Complications and functional outcome after supracricoid partial laryngectomy with cricohyoidoepiglottopexy.

We present a review of the postoperative course, complications, and functional outcome of 190 patients consecutively treated with supracricoid partial laryngectomy with cricohyoidoepiglottopexy. The average times until removal of the tracheostomy and nasogastric feeding tubes were 9 and 16 days, respectively. The postoperative mortality rate was 1%. Major complications included pneumonia from aspiration, cervical wound infection, symptomatic laryngocele, ruptured pexis, laryngeal chondroradionecrosis, and laryngeal stenosis in 8.5%, 4.2%, 3.1%, 1%, 0.5%, and 0.5% of the patients, respectively. Completion total laryngectomy, permanent gastrostomy, and permanent tracheostomy were requested in 0.5% of the patients. Normal swallowing without gastrostomy and respiration without tracheostomy was achieved by the first postoperative year in 98.4% (187/190) of the patients. This article presents a univariate analysis of the potential correlation between various variables and the duration of tracheostomy and the length of time the nasogastric feeding tubes were inserted, the mortality incidence and causes, the incidence and type of the various complications, and the duration of hospitalization. Comparison of our data with the reported functional results after vertical partial laryngectomy suggested that supracricoid partial laryngectomy with cricohyoidoepiglottopexy does not result in an increased rate of postoperative complications.

Supracricoid partial laryngectomy with cricohyoidoepiglottopexy for "early" glottic carcinoma classified as T1-T2N0 invading the anterior commissure.

PURPOSE: "Early" glottic squamous cell carcinoma classified as T1-T2N0 with anterior commissure invasion is conventionnaly managed with vertical partial laryngectomy (VPL) or radiation therapy (RT). At our insitution, in the early 1980s, vertical partial laryngectomy was progressively replaced by supracricoid partial laryngectomy with cricohyoidoepiglottopexy (SCPL-CHEP). The medical files and operative charts of 62 patients with "early" glottic carcinoma classified as T1-T2N0 invading the anterior commissure, consecutively managed with cricohyoidoepiglottopexy, were retrospectively reviewed to ascertain whether any conclusions could be drawn regarding this treatment modality. MATERIALS AND METHODS: Survival, local control, nodal recurrence, distant metastasis, and metachronous second primary tumor estimate was analyzed using the Kaplan-Meier life table method. RESULTS: The 3- and 5-year actuarial survival estimate was 93.3% and 86.5%, respectively. The 3- and 5-year actuarial local control estimate was 98.2%. The only patient with local recurrence was successfully salvaged with RT resulting in an overall 100% local control rate and laryngeal preservation rate. The 3- and 5-year actuarial nodal recurrence estimate was 1.8%. The 3- and 5-year actuarial distant metastasis estimate was 0% and 2%, respectively. Aspiration related completion total laryngectomy and permanent tracheostomy never occurred. CONCLUSION: The present retrospective study suggests that cricohyoidoepiglottopexy for glottic carcinoma classified as T1-T2 invading the anterior commissure resulted in higher local control rates and overall laryngeal preservation rate when compared with historical series using either VPL or RT. Further series are warranted to confirm our results.

Functional outcome and prognosis factors after supracricoid partial laryngectomy with cricohyoidopexy.

A retrospective analysis of the medical records and operative files of 124 patients who consecutively underwent supracricoid partial laryngectomy with cricohyoidopexy (SCPL-CHP) was undertaken. The objective of this study was to analyze the postoperative course and functional results of SCPL-CHP. The mean duration of follow-up was 7 years (range 1 to 20 years). The postoperative mortality was 1.6%. The average times until tracheostomy and nasogastric feeding tube removal were 8 and 22 days, respectively. All patients but 1 were decannulated. The rate of pneumonia from aspiration was 11.5%. Completion total laryngectomy and permanent gastrostomy were required in 2.5% and 2.5% of patients, respectively. Overall normal swallowing without permanent gastrostomy and respiration without tracheostomy were achieved by the first postoperative year in 91% and 99.1% of patients, respectively. Univariate analysis of the potential correlation between various variables and the duration of the tracheostomy and nasogastric feeding tube, the incidence and causes of mortality, the incidence and type of the various complications, the recovery of swallowing, and the length of hospitalization is presented. The report also discusses the management and follow-up care.

Tracheal resection with end-to-end anastomosis for isolated postintubation cervical trachea stenosis: long-term results.

A 20-year experience with end-to-end tracheal resection and anastomosis for isolated postintubation stenosis of the cervical trachea, in a consecutive series of 32 adult patients, has been reviewed. Surgical death was never encountered. The overall incidences for superficial wound infection, pneumonia, and inferior left laryngeal nerve paralysis were 6.2%, 3.1%, and 3.1%, respectively. One-, 3- and 5-year actuarial anastomosis success rates were 96.7%, 93.3%, and 93.3%, respectively. Successful revision tracheal end-to-end anastomosis was performed once, resulting in an overall 96.9% success rate in our series. None of the following variables-sex, age, cause for intubation, intubation type (laryngotracheal and/or tracheotomy) and duration, delay from initial injury, presence of an open stoma, number of tracheal rings resected, and type of sutures used-were statistically related to the anastomosis success rate or the incidence of complications.

Cisplatin-based neoadjuvant chemotherapy and combined resection for ethmoid sinus adenocarcinoma reaching and/or invading the skull base.

OBJECTIVE: To review our experience with cisplatin-based neoadjuvant chemotherapy before en bloc resection via a combined neurosurgical and transfacial approach for ethmoid sinus adenocarcinoma reaching and/or invading the skull base. DESIGN: Case series. SETTING: A tertiary care center and university teaching hospital. PATIENTS: Twenty-two patients with primary untreated ethmoid sinus adenocarcinoma reaching and/or invading the skull base consecutively treated between 1984 and 1992 with cisplatin-based neoadjuvant chemotherapy and combined neurosurgical and transfacial approach. MAIN OUTCOME MEASURES: Statistical analysis of survival, local control, nodal recurrence, distant metastasis, and metachronous second primary tumor incidence based on the Kaplan-Meier actuarial method. Univariate analysis was performed to analyze the relationships between various factors, survival, and local recurrence. Clinical response, histological response, toxic effects of chemotherapy, and postoperative course were also reported. RESULTS: The Kaplan-Meier 3-year survival, local control, nodal recurrence, and distant metastasis estimates were 68.1%, 65.7%, 5.3%, and 10%, respectively. Metachronous second primary tumor was not encountered in our series. Survival was statistically more likely to be reduced in patients with intrasphenoidal tumor extent (P = .04) and local recurrence (P = .01). Local recurrence was statistically more likely in patients with intrasphenoidal tumor extent (P = .002) and no response to cisplatin-based neoadjuvant chemotherapy (P = .03). CONCLUSIONS: The results achieved suggest that cisplatin-based neoadjuvant chemotherapy before combined neurosurgical and transfacial approach should be further investigated for the treatment of ethmoid sinus adenocarcinoma reaching and/or invading the skull base.

Supracricoid partial laryngectomy after failed laryngeal radiation therapy.

Twelve patients managed with supracricoid partial laryngectomies (SCPLs) after failed laryngeal radiation therapy (RT) were evaluated. None of the recurrent tumors were amenable to vertical or horizontal partial laryngectomy. Results were analyzed for tracheostomy decannulation, oral alimentation, morbidity, local control, and survival. Major complications included perichondritis (2 patients), laryngeal stenosis (2 patients), and pneumonia from aspiration (1 patient). Mucocutaneous fistula and cricoarytenoid joint ankylosis were not encountered. Margins of resection were uninvolved in all cases. The Kaplan-Meier 3-year actuarial survival and local control estimate was 83.3%. Salvage total laryngectomy allowed for an overall 100% local control rate and a 75% laryngeal preservation rate. This preliminary report suggests that, in patients with failed laryngeal RT not amenable to vertical or horizontal partial laryngectomy, the SCPL procedures should be discussed before advocating salvage total laryngectomy. Further series analyzing the role and limitations of the various SCPL procedures after failed laryngeal RT are warranted.

[Supra-cricoid partial laryngectomy extended to the anterior arch of the cricoid with tracheo-crico-hyoido-epiglottopexy. Oncologic and functional results]. / Laryngectomie partielle supracricoidienne étendue à l'arc antérieur du cricoïde avec trachéocricohyoidoépiglottopexie. Résultats carcinologiques et fonctionnels.

21 patients with glottic carcinoma presenting anterior infraglottic extent of tumor, classified T2-T4, were offered and extended supracricoid partial laryngectomy with tracheocricohyoidoepiglottopexy (TCHEP) between 1979 and 1994 at our department. The technique for the procedure, the duration of tracheotomy tube, naso-gastric feeding tube, and hospital stay are presented. Postoperative complications and management were described. The 5-year actuarial survival, local control, nodal recurrence, distant metastasis, and metachroneous second primary tumor estimate was 74.7%, 88.9%, 11.1%, 22.4% and 15%, respectively. Overall a 95.2% (20/21) local control rate was achieved with a 90.5% (19/21) laryngeal preservation rate.

[Laryngectomies and pharyngo-laryngectomies with tracheo-laryngo-pharyngeal shunt of Pearson type. Technique, indications and preliminary results]. / Laryngectomies et pharyngo-laryngectomies avec shunt trachéo-laryngo-pharyngé de type "Pearson". Technique, indications et résultats préliminaires.

The preliminary results achieved in a series of 10 patients consecutively managed at our department with Pearson's subtotal pharyngolaryngectomy, during the year 1995, are presented. The surgical procedure is described. Follow up varied from 6 to 13 months. None of the patients were lost to follow-up. None of the patients recurred locally or died from surgical-related complications. Nine patients achieved successful rehabilitation of speech and voice. One patient refused to use a functional shunt. Speech and voice parameters achieved by the third postoperative month are presented. Postoperative swallowing impairment was not encountered. The preliminary data achieved and the review of the medical literature suggested that Pearson's subtotal pharyngolaryngectomy should be discussed in patients conventionally managed with total laryngectomy or pharyngolaryngectomy and tracheosophageal puncture with voice prosthesis insertion.

[Long-term results of total conservative parotidectomy for pleomorphic adenoma]. / Résultats à long terme de la parotidectomie totale conservatrice pour adénome pléomorphe.

OBJECTIVES: Evaluation of the long-term results (10 and 15 years) achieved with total conservative parotidectomy for pleomorphic adenoma. METHODS: A retrospective analysis of the files of 127 patients with pleomorphic adenoma of the parotid gland consecutively treated with a total conservative parotidectomy at our department from 1970 to 1985. Actuarial analysis (Kaplan Meier method) of survival and local recurrence, as well as overall estimation of immediate and definite postoperative facial paresis and paralysis was performed. RESULTS: Ten- and fifteen-year survival and local control estimations were 90.8% and 99.1%, respectively. Immediate and permanent facial paresis and paralysis overall estimates were 64.6% and 6.3% and 2.1% and 0%, respectively. CONCLUSION: Total conservative parotidectomy for pleomorphic adenoma results in a very high long term local control associated with a very low rate of facial dysfunction.

[Inoperable tracheal and cricoid-tracheal stenoses. Results of laser therapy and prolonged calibration]. / Les sténoses trachéales et cricotrachéales inopérables. Résultats du traitement par le laser et le calibrage prolongé.

Palliative desobstruction was performed with laser and a Montgomery T tube in 11 patients with tracheal or cricotracheal stenosis. Surgery was theoretically indicated for these long thick stenotic areas with underlying diseased cartilage but could not be performed due to the poor clinical status of the patients or recurrence after anastomosis. Calibration with the Montgomery T tube was maintained for a mean of 5 years. The T tube was removed in 3 patients and was well tolerated in 4. Two patients died during the course of the study and two others required a definitive tracheotomy. Palliative treatment with Laser desobstruction and long-term calibration can be a useful alternative to conventional surgery.

[Laser CO2 arytenoidectomy by endoscopic approach in bilateral laryngeal paralysis. Apropos of 45 cases]. / Aryténoïdectomie par voie endoscopique au laser CO2 dans les paralysies récurrentielles bilatérales. A propos de 45 cas.

Between 1980 and 1993, 45 patients with bilateral cord abductor paralysis were treated by carbon dioxide endoscopic laser arytenoidectomy. Thyroid surgery was the main cause of bilateral laryngeal palsy (67%). Seven patients, who were tracheotomised before treatment, were decanulated. Ninety-one percent of the patients recovered physiologic respiration. The follow up period lasted from one month to thirteen one-half years. Advantages and disadvantages of laser arytenoidectomy are compared with other techniques.

[Dysfunction of the facial nerve following total conservative parotidectomy for pleomorphic adenoma]. / Dysfonctionnement du nerf facial après parotidectomie totale conservatrice de première intention pour adénome pléomorphe.

Two hundred and forty seven previously untreated pleomorphic adenoma of the parotid gland were operated with a total conservative parotidectomy between 1965 and 1992. The overall incidence for temporary facial nerve paresis and paralysis was 63.1% and 5.2%, respectively. None of the following variables sex, age, tumor size, tumor location, tumor contact with the facial nerve, degeneration of the pleomorphic adenoma, inadvertent tumor spillage, use of Surgical, and postoperative hematoma were statistically related to facial nerve dysfunction. Kaplan-Meier actuarial analysis demonstrated that facial nerve dysfunction recovery was noted until the 18th postoperative month. The use of the linear regression model with Pearson correlation underscores that the recovery time of facial nerve function significantly statistically increased with the patient's age (p = .0017). The overall incidence for permanent facial paresis and paralysis was 3.6% and 0%, respectively. Implications of these findings are discussed together with a review of the medical literature.

[Analysis of results of pharyngotomy in the surgical treatment of sleep apnea syndrome. Apropos of 150 cases]. / Analyse des résultats de la pharyngotomie dans le traitement chirurgical du syndrome d'apnée du sommeil. A propos de 150 cas.

The indications and limitations of simple veloamygdalotomy as surgical cure for sleep apnoea were analyzed on the basis of results obtained in the first 150 cases treated prospectively by pharyngotomy. Clinical and polysomnographic results were analyzed as possible factors predicting success or failure. With a success rate of 80%, pharyngotomy is a simple and effective treatment for patients with minor forms of sleep apnoea (initial apnoea/hypopnoea index < 20) and no severe obesity. It appears unreasonable to propose isolated pharyngotomy if the initial index is < 30 since the success rate in the cases is only 27%. Nasal repermeation does not improve overall results significantly. The lack of patient compliance to diagnostic and therapeutic modalities is an unavoidable reality due to human, social and economic implications.

[Functional endoscopic surgery of sinusal mucocele]. / Chirurgie fonctionnelle endoscopique des mucocèles sinusiennes.

The treatment of paranasal sinus mucoceles must assure complete removal and prevention of recurrence. In order to clarify the precise indications for endoscopic management, a retrospective study was undertaken on 16 patients with paranasal sinus mucoceles treated by this method. All of the patients underwent endoscopic exploration with or without an associated bicoronal approach. The follow-up period varied between 3 months and 46 months with a mean of 24. The results were considered satisfactory if the patient's symptoms disappeared and follow-up endoscopy revealed persistence of sinus permeability. Functional endoscopic surgery can be considered as an alternative method in treatment of sinus mucoceles. Only mucoceles confined to the lateral wall of the frontal sinus, and the extended mucoceles, seem to be an out of the way place to endoscopic sinus surgery alone. In these cases, the access has to be completed by an external approach. Concerning adequate recanalization of the nasofrontal duct, results seem encouraging, however a long-term follow-up is necessary to obtain an accurate assessment of the results.

[Cisplatin-fluorouracil chemotherapy in epidermoid cancers of glottic origin staged as T2]. / Chimiothérapie cisplatine-fluorouracile dans les cancers epidermoides à point de départ glottique classes T2.

A retrospective analysis of 94 patients presenting well-differentiated untreated invasive glottic squamous cell carcinomas, staged as T2 according to the 1987 Union Internationale contre le Cancer staging classification system, managed at our institution from March 1982 to April 1991 with cisplatin-fluorouracil neo-adjuvant chemotherapy, was conducted. Following neo-adjuvant chemotherapy, partial laryngeal surgery, and radiation therapy were performed in 85.1% (80/94) and 4.2% (3/94) of cases, respectively. Perioperative chemotherapy (fluorouracil) and postoperative chemotherapy (cisplatin-fluorouracil) was performed in 68.7% (55/80) and 63.7% (51/80) of patients who underwent surgery, respectively. Following neoadjuvant chemotherapy, one patient (1.1%) refused any form of treatment, and "exclusive" chemotherapy was performed in 9.6% (9/94) of cases. A 3-year follow-up was always achieved and 66 patients (70.2%) presented with a 5-year follow-up. A complete clinical response was achieved in 32.9% of cases following neo-adjuvant chemotherapy. A complete histological response was noted in 31.2% (25/80) of patients treated with partial laryngeal surgery following neo-adjuvant chemotherapy. A strong statistical relation was noted between complete clinical response and complete histological response (p < .0001). Chemotherapy related death never occurred in our series however chemotherapy related toxicity lead to reduction in the drug dosages and chemotherapy arrest in 14.3% and 3.6% of cases, respectively. The Kaplan-Meier 5-year survival, local recurrence, nodal recurrence, distant metastasis, and second primary estimate was 84.9%, 8.4%, 1.1%, 2.2%, and 10%, respectively. The overall local recurrence rate varied from 25% following neo-adjuvant chemotherapy and radiotherapy, to 33.3% following "exclusive" chemotherapy, and 3.7% following neo-adjuvant chemotherapy and partial laryngeal surgery. Overall local control and laryngeal preservation was achieved in 98.9% and 97.8% of patients respectively. Our data suggests that the use of neo-adjuvant cisplatin-fluorouracil induction chemotherapy deserves further consideration in the management of glottic carcinomas staged as T2.