[Abnormal movements of the larynx. Diagnostic approach and therapeutic perspectives]. / Les mouvements anormaux du larynx. Approche diagnostique et perspective thérapeutique.

Laryngeal movement disorders of neurological cause are actually misunderstood. In the course of chorea, or tardive post neuroleptic dyskinesia, vocal, swallowing for threatening breathing troubles could occur. Ten patients with generalized dyskinesias were studied by endoscopy with flexible laryngoscope and laryngeal electromyogram. Four of them were choreic and six had tardive dyskinesia (one had a severe breathing disorder). Nine patients had abnormal movement disorders (MD) involving intrinsic laryngeal musculature. MD were spontaneous or were triggered by vocalization. These facts suggest that dyskinesia as they involved the upper airway tract could be life threatening. Laryngeal electromyography is a useful method for diagnosis and treatment of these dyskinesia. As in spasmodic dysphonia, botulinum toxin could be helpful in this local treatment.

Postlaryngectomy voice restoration. A prospective study in 83 patients.

From July 1985 until May 1990, 83 patients underwent a total laryngectomy. We prospectively studied voice restoration in 81 of them (two died postoperatively). Esophageal voice was used by 19 patients; a tracheoesophageal procedure (myomucosal shunt, primary or secondary puncture with Blom-Singer prosthesis) by 41; and 21 patients had no voice restoration. Results were assessed according to voice quality and usage. Tracheoesophageal speech had a success rate of 73% (good voice, daily use) after 1 month, while esophageal voice proved to have only a 5% success rate. Thirty patients (37%), however, remained without a substitute voice. The reasons for their exclusion are presented; they include a high rate of refusal.

[Stage T1 malignant tumors of the arythenoid. Analysis of a series of 26 cases]. / Tumeurs malignes de l'aryténoïde classées T1. Analyse d'une série de 26 cas.

26 malignant tumours of the arytenoid classified as T1 according to the UICC 1987, were treated in the ENT and Cervico-Facial Surgery wards to Hospital Laennec between 1961 and 1990. The natural history of these lesions, locoregional efficiency of the different treatments used, the part played by chemotherapy, survival, causes of death and therapeutic modalities used as a last measure, have been analysed. The frequency of tumours with neuroendocrine has been emphasized. Such a diagnosis should be questioned when the initial biopsy does not diagnose a well differentiated epidermoid carcinoma. The use of argyrophil colouring in order to find neurosecretive granules helps in carrying out the diagnosis. The treatment of tumours, classed T1 N0 M0, of the arytenoid, is based on partial, laryngeal surgery associated with a preventive, jugulo-carotidian-ipsilateral ganglionary intervention.

Carcinoid (neuroendocrine) tumor of the arytenoid.

We reviewed three cases of neuroendocrine carcinoid tumors of the larynx, located on the arytenoid cartilage, treated between 1962 and 1985 at the Laennec Hospital, University of Paris (France) V. Staging was performed according to the 1979 American Joint Committee for Cancer Staging Classification. None of the lesions were associated with symptoms of the carcinoid syndrome. Local and nodal recurrences, distant metastasis, and survival were analyzed. Among the 112 reported carcinoid (neuroendocrine) tumors of the larynx, arytenoid location represented 28.6% (32/112) of the cases. A review of these 32 patients was performed to analyze the problems associated with that location.

[Vocal restoration by tracheo-esophageal fistula. Evaluation of a 5 years' experience]. / La restauration vocale par procédé de fistule trachéo-oesophagienne. Bilan de 5 années de pratique.

Between december 1985 and august 1990, 70 patients with total laryngectomy had their voice restaured by creation of tracheo-esophageal fistula. The tracheo-esophageal fistula was created during laryngectomy in 33 cases (20 punctures with Blom Singer prostheses, 13 surgical shunts), a few weeks later after surgery of radiotherapy in 17 cases or when production of esophageal voice feld in 20 cases. No major complication was observed. Results following voice recovery were satisfactory in 78.5% of cases (normal voice), one month after the procedure. Results are better when tracheo-oesophageal fistula was used initially (88%), than performed secondary (55%). After one year, results were satisfactory in 75.5% of cases.

[Patients excluded from voice restoration after total laryngectomy]. / Les exclus de la restauration vocale après laryngectomie totale.

Concerning 73 radical laryngectomy operations carried out at the Hôpital Tenon in the period between july 1985 and july 1989, the authors studied the mode of vocal restoration used and the patient population not benefitting from any of the procedures used. Esophageal voice was utilized initially in 19 patients; a tracheo-esophageal fistula (surgical shunt or puncture with Blom-Singer prosthesis) was created during laryngectomy in 19 patients, and secondary tracheo-esophageal puncture was performed in 13 others. Twenty patients had no vocal restoration operation performed. In a large number of the patients, the tracheo-esophageal fistulas restored a normal voice. In the end, 38% of the laryngectomized patients did not have their voice restored. The various causes for such a high percentage of exclusions that are discernable are discussed. Lack for motivation on the part of the patients is a major reason, irrespective of the technique used.