Stentless mirrored L-shaped septonasal flap versus stented flapless technique for endoscopic endonasal repair of bilateral congenital choanal atresia: a prospective randomised controlled study.

OBJECTIVES: To compare the outcomes of endoscopic repair of bilateral congenital choanal atresia using a flap technique without stenting versus endoscopic repair using stenting without a flap. METHODS: A prospective randomised controlled study was conducted, comprising 72 patients with bilateral congenital choanal atresia. The patients were randomised into two groups. Group A (42 patients) underwent endoscopic repair using a mirrored L-shaped flap without stenting, and group B (30 patients) underwent endoscopic repair using stenting without a flap. RESULTS: At a mean follow-up period of 18.2 months, endoscopic assessment revealed a patent posterior choana in 81 per cent and 83.33 per cent of patients in group A and group B respectively. Choanal stenosis occurred in 21.40 per cent and 33.33 per cent of patients in group A and group B respectively. Granulation tissue was observed in 28.6 per cent and 53.3 per cent of patients in group A and group B respectively. CONCLUSION: The endoscopic approach utilising a flap without stenting is safe and effective, with a high success rate.

Effect of primary neopharyngeal repair on acoustic characteristics of tracheoesophageal voice after total laryngectomy.

OBJECTIVES: The tracheoesophageal puncture technique of voice restoration enables successful voice rehabilitation after total laryngectomy. Because post-operative voice quality can vary significantly, depending on which type of hypopharyngeal repair is chosen, the aim of this study was to evaluate the effect of such repair on tracheoesophageal puncture voice after total laryngectomy. STUDY DESIGN: Prospective, clinical study. SETTING: Otolaryngology department, Tanta University, Egypt. METHODS: Tracheoesophageal puncture voice was quantitatively and qualitatively evaluated in 40 patients using a Provox 2TM prosthesis after standard total laryngectomy. The patients were divided, according to the type of hypopharyngeal repair, into four groups of 10 cases each, as follows: group one, pharyngoesophageal myotomy; group two, pharyngeal plexus neurectomy; group three, non-muscle vertical repair; and group four, transverse repair. These surgical groups were compared with each other with respect to different voice parameters. RESULTS: Patient profiles were almost equivalent in all surgical groups. The mean values of most of the parameters of quantitative tracheoesophageal puncture voice did not differ significantly, comparing the four surgical groups; however, a slightly significant difference was observed regarding loud intensity in the non-muscle repair group, and soft and loud jitter in the transverse repair group. Mean values for qualitative measures of intelligibility and communicative effectiveness did not show significant difference. However, a slightly significant difference was observed regarding fluency, word correctness, speaking rate and wetness, with higher values for all these parameters except wetness in the myotomy group, and higher values for wetness in the non-muscle repair group. CONCLUSION: The four hypopharyngeal repair types--primary pharyngoesophageal myotomy, pharyngeal plexus neurectomy, non-muscle vertical repair and transverse hypopharyngeal repair--were almost equivalent in prevention of pharyngoesophageal spasm in total laryngectomy patients who had undergone primary tracheoesophageal puncture for voice restoration.

Managing problems with tracheoesophageal puncture for alaryngeal voice rehabilitation.

OBJECTIVES: The tracheoesophageal puncture (TEP) technique and the insertion of its associated voice prostheses may give rise to adverse events. We present our experience with this technique, paying special attention to the incidence and management of these adverse events. STUDY DESIGN: A retrospective clinical analysis was undertaken. METHODS: Seventy-five laryngectomized patients underwent TEP for voice restoration. They were divided into two groups: group one, 43 patients with secondary TEP; and group two, 32 patients with primary TEP. Patient medical records were reviewed for data on the incidence, management and outcome of adverse events encountered during patients' follow up. RESULTS: Problems that arose in the patients were itemized as either early or late. The same patient could develop one or more problems in either group. The management of these problems, concerning the creation and maintenance of the TEP and associated prostheses, was noted. In group one, results were initially favourable in 91 per cent of patients and still positive in 81.4 per cent after three years. In group two, early results were favourable in all patients, and only two patients asked for late elective closure of the TEP (with a success rate of 93.7 per cent). CONCLUSIONS: Via an intensive and multidisciplinary approach to problems, most of the inevitable adverse events could be solved adequately, minimizing the discomfort of patients who had undergone laryngectomy and indwelling voice prosthesis insertion.