ABSTRACT
OBJECTIVE: To evaluate the suprahyoid approach to treatment of squamous cell carcinoma of the base of the tongue at Groote Schuur Hospital between 1999 and 2004. DESIGN AND METHOD: Retrospective analysis was done of patients with base-of-tongue squamous cell carcinoma treated using the suprahyoid approach. RESULTS: Seventeen patients underwent treatment for base-of-tongue squamous cell carcinoma utilising the suprahyoid approach. Complete medical records were available for 15 of these patients. The most common presenting symptoms were neck mass (40%) and referred otalgia (33%). Alcohol was a risk factor in more patients (64%) than smoking (47%). Adverse pathological findings were present in less than 50% of patients (involved margins 20%, perineural invasion 40%, vascular invasion 33%). Functional outcome in terms of speech intelligibility was excellent and there were minimal swallowing problems, with most patients using compensatory strategies and dietary modification. There were 2 subsequent deaths (13%) as a result of distant metastasis and a second primary. CONCLUSION: The suprahyoid approach to treatment of base-of-tongue squamous cell carcinoma provides good exposure, local tumour control and excellent functional outcome.
Subject(s)
Carcinoma, Squamous Cell/surgery , Hyoid Bone , Tongue Neoplasms/surgery , Tongue/surgery , Aged , Carcinoma, Squamous Cell/physiopathology , Developing Countries , Female , Hospitals, University , Humans , Male , Middle Aged , Retrospective Studies , South Africa , Tongue/physiopathology , Tongue Neoplasms/physiopathology , Treatment OutcomeABSTRACT
This report discusses 15 non-cleft palate children who developed velopharyngeal incompetence (VPI) after adenotonsillectomy. Eight boys and 7 girls with a mean age of 6.2 years (range 4.3-11 years) were treated between 1970 and 1993. After 2 years conservative management to allow for spontaneous resolution, only (7 children) 47% achieved normal resonance. Speech therapy was employed mainly for those patients with unrelated articulation errors. Fifty-three percent (8 children) required surgery for persistent hypernasality and in 6 a pharyngoplasty was performed and in one child a posterior pharyngeal cartilage graft was inserted. One case is still to have surgical intervention. Half of the non-cleft children who develop VPI after adenotonsillectomy will respond to conservative management.
Subject(s)
Adenoidectomy/adverse effects , Tonsillectomy/adverse effects , Velopharyngeal Insufficiency/etiology , Articulation Disorders/etiology , Articulation Disorders/therapy , Child , Child, Preschool , Female , Humans , Male , Pharynx/surgery , Retrospective Studies , Speech Therapy , Treatment Outcome , Velopharyngeal Insufficiency/therapy , Voice QualityABSTRACT
We present a 2-year (1991/92) review of tracheo-oesophageal speech following total laryngectomy with tracheo-oesophageal fistula formation and subsequent use of a voicing prosthesis. Thirty-five primary fistulas and four secondary fistulas were created. Initially, 86% of patients obtained daily use of intelligible, fluent voice with few extraneous stomal sounds. Over a 2-3-month period following surgery, approximately one-third of these lost their fistula speech. The reasons for this were mainly related to psychological and socio-economic factors. Patient selection, surgical technique and postoperative management are described. Although a successful outcome requires a consolidated team approach, primary health care workers also need to know about postlaryngectomy prosthetic (fistula) speech and its management.
Subject(s)
Laryngectomy/rehabilitation , Speech, Alaryngeal/methods , Voice Training , Esophagus , Humans , Laryngectomy/psychology , Larynx, Artificial , Postoperative Period , Prospective Studies , Speech, Esophageal , TracheaABSTRACT
The purpose of this study was to investigate the speech results of five different techniques of repair of only the cleft soft palate and also to assess the effect of timing of repair on speech results. A total of 184 patients (73 males, 111 females) underwent either a Dorrance repair (25 patients), a Wardill repair (41 patients), a Perko repair (19 patients), a von Langenbeck repair (79 patients), or a Furlow Z-plasty (20 patients) between 1964 and 1989. Articulation, intelligibility, and resonance were assessed by usually two but at least one speech therapist. All the children underwent videofluoroscopy. The follow-up period was from 3 to 24 years, with a mean of 9.6 years. The Furlow Z-plasty and Perko repair yielded the best speech results. There was a significant difference in speech and less velopharyngeal incompetence (Fisher's exact test, p = 0.0218) when the palate was repaired prior to 6 months of age as compared with after 6 months of age (for all the techniques except the Dorrance repair). Fistulas are uncommon after repair of only the soft palate.
Subject(s)
Cleft Palate/surgery , Palate, Soft/surgery , Speech/physiology , Velopharyngeal Insufficiency/etiology , Child , Cleft Palate/epidemiology , Cleft Palate/physiopathology , Female , Follow-Up Studies , Humans , Incidence , Infant , Male , Maxillofacial Development/physiology , Speech Intelligibility/physiology , Time Factors , Velopharyngeal Insufficiency/epidemiology , Voice Quality/physiologyABSTRACT
Velopharyngeal incompetence occurs in approximately 25% of cases after primary palatoplasty. There is controversy regarding the best method of surgical management of velopharyngeal incompetence. Between 1986 and 1993, 13 children with velopharyngeal incompetence after primary palatoplasty underwent Furlow Z-plasty repair. All children were assessed by a speech therapist and with videofluoroscopy pre- and postoperatively. The Furlow Z-plasty was performed at a mean age of 7.8 years (range, 4-12 years). Eleven children achieved normal resonance, and all 13 demonstrated improved velopharyngeal function on videofluoroscopy. The Furlow Z-plasty is effective treatment for children with velopharyngeal incompetence.
