ABSTRACT
BACKGROUND: Protection of suture line of neopharynx after a laryngectomy or near total laryngectomy with vascularized tissues is of utmost importance in preventing a wound related complication. METHOD: A simple technique of harvesting bilateral pedicled infrahyoid muscle myofascial or myoperichondrial flap to protect the fashioned neopharynx in a Total or Near Total laryngectomy is described. CONCLUSION: Pedicled infrahyoid muscle, myofascial or myoperichondrial flap is a simple quick and reliable option to protect the fashioned neopharynx in a Total or Near Total laryngectomy against major wound complications like pharyngocutaneous leaks and fistula formation.
Subject(s)
Face/surgery , Laryngectomy/methods , Surgical Flaps , Composite Tissue Allografts , Humans , Vascularized Composite AllotransplantationABSTRACT
CONCLUSIONS: Quality of life (QOL) scores were significantly higher among voice rehabilitated patients although this was accompanied by significant immediate and long-term morbidity and a cost implication for the patient. OBJECTIVE: We present a prospective and cross-over study of overall QOL and morbidity related to voice restoration in laryngectomees. METHODS: The EORTC QOL questionnaire (QLQ-C30 and QLQ-H&N-35) was distributed among all the consenting patients alive after laryngectomy from January 2008 to October 2009. In patients who had secondary voice rehabilitation, post-rehabilitation QOL scores were collected separately. Comparison of QOL between the non-rehabilitated and rehabilitated cohorts was done and a cross-over study of pre-rehabilitation and post-rehabilitation scores were done in the second cohort. RESULTS: A total of 113 patients were studied. QOL scores were significantly higher among voice rehabilitated patients.
Subject(s)
Laryngeal Neoplasms/surgery , Laryngectomy/methods , Quality of Life/psychology , Voice Disorders/rehabilitation , Cohort Studies , Cross-Over Studies , Developing Countries , Follow-Up Studies , Humans , Prospective Studies , Surgical Flaps , Surveys and Questionnaires , Voice Disorders/economics , Voice Disorders/psychologyABSTRACT
OBJECTIVE: Although fibre-optic bronchoscopic intubation is well recognized as the most valuable adjunct for elective management of the difficult airway its precise role in oncological head and neck emergencies has not been evaluated. The objective of this study was to evaluate the role of fibre-optic intubation in such emergencies. METHODS: This was a consecutive case series study by a single surgeon (the otolaryngologist) and anaesthetist team, taking place in a regional tertiary-referral head and neck surgical oncology centre. A series of 17 consecutive oncological head and neck emergency patients underwent fibre-optic intubation with a Portex endotracheal tube of inner diameter > or =7 mm, with the aid of a 6-mm (EB-1830T2) Pentax fibre-optic video bronchoscope. The study assessed occurrence of: avoidance of tracheostomy in bleeding emergencies; a well placed, uncomplicated tracheostomy in airway obstruction; and successful intubation. RESULTS: Two cases were decannulated completely. All cases were successfully intubated and a tracheostomy was avoided in all cases in which emergency intubation was required and the patient was bleeding. We conclude that fibre-optic bronchoscopic intubation is a viable option in head and neck oncological emergencies due to upper airway obstruction and tumour bleeding. Clinical and endoscopic judgement and operator experience are the key factors determining success.
