scholarly journals Free Flap microvascular pharyngeal closure results in improved dysphagia-specific quality of life following total laryngectomy

2021 ◽  
Author(s):  
Eoin F. Cleere ◽  
Sherif Mamdouh ◽  
Emma Devoy-Flood ◽  
Marie-Therese O’Callaghan ◽  
Fiachra Martin ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Free Flap ◽  
Total Laryngectomy ◽  
Postoperative Morbidity ◽  
Surgical Morbidity ◽  
Level Of Evidence ◽  
Md Anderson ◽  
Anderson Dysphagia Inventory ◽  
Inpatient Length Of Stay

Abstract Background Total laryngectomy (TL) as either a primary or salvage treatment strategy remains an effective oncologic operation in the management of laryngeal cancer. Dysphagia is the most common complication following TL and this has a significant impact on patients’ quality of life (QOL). Following removal of the larynx, a number of pharyngeal closure techniques exist. We aimed to evaluate the effect pharyngeal closure techniques have on dysphagia-specific QOL postoperatively. Methods We retrospectively reviewed patients who had undergone TL at our institution (2014–2019). Patients alive at the time of study were invited to complete the MD Anderson Dysphagia Inventory (MDADI). Outcomes were compared among Primary Closure (PC), Pedicled Pectoralis Major Myocutaneous Flap (PMMF) and Free Flap (FF) closure groups. Results There were 27 patients identified for inclusion. Eight patients (30%) underwent PC, 10 patients (37%) had PMMF-assisted closure and 9 patients (33%) underwent FF-assisted closure. Patients within the FF group scored consistently higher MDADI scores across all subscales (emotional, functional, physical, global) as well as composite MDADI score in comparison to the PC and PMMF groups. FF closure was associated with a reduced inpatient length of stay (LOS). Additionally, no significant differences in postoperative morbidity including rates of pharyngo-cutaneous fistula (PCF) were observed between groups. Conclusions We now advocate FF closure for our patients following salvage TL due to the improved dysphagia-specific QOL, reduced inpatient LOS and lack of additional surgical morbidity. Level of evidence, Level III, therapeutic/prognostic study.

scholarly journals Ποιότητα ζωής των ασθενών μετά από ολική λαρυγγεκτομή

2017 ◽  
Author(s):  
Γιάννης Θρασυβούλου
Keyword(s):  
Quality Of Life ◽  
Life Questionnaire ◽  
Cross Sectional ◽  
Quality Of Life Questionnaire ◽  
Md Anderson ◽  
Anderson Dysphagia Inventory

Η παρούσα μελέτη έχει σκοπό να συγκρίνει την οριζόντια και την κάθετη μέθοδο σύγκλισης του νεοφάρυγγα μετά από ολική λαρυγεκτομή όσον αφορά την καταποτική λειτουργία των ασθενών, και την κατάποση σε σχέση με την ποιότητα ζωής. Η πιθανή επίδραση άλλων θεραπειών και της ηλικίας εξετάστηκε επίσης. Διενεργήθηκε cross – sectional μελέτη σε 52 ασθενείς με ολική λαρυγγεκτομή. Σε όλους τους ασθενείς διανεμήθηκαν ερωτηματολόγια δυσφαγίας (MD Anderson Dysphagia Inventory) και ποιότητας ζωής (MD Anderson Quality of life Questionnaire). Για σύγκριση μεταξύ των ομάδων χρησιμοποιήθηκαν οι μη παραμετρικές δοκιμασίες Mann-Whitney και ο δείκτης κατάταξης Spearman’s. Άλλες παράμετροι όπως πρωτογενής λαρυγγεκτομή (χωρίς άλλη θεραπεία), λαρυγγεκτομή ως θεραπεία διάσωσης και λαρυγγεκτομή ακολουθούμενη από χημειοακτινοθεραπεία εξετάστηκαν με την μέθοδο Kruskal-Wallis. Χρησιμοποιήθηκαν πολλαπλή γραμμική παλινδρόμηση για να εξεταστεί η συμβολή της ομιλίας και της κατάποσης μετά την λαρυγγεκτομή, στην ποιότητα ζωής. Τα ερωτηματολόγια συμπληρώθηκαν από 34 ασθενείς; 31 άρρενες και 3 γυναίκες. Η μέση ηλικία ήταν 66.8 έτη. Οι 16 ασθενείς είχαν οριζόντια σύγκλιση του νεοφάρυγγα και οι 18 κάθετη σύγκλιση του νεοφάρυγγα. Ο δείκτης ποιότητας ζωής ήταν 91,5 (+12.5) στους ασθενείς με οριζόντια σύγκλιση και 68.3 (+18.4) στους ασθενείς με κάθετη σύγκλιση. Η τιμή του δείκτη ποιότητας ζωής ήταν 81.1 (11.67) για την οριζόντια και 80.78 (12.13) για την ομάδα της κάθετης συρραφής. Ο συντελεστής συσχέτισης ήταν θετικός και στις δύο ομάδες ασθενών, αλλά ήταν αυξημένος στην ομάδα της οριζόντιας συρραφής. Η ποιότητα ζωής και ο δείκτης δυσφαγίας δεν επηρεάστηκαν από επικουρικές θεραπείες αλλά ούτε από την ηλικία. Η οριζόντια σύγκλιση σε σύγκριση με την κάθετη σύγκλιση του νεοφάρυγγα οδηγεί σε βελτιωμένη μετεγχειρητική κατάποση – ποιότητα ζωής. Οι επικουρικές θεραπείες και η ηλικία δεν επηρεάζουν την κατάποση ή την ποιότητα ζωής. Οι ωτορινολαρυγγολόγοι πρέπει να επιλέγουν την κατάλληλη μέθοδο σύγκλισης του νεοφάρυγγα για τα βέλτιστα αποτελέσματα της κατάποσης.

scholarly journals Utilização de protocolos de qualidade de vida em disfagia: revisão de literatura

Revista CEFAC ◽  
2015 ◽  
Vol 17 (4) ◽  
pp. 1333-1340 ◽  
Author(s):  
Bruna Franciele da Trindade Gonçalves ◽  
Gabriele Rodrigues Bastilha ◽  
Cintia da Conceição Costa ◽  
Renata Mancopes
Keyword(s):  
Quality Of Life ◽  
Deglutition Disorders ◽  
Swallowing Disorders ◽  
Quality Of Life Questionnaires ◽  
Dysphagia Handicap Index ◽  
Md Anderson ◽  
Anderson Dysphagia Inventory

Resumo:O objetivo deste estudo foi identificar os protocolos existentes sobre qualidade de vida (QV) em disfagia e verificar a utilização dos mesmos no tratamento fonoaudiológico. Realizou-se pesquisa teórica e exploratória com a técnica de revisão da literatura nas bases de dados SCOPUS, Trip Database, LILACS, PubMed, SciELO, Google Schoolar, periódicos Capes e MedLine. O período de busca compreendeu os anos entre 2004 e 2014 e foram utilizados os seguintes descritores: deglutição; transtornos da deglutição; qualidade de vida; questionários e os seus respectivos termos em inglês deglutition; deglutition disorders; quality of Life; questionnaires. Foram encontrados na literatura o protocolo Quality of life in Swallowing Disorders-SWAL-QOL, o qual estabelece o comprometimento da deglutição independente da etiologia; o MD Anderson Dysphagia Inventory, que é específico para sujeitos submetidos à tratamento de câncer de cabeça e pescoço e o Dysphagia Handicap Index,que avalia os efeitos da disfagia sobre a qualidade de vida (QV) em sujeitos com diferentes patologias de base e pode ser utilizado em níveis mais baixos de escolaridade. A literatura propõe diferentes protocolos que avaliam a QV em disfagia, sendo que os mais utilizados avaliam a QV de forma geral, relacionada ao câncer de cabeça e pescoço e de sujeitos com diferentes diagnósticos médicos. A utilização desses protocolos pode auxiliar e complementar a avaliação clínica e objetiva da deglutição, uma vez que, retratam a autoavaliação referida pelo sujeito, sendo este ponto de vista de extrema importância para o tratamento fonoaudiológico.

Preliminary Functional Outcomes and Quality of Life after Tongue Reconstruction with the Vastus Lateralis Myofascial Free Flap

2021 ◽  
Author(s):  
Armando De Virgilio ◽  
Andrea Costantino ◽  
Raul Pellini ◽  
Gerardo Petruzzi ◽  
Giuseppe Mercante ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Head And Neck ◽  
Free Flap ◽  
Functional Outcomes ◽  
Vastus Lateralis ◽  
Life Questionnaire ◽  
Donor Area ◽  
Tongue Reconstruction ◽  
Eortc Qlq

AbstractThe aim of the present study is to report our preliminary experience with the vastus lateralis myofascial free flap (VLMFF) for tongue reconstruction according to tongue and donor site functional outcomes. Twelve consecutive patients (F: 5; median age: 54.0 years, interquartile range or IQR 42.75–69.0) were included. The validated European Organization for Research and Treatment of Cancer of the Head and Neck 35 Quality of Life Questionnaire (EORTC QLQ-H&N35) and the performance status scale for head and neck cancer (PSS-HN) questionnaires were used to assess the health-related quality of life (HRQOL). The lower extremity functional scale (LEFS) was used to self-report the donor area function. All patients were successfully treated, and no VLMFF failure was detected during a median follow-up period of 10.5 months (IQR: 6.5–33.0). The HRQOL showed a median EORTC QLQ-H&N35 score of 56.0 (IQR: 50.0–72.5). The median PSS-HN score was 80.0 (IQR: 45.0–95.0), 75.0 (IQR: 62.5–100.0), 75.0 (IQR: 62.5–100.0) for “Normalcy of Diet,” “Public Eating,” and “Understandability of Speech,” respectively. The self-reported function of the lower extremities (donor area) showed a median LEFS of 59.0 (IQR: 32.5–74.0). This study reports optimistic data regarding the functional and quality of life outcomes after tongue reconstruction using VLMFF. Prospective controlled studies are needed to demonstrate advantages and disadvantages when compared with other reconstructive techniques.

Effect of Augmentative Technology on Communication and Quality of Life After Tracheostomy or Total Laryngectomy

2021 ◽  
pp. 019459982110137
Author(s):  
Catherine T. Haring ◽  
Janice L. Farlow ◽  
Marie Leginza ◽  
Kaitlin Vance ◽  
Anna Blakely ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Total Laryngectomy ◽  
Electronic Communication ◽  
Well Being ◽  
Chi Square ◽  
Communication Device ◽  
Patient Reported ◽  
Communication Devices ◽  
Related Quality

Objective Surgical procedures that render patients acutely aphonic can cause them to experience significant anxiety and distress. We queried patient perceptions after tracheostomy or laryngectomy and investigated whether introducing augmentative technology was associated with improvement in patient-reported outcomes. Methods Participants included hospitalized patients who acutely lost the ability to speak due to tracheostomy or total laryngectomy from April 2018 to December 2019. We distributed questions regarding the patient communication experience and relevant questions from the validated V-RQOL questionnaire (Voice-Related Quality of Life). Patients were offered a tablet with the electronic communication application Verbally. Pre- and postintervention groups were compared with chi-square analyses. Results Surveys were completed by 35 patients (n = 18, preintervention; n = 17, postintervention). Prior to using augmentative technology, 89% of patients who were aphonic reported difficulty communicating, specifically noting breathing or suctioning (56%), treatment and discharge plans (78%), or immediate needs, such as pain and using the bathroom (39%). Communication difficulties caused anxiety (55%), depression (44%), or frustration (62%), and 92% of patients were interested in using an electronic communication device. Patients reported less trouble communicating after the intervention versus before (53% vs 89%, P = .03), including less difficulty communicating about treatment or discharge plans (35% vs 78%, P < .01). V-RQOL scores were unchanged. Discussion Acute loss of phonation arising from surgery can be highly distressing for patients, and use of augmentative technology may alleviate some of these challenges by improving communication. Further studies are needed to identify what additional strategies may improve overall well-being. Implications for Practice Electronic communication devices may benefit patients with acute aphonia.

scholarly journals Analysis of speech and swallowing and quality of life in patients undergoing subtotal glossectomy with free flap reconstruction followed by radiotherapy

2021 ◽  
Vol 8 (1) ◽  
pp. 37-41
Author(s):  
Angelos Mantelakis ◽  
Konstantinos Vachtsevanos ◽  
Harry V. M. Spiers ◽  
Christina Gavriilidou ◽  
Stamatis Sapountzis
Keyword(s):  
Quality Of Life ◽  
Free Flap ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction

scholarly journals Long-term outcome and quality of life after CNS cavernoma resection: eloquent vs. non-eloquent areas

2021 ◽  
Author(s):  
Loay Shoubash ◽  
Jörg Baldauf ◽  
Marc Matthes ◽  
Michael Kirsch ◽  
Matthias Rath ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Short Form ◽  
Preoperative Evaluation ◽  
Patient Counseling ◽  
Surgical Morbidity ◽  
Term Outcome ◽  
Long Term Outcome

AbstractThe aim of this study is to analyze the long-term quality of life after surgery of cavernoma. A monocentric retrospective study was conducted on 69 patients with cavernoma treated microsurgically between 2000 and 2016. The eloquence was adopted from Spetzler-Martin definition. A most recent follow-up was elicited between 2017 and 2019, in which the quality of life (QoL) was evaluated with the Short Form-12 questionnaire (SF12). Forty-one lesions were in eloquent group (EG), 22 in non-eloquent group (NEG), 3 in orbit, and 3 in the spinal cord. Postoperative worsening of the modified Rankin scale (mRS) occurred in 19.5% of cases in EG versus 4.5% in NEG. After a mean follow-up of 6.5 years (SD 4.6), the neurological status was better or unchanged compared to baseline in 85.4% of EG and 100% of NEG. Regarding QoL assessment of 44 patients (EG n = 27, NEG n = 14) attended the last follow-up. Patients after eloquent cavernoma resection reported a non-inferior QoL in most SF12 domains (except for physical role) compared to NEG. However, they reported general health perception inferior to norms, which was affected by the limited physical and emotional roles. At a late follow-up, the surgical morbidity was transient in the NEG and mostly recovered in the EG. The QoL comparison between eloquent and non-eloquent cavernomas created interesting and new data after prolonged follow-up. These results add value for decision-making as well as patient counseling for future encountered cases. Preoperative evaluation of QoL is recommended for future studies to assess QoL dynamics.

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