scholarly journals Pharyngocutaneous Fistulas Following Total Laryngectomy

2021 ◽  
Author(s):  
Alexandru Nicolaescu ◽  
Șerban V.G. Berteșteanu ◽  
Raluca Grigore ◽  
Mihnea Cojocărița-Condeescu ◽  
Bogdan Popescu ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Total Laryngectomy ◽  
Locally Advanced ◽  
Esophageal Fistula ◽  
Vocal Rehabilitation ◽  
Multiple Factors ◽  
Concomitant Factors ◽  
Prolong Hospital Stay

Total laryngectomy is still the final therapeutic solution in cases of locally advanced laryngeal cancer, as well as in cases of therapeutic failure of organ-sparing surgery or radiation therapy. Following excision of the larynx, the remaining pharynx is reconstructed to obtain continuity of the upper digestive tract. One of the most common complications in these patients, despite constant refinement of the procedure, is the development of a pharyngo-cutaneous fistula. These fistulas prolong hospital stay and often require a second surgical procedure, increasing morbidity and cost for the patient, while diminishing his quality of life. Some risk-factors have been identified, but only some may be corrected before surgery to lower this risk. Managing the fistula once present depends on multiple factors, essential being the size of the fistula as well as the position and concomitant factors, with options ranging from conservative measures to aggressive reconstructive surgery with local miocutaneous flaps. Modern vocal rehabilitation with T.E.P. (tracheo-esophageal puncture) and vocal prosthesis placement presents a new challenge – because of the risk of developing a tracheo-esophageal fistula, with an even higher risk for the patient because of tracheal aspiration. Understanding healing mechanisms of these structures is key to proper management of this complication.

scholarly journals Subtotal laryngectomy with formation of a laryngotracheal shunt in vocal rehabilitation of patients with stage III and IV locally advanced larynx and laryngopharynx cancer (literature review)

2021 ◽  
Vol 11 (1) ◽  
pp. 96-100
Author(s):  
E. N. Menkova ◽  
D. E. Kulbakin ◽  
E. A. Krasavina ◽  
M. R. Mukhamedov ◽  
V. A. Alekseev ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Surgical Treatment ◽  
Locally Advanced ◽  
Stage Iii ◽  
Advanced Stage ◽  
Vocal Rehabilitation ◽  
Vocal Function ◽  
Advantages And Disadvantages ◽  
Accepted Standard

Currently accepted standard of surgical treatment of patients with locally advanced stage III and IV laryngeal and laryngopharyngeal cancer is laryngectomy which leads to loss of vocal function. Therefore, vocal rehabilitation is one of the most important tasks of the doctor. It allows to increase quality of life of patients after treatment. Currently used techniques of vocal rehabilitation have their advantages and disadvantages. The article considers various techniques of vocal rehabilitation, primarily, subtotal laryngectomy with laryngotracheal shunt as a promising method of surgical rehabilitation of patients with locally advanced caner of the larynx and laryngopharynx.

Use of Larynx-Preservation Strategies in the Treatment of Laryngeal Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update

2018 ◽  
Vol 36 (11) ◽  
pp. 1143-1169 ◽  
Author(s):  
Arlene A. Forastiere ◽  
Nofisat Ismaila ◽  
Jan S. Lewin ◽  
Cherie Ann Nathan ◽  
David J. Adelstein ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Laryngeal Cancer ◽  
Total Laryngectomy ◽  
Locally Advanced ◽  
Elective Neck Dissection ◽  
Head Neck Cancer ◽  
Swallowing Function ◽  
Laryngeal Function ◽  
Larynx Preservation

Purpose To update the guideline recommendations on the use of larynx-preservation strategies in the treatment of laryngeal cancer. Methods An Expert Panel updated the systematic review of the literature for the period from January 2005 to May 2017. Results The panel confirmed that the use of a larynx-preservation approach for appropriately selected patients does not compromise survival. No larynx-preservation approach offered a survival advantage compared with total laryngectomy and adjuvant therapy as indicated. Changes were supported for the use of endoscopic surgical resection in patients with limited disease (T1, T2) and for initial total laryngectomy in patients with T4a disease or with severe pretreatment laryngeal dysfunction. New recommendations for positron emission tomography imaging for the evaluation of regional nodes after treatment and best measures for evaluating voice and swallowing function were added. Recommendations Patients with T1, T2 laryngeal cancer should be treated initially with intent to preserve the larynx by using endoscopic resection or radiation therapy, with either leading to similar outcomes. For patients with locally advanced (T3, T4) disease, organ-preservation surgery, combined chemotherapy and radiation, or radiation alone offer the potential for larynx preservation without compromising overall survival. For selected patients with extensive T3 or large T4a lesions and/or poor pretreatment laryngeal function, better survival rates and quality of life may be achieved with total laryngectomy. Patients with clinically involved regional cervical nodes (N+) who have a complete clinical and radiologic imaging response after chemoradiation do not require elective neck dissection. All patients should undergo a pretreatment baseline assessment of voice and swallowing function and receive counseling with regard to the potential impact of treatment options on voice, swallowing, and quality of life. Additional information is available at www.asco.org/head-neck-cancer-guidelines and www.asco.org/guidelineswiki .

scholarly journals The impact of vocal rehabilitation on quality of life and voice handicap in patients with total laryngectomy

2016 ◽  
Vol 21 (1) ◽  
pp. 127 ◽  
Author(s):  
Magdalena Chirilă ◽  
Cristina Tiple ◽  
Tudor Drugan ◽  
FlorinaVeronica Dinescu ◽  
Rodica Mureşan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Total Laryngectomy ◽  
Vocal Rehabilitation ◽  
The Impact

Clinical case of a comorbid patient with arterial hypertension

2020 ◽  
pp. 31-39
Author(s):  
Ella Polozova ◽  
Vsevolod Skvortsov ◽  
Olga Radaykina ◽  
Mariya Narvatkina ◽  
Anastasiya Seskina ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Arterial Hypertension ◽  
Clinical Picture ◽  
Clinical Case ◽  
Diagnosis And Treatment ◽  
The Moment

The widespread prevalence of comorbid pathology determines the relevance of this problem. Comorbid pathology due to the interaction of diseases, drug pathomorphism, age characteristics of the patient, significantly changes clinical picture and course of the main nosology, affects severity of complications and their nature, significantly affects quality of life and prognosis of patients. Diagnosis and treatment of many diseases is complicated in the conditions of comorbidity. The article presents a clinical case of a comorbid patient with arterial hypertension from the moment of exposure to risk factors and ending with the formation of many concomitant diseases, as an example of trans-nosological comorbidity.

OSTEOPOROSIS AND RISK FACTORS IN THE PATIENTS ON CHRONIC HEMODIALYSIS

2015 ◽  
pp. 50-58
Author(s):  
Thi Dung Nguyen ◽  
Tam Vo
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Bone Density ◽  
Region Of Interest ◽  
Cross Sectional Study ◽  
Chronic Hemodialysis ◽  
Cross Sectional ◽  
X Ray ◽  
Density Reduction

Background: The patients on hemodialysis have a significantly decreased quality of life. One of many problems which reduce the quality of life and increase the mortality in these patients is osteoporosis and osteoporosis associated fractures. Objectives: To assess the bone density of those on hemodialysis by dual energy X ray absorptiometry and to examine the risk factors of bone density reduction in these patients. Patients and Method: This is a cross-sectional study, including 93 patients on chronic hemodialysis at the department of Hemodialysis at Cho Ray Hospital. Results: Mean bone densities at the region of interest (ROI) neck, trochanter, Ward triangle, intertrochanter and total neck are 0.603 ± 0.105; 0.583 ± 0.121; 0.811 ± 0.166; 0.489 ± 0.146; 0.723 ± 0.138 g/cm2 respectively. The prevalences of osteoporosis at those ROI are 39.8%, 15.1%; 28%; 38.7%; and 26.9% respectively. The prevalences of osteopenia at those ROI are 54.8%; 46.3%; 60.2%; 45.2% and 62.7% respectively. The prevalence of osteopososis in at least one ROI is 52.7% and the prevalence of osteopenia in at least one ROI is 47.3%. There are relations between the bone density at the neck and the gender of the patient and the albuminemia. Bone density at the trochanter is influenced by gender, albuminemia, calcemia and phosphoremia. Bone density at the intertrochanter is affected by the gender. Bone density at the Ward triangle is influenced by age and albuminemia. Total neck bone density is influenced by gender, albuminemia and phosphoremia. Conclusion: Osteoporosis in patients on chronic hemodialysis is an issue that requires our attention. There are many interventionable risk factors of bone density decrease in these patients. Key words: Osteoporosis, DEXA, chronic renal failure, chronic hemodialysis

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