Speech Restorative Surgery In Pyriform Fossa Carcinoma

Abstract

Objective: To assess functional outcome with respect to speech and swallowing in patients undergoing speech restorative surgery for pyriform fossa carcinoma. Setting: Tertiary Care Cancer Referral Centre. Materials and Method: A total of 300 patients with pyriform sinus carcinoma underwent surgical intervention with/without adjuvant radiotherapy between 1990-2000. The present study details 123 patients(40%) with T1 T4 pyriform fossa carcinoma who underwent speech restorative surgeries , having no significant contraindication for the same. 23 patients with supracricoid tumor and good pulmonary reserve were subjected to Extended Supraglottic Laryngopharyngectomy (Ext.SGLP); 89 patients with a tumor free interarytenoid mucosa underwent Near Total Laryngectomy (NTLP) and 11 Total Laryngectomy with partial pharyngectomy with Tracheoesophageal (TLP+TE) voice prosthesis. Outcome measure: Successful social rehabilitation pertaining to swallow without aspiration and good speech intelligibility. Results: All except 17% patients in Ext. SGLP were able to swallow without aspiration. speech quality was best in this group(90%), followed in order by ntlp(85%) and tlp with te prosthesis(80%). locoregional control rate at 3 years was 80% in the ext. sglp group(median follow up 23 months, range 2-70 months), 85% in ntlp (median 24 months, range 2-118 months) and 73% for the tlp+te group (median 20 months range 3-132 months). Conclusion: These biologically aggressive malignancies are amenable to speech restoration with conservation surgery (ext. SGLP) , NTLP and voice prosthesis with a locoregional control rate comparable with literature. Presented at :Association of Otolaryngologist of India – South zone Conference as Practicing ENT SURGEON AWARD PAPER Category on 14/9/ 02. Second National Meet for Foundation of Head & Neck Oncology, Calcutta ,India, January 2003.