scholarly journals Surgical alternative to tracheoesophageal prosthesis for voice preservation in selected hypopharyngeal carcinoma

2020 ◽  
Vol 6 (10) ◽  
pp. 1850
Author(s):  
Neena Choudhary ◽  
Shweta Jaitly ◽  
Rajeev Kumar Verma ◽  
Shashank Gupta ◽  
Para Choudhary
Keyword(s):  
Surgical Complications ◽  
Total Laryngectomy ◽  
Case Series ◽  
Functional Results ◽  
Hypopharyngeal Carcinoma ◽  
Pharyngocutaneous Fistula ◽  
Safe Alternative ◽  
Prospective Case Series ◽  
Voice Preservation ◽  
Ethical Clearance

<p><strong>Background</strong><strong>: </strong>Pearson’s near-total laryngectomy (NTL) is a voice- preserving alternative to total laryngectomy in patients with advanced but localized laryngeal and hypopharyngeal cancers, wherein lung- powered speech is achieved by creation of a dynamic biological trachea-pharyngeal shunt. Report our experience with NTL in a series of 24 patients.</p><p><strong>Methods:</strong> A prospective case series analysis was done at VMMC and Safdarjung Hospital from January 2014- September 2019 after attaining ethical clearance. 24 patients with lateralized, locally a post- cricoid areas were included in the study. Patients who had involvement of the post cricoid region, interarytenoid region or involvement of bilateral cricoarytenoid units were excluded from the study. The subjects underwent Pearson’s NTL and were followed- up to examine for disease- control and functional results.</p><p><strong>Results:</strong> 22 patients (91.6%) attained a good quality voice following surgery with 2 patients (8.3%) developing minor aspiration problems. 1 patient (4.16%) developed local recurrence after 5 months. Surgical complications were surgical site infection (20.8%), pharyngocutaneous fistula (16.67%) and shunt stenosis (4.16%).</p><p><strong>Conclusion</strong>: NTL is an oncologically safe alternative to total laryngectomy in selected patients and is capable of achieving excellent functional results with minimal surgical complications and post-operative maintenance.</p>

Pectoralis Myofascial Flap during Salvage Laryngectomy Prevents Pharyngocutaneous Fistula

2009 ◽  
Vol 141 (2) ◽  
pp. 190-195 ◽  
Author(s):  
Urjeet A. Patel ◽  
Sanjay P. Keni
Keyword(s):  
Total Laryngectomy ◽  
Public Hospital ◽  
Chart Review ◽  
Tertiary Care ◽  
Case Series ◽  
Pharyngocutaneous Fistula ◽  
Reliable Technique ◽  
Fistula Rate ◽  
Salvage Laryngectomy ◽  
Pectoralis Flap

OBJECTIVE: To determine the rate of pharyngocutaneous fistula after salvage laryngectomy and assess if pectoralis myofascial flap reinforcement over primary pharyngeal closure prevents pharyngocutaneous fistula. STUDY DESIGN: Case series with chart review. SETTING: Tertiary-care public hospital. SUBJECTS AND METHODS: This study included 43 patients undergoing total laryngectomy between 2003 and 2008. Pectoralis myofascial flap reinforcement of the pharyngeal closure during salvage laryngectomy was performed on patients after June 2006. The main outcome measure was pharyngocutaneous fistula after primary laryngectomy, salvage laryngectomy, and salvage laryngectomy with pectoralis flap reinforcement. RESULTS: Of the 43 patients, 26 were treated with primary total laryngectomy while 17 received salvage laryngectomy. Seven of 26 patients (27%) undergoing primary total laryngectomy developed pharyngocutaneous fistula. All patients in this group were closed primarily with no flap reinforcement. For salvage laryngectomy, four of seven patients (57%) with primary pharyngeal closure developed pharyngocutaneous fistula; however, none of 10 patients (0%) undergoing salvage laryngectomy with pectoralis myofascial flap reinforcement developed fistula ( P < 0.02; 0%-23%; 95% CI). CONCLUSIONS: With pectoralis myofascial flap reinforcement, pharyngocutaneous fistula rate after salvage laryngectomy dropped to 0 percent in this study (0%-23%; 95% CI). This is a simple, reliable technique that prevents postoperative pharyngocutaneous fistula and its associated morbidity after salvage laryngectomy.

scholarly journals Non-Surgical Strategies for Assisting Closure of Pharyngocutaneous Fistula after Total Laryngectomy: A Systematic Review of the Literature

2021 ◽  
Vol 11 (1) ◽  
pp. 100
Author(s):  
Luca Giovanni Locatello ◽  
Giuseppe Licci ◽  
Giandomenico Maggiore ◽  
Oreste Gallo
Keyword(s):  
Systematic Review ◽  
Surgical Treatment ◽  
Total Laryngectomy ◽  
Case Series ◽  
Present Review ◽  
Standard Group ◽  
Pharyngocutaneous Fistula ◽  
Small Series ◽  
Botulinum Toxin Therapy ◽  
Non Surgical Treatment

Background: Pharyngocutaneous fistula (PCF) is a frequent complication after total laryngectomy, with an incidence of up to 65%. Many conservative or invasive approaches are available and the choice among them is usually made on a case-by-case basis. The aim of the present review is to critically summarize the available evidence of the effectiveness of the non-surgical management of PCF. Methods: A systematic review and a meta-analysis of the literature were conducted, according to the PRISMA guidelines. Studies investigating botulinum toxin therapy, scopolamine transdermal patch, hyperbaric oxygen therapy (HBOT), and negative pressure wound therapy (NPWT) were assessed. Complete fistula closure after the initiation of non-surgical treatment was the main outcome. Results: After the application of selection criteria, a total of seven articles and 27 patients were included in the present review. All the eligible studies were descriptive case series, while only one article used a standard group as a comparison. The mean age was 63.3 and 14 patients (51.9%) had previously received RT. The reported comorbidities were diabetes, ischemic heart disease, hypertension, dyslipidemia, COPD, and atrial fibrillation. With a mean healing time of 25.0 days, the overall success rate was 92.6%. Conclusions: Non-surgical treatment of PCF is only based on the experience of small series. Although success rates seem promising, the absence of properly designed comparative studies does not allow us, at present, to identify ideal candidates for these non-invasive management strategies for PCF.

scholarly journals Near-total laryngectomy (Pearson's method): Radical surgical procedure with preservation of phonatory function

2002 ◽  
Vol 55 (11-12) ◽  
pp. 481-484 ◽  
Author(s):  
Rajko Jovic ◽  
Herwig Swoboda
Keyword(s):  
Quality Of Life ◽  
Surgical Procedure ◽  
Total Laryngectomy ◽  
Cricoid Cartilage ◽  
Operative Procedure ◽  
Functional Results ◽  
Hypopharyngeal Carcinoma ◽  
First Results ◽  
Advanced Stages

Introduction Patients with advanced T3 and T4 laryngeal and hypopharyngeal carcinoma need surgical treatment - total laryngectomy. Excision of the larynx affects enormously the quality of patient's life. Near total laryngectomy appeared about twenty years ago, and was accepted worldwide during the last decade of the twentieth century. Two years ago we started performing this operative procedure. Although we still don't have great experience, first results are satisfying. We point to the importance of this procedure especially in developing countries, where phonatory protheses are expensive, patients' education of esophageal speech is not satisfactory and number of those who were successfully trained is small. The aim of this paper was to introduce near total laryngectomy as a surgical procedure which improves quality of life of patients with advanced stages of laryngeal and hypopharyngeal carcinoma. Near total laryngectomy The original procedure described by Pearson was very complicated to understand, so we accepted Monux procedure which is easier. The resection of the laryngeal structures corresponds to those in total laryngectomy, but we spare a small part of cricoid cartilage and whole or 2/3 of the healthy vocal cord. Conclusion A number of arguments, presented in this paper, speak in favor of near total laryngectomy. This technique has the same oncological results as total laryngectomy, but much better functional results and quality of life in patients with laryngeal and some hypopharyngeal carcinomas.

scholarly journals Retrospective analysis of total laryngectomy with post-operative radiotherapy for CA larynx in a tertiary care centre: a case series

2019 ◽  
Vol 5 (3) ◽  
pp. 653
Author(s):  
S. Mohamed Siddique ◽  
G. Selvarajan
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Total Laryngectomy ◽  
Postoperative Radiotherapy ◽  
Tertiary Care ◽  
Case Series ◽  
Treatment Modalities ◽  
Pharyngocutaneous Fistula ◽  
Operative Care

<p class="abstract"><strong>Background:</strong> Squamous cell carcinoma is the most common malignancy of the larynx. Various treatment modalities are available. Recently, total laryngectomy is a viable option as primary treatment or salvage surgery after radiotherapy than organ preservation surgeries. The aim was to analyse the results of the patients with advanced laryngeal cancers treated with total laryngectomy and postoperative radiotherapy.</p><p class="abstract"><strong>Methods:</strong> It is a retrospective study from January 2015 to June 2018 with 16 patients with squamous cell carcinoma of larynx. Detailed history, examination, radiological, endoscopic evaluation of tumour, tissue biopsy proof and staging was done.  </p><p class="abstract"><strong>Results:</strong> Of the 16 patients (15 male and 1 female), 12 patients (75%) were primary cases and 4 patients (25%) were radiorecurrent. 14 patients (87%) had pre-operative tracheostomy done and 2 patients (13%) had undergone direct laryngectomy. All the 16 patients had transglottic growth. All the patients had undergone total laryngectomy with post-operative radiotherapy. No pharyngocutaneous fistula reported. One patient (6%) had neck edema. One patient (6%) had nodal recurrence.</p><p class="abstract"><strong>Conclusions:</strong> Total laryngectomy with post-operative radiotherapy affords a longer period of survival compared to radiotherapy alone. Minimal complications in our study are attributed to thorough pre-operative evaluation, meticulous surgical technique and post-operative care.</p><p class="abstract"> </p>

Shell Brace for Stage II Posterior Tibial Tendon Insufficiency

2008 ◽  
Vol 29 (11) ◽  
pp. 1095-1100 ◽  
Author(s):  
Fabian Krause ◽  
Adrian Bosshard ◽  
Oliver Lehmann ◽  
Martin Weber
Keyword(s):  
Case Series ◽  
Functional Results ◽  
Nonoperative Treatment ◽  
Stage Ii ◽  
Stage Iii ◽  
Patient Acceptance ◽  
Posterior Tibial Tendon ◽  
Posterior Tibial ◽  
Prospective Case Series ◽  
The Impact

Background: The nonoperative treatment of posterior tibial tendon insufficiency (PTTI) can lead to unsatisfactory functional results. Short-term results are available but the impact on the evolution of the deformity is not known. To address these problems, a new brace for the flexible Stage II deformity was developed, and midterm followup was obtained. Materials and Method: In a prospective case series, eighteen patients (mean age 64.2 years; range, 31 to 82; four male, 14 female) with flexible Stage II PTTI were fitted with the new custom-molded foot orthosis. At latest followup of a mean of 61.4 (range, 20 to 87) months, functional results were assessed with the AOFAS ankle hindfoot score and clinical or radiographic progression was recorded. Results: The score improved significantly from a mean of 56 points (range, 20 to 64) to a mean of 82 points (range, 64 to 100, p < 0.001). Three patients (3/18, 16%) had a clinical progression to a fixed deformity (Stage III) and a radiographic increase of their deformity. All the other patients were satisfied with the brace's comfort and noted an improvement in their mobility. Complications were seen in three patients (3/18, 16%), and consisted of the development of calluses. Conclusion: The “shell brace” is a valuable option for nonoperative treatment of the flexible Stage II PTTI. Hindfoot flexibility was conserved throughout the observation period in all but three patients. Functional outcome and patient acceptance was above average. Problems were few, and closely associated with a progression to a fixed, Stage III deformity. Level of Evidence: II, Prospective Case Series

Ultrasound-Guided Lumbar Sympathetic Ganglion Blockade Using Shamrock Method: A Prospective Case Series

2016 ◽  
Vol 3 (3) ◽  
pp. 114-118 ◽  
Author(s):  
Dan-Xu Ma ◽  
Yun Wang ◽  
Meng-Meng Bao ◽  
Chen Zhang ◽  
Xue-Yang Li ◽  
...  
Keyword(s):  
Sympathetic Ganglion ◽  
Case Series ◽  
Ultrasound Guided ◽  
Prospective Case Series
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