy/rehabilitation , Male , Middle Aged , Phonation , Postoperative Complications , Speech, AlaryngealABSTRACT
Horizontal glottectomy is a procedure which allows removal of the whole glottis, together with its cartilaginous framework. It is performed by means of two horizontal incisions, the lower through the cricothyroid membrane, and the upper one across the wings of the thyroid. The gap is then closed by approximating the cricoid to the thyroid remnants (cricothyropexy). The indications for horizontal glottectomy are: 1) "double" cancers (i.e. two independent tumors, one on each vocal cord). 2) Hyperkeratosis of the glottis associated with carcinoma in situ. 3) Verrucous cancers of the glottis. 4) Cancers of one vocal cord invading the opposite one via the anterior commissure. In a period of 4 years, 16 patients have been operated on with good early results.
