learning-modern-laryngeal-surgery-in-a-dissection-laboratory

Learning Modern Laryngeal Surgery in a Dissection Laboratory

Surgery for laryngeal malignancies requires millimetric accuracy from the different endoscopic and open techniques available. Practice of this surgery is ...

Candiolo Cancer Institute, FPO-IRCCS

The aim was to investigate telephonic voice intelligibility in patients treated for laryngeal cancer using different approaches. In total, 90 patients treated for laryngeal cancer using different approaches and 12 healthy volunteers were recruited. Each patient and each healthy control read a list of words and sentences during a telephone call. Six auditors listened to each telephonic recording and transcribed the words and sentences they understood. Mean intelligibility rates for each treatment were assessed and compared. Regarding words, the poorest intelligibility was noted for type II open partial horizontal laryngectomies, followed by total laryngectomies. The best intelligibility was found for transoral laser microsurgery, followed by radiotherapy alone. For sentences, the poorest intelligibility was noted for type II open partial horizontal laryngectomies, followed by chemoradiotherapy. The best intelligibility was found for radiotherapy alone and transoral laser microsurgery. More aggressive surgery as well as chemoradiotherapy correlated with significantly poorer outcomes. Transoral laser microsurgery or radiotherapy alone ensured the best telephonic voice intelligibility. Intermediate-advanced T stages at diagnosis also showed significantly poorer intelligibility outcomes, suggesting that T stage represents an independent negative prognostic factor for voice intelligibility after treatment.

Telephonic voice intelligibility after laryngeal cancer treatment: is therapeutic approach significant?

To describe current evidence about supratracheal laryngectomies, focusing on indications, contraindications, oncologic results, functional outcomes and side-effects of this 'extreme' function-sparing surgical approach to laryngeal cancer.

Supratracheal partial laryngectomy: indications, oncologic and functional results.

Several studies have previously analyzed the relationship between QOL and signs of dysphagia in patients treated for head and neck cancer and have reported heterogeneous findings. To the best of our knowledge, no study has previously investigated this relationship among patients who underwent open partial horizontal laryngectomy (OPHL). The aim of the study is to determine if patient-reported swallowing-related QOL can discriminate between safe and unsafe swallowing in OPHL patients.

Relationship between swallowing-related quality of life and fiberoptic endoscopic evaluation of swallowing in patients who underwent open partial horizontal laryngectomy.

Dysphagia is common after an open partial horizontal laryngectomy (OPHL). The mechanisms causing lower airways' invasion and pharyngeal residue are unclear. The study aims to examine physio-pathological mechanisms affecting swallowing safety and efficiency after OPHL. Fifteen patients who underwent an OPHL type IIa with arytenoid resection were recruited. Videofluoroscopic examination of swallowing was performed. Ten spatial, temporal, and scalar parameters were analyzed. Swallowing safety and efficiency were assessed through the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) scale. Swallowing was considered unsafe or inefficient for a DIGEST safety or efficiency grade ≥2, respectively. Videofluoroscopic measurements were compared between safe vs. unsafe swallowers, and efficient vs. inefficient swallowers. Seven patients (46.7%) showed unsafe swallowing and 6 patients (40%) inefficient swallowing. Unsafe swallowers had worse laryngeal closure ( = 0.021). Inefficient swallowers presented a longer pharyngeal transit time ( = 0.008), a reduced pharyngoesophageal segment opening lateral ( = 0.008), and a worse tongue base retraction ( = 0.018 with solids and  = 0.049 with semisolids). In conclusion, swallowing safety was affected by incomplete laryngeal closure, while swallowing efficiency was affected by increased pharyngeal transit time, reduced upper esophageal sphincter opening, and incomplete tongue base retraction. The identified physio-pathological mechanisms could represent targets for rehabilitative and surgical approaches in patients with dysphagia after OPHL.

Swallowing Safety and Efficiency after Open Partial Horizontal Laryngectomy: A Videofluoroscopic Study.

The application of CO fiber laser technology to ENT surgery has led to new interesting scenarios, both in endoscopic and in open surgical approaches.

Article	Year
Telephonic voice intelligibility after laryngeal cancer treatment: is therapeutic approach significant? European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery\| PubMed ID: 27435595	2017
Supratracheal partial laryngectomy: indications, oncologic and functional results. Current opinion in otolaryngology & head and neck surgery\| PubMed ID: 28169863	2017
Relationship between swallowing-related quality of life and fiberoptic endoscopic evaluation of swallowing in patients who underwent open partial horizontal laryngectomy. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery\| PubMed ID: 29423747	2018
Swallowing Safety and Efficiency after Open Partial Horizontal Laryngectomy: A Videofluoroscopic Study. Cancers\| PubMed ID: 30999620	2019
Open partial horizontal laryngectomy using CO fiber laser. Head & neck\| PubMed ID: 31066480	2019

Marco Fantini

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