Abstract
ABSTRACTObjective To describe functional and quality of life results after extended supratracheal laryngectomy.Methods In the period from September 2009 to January 2018, 11 male subjects were submitted to extended supratracheal laryngectomy. Swallowing abilities were assessed through videofluoroscopy and the clinical scale Functional Communication Measures of Swallowing. The voices were classified by means of the perceptual-auditory analysis Consensus Auditory-Perceptual Evaluation of Voice. All subjects completed a self-assessment questionnaire for voice and swallowing.Results Aspiration was found in four patients and all presented stasis in different structures. All subjects in this study were exclusively orally fed and hydrated. In the evaluation of quality of life in swallowing, patients had mean >80 in all areas (83.47 mean of scores). The general degree and the presence of roughness were the highest means present in Consensus Auditory-Perceptual Evaluation of Voice (37.81 and 49.36, respectively). The mean of 33.36 (±22.56) had little impact on quality of life under the perspective of vocal aspects.Conclusion After supratracheal laryngectomy, swallowing was sufficiently restored and the quality of life was satisfactory. The voice presents severely impaired quality and preserved oral communication, with low impact on the activities of daily living. All individuals who maintained two cricoarytenoid units presented better functional results in swallowing and voice.
Highlights
Laryngeal cancer is the second most common respiratory malignancy in the world, and has one of the highest incidences of head and neck tumors
The surgical technique of supratracheal laryngectomies (STL) consists of resection of the thyroid cartilage and its paraglottic space, preservation of the posterior part of the cricoid cartilage, maintenance of the hyoid bone, epiglottis and at least one arytenoid cartilage.[12,13,16] Its reconstruction is described with two variations: tracheohyoidopexy (THP), which consists of the maintenance of both or only one cricoarytenoid unit (CAU); tracheohyoidoepiglottopexy (THEP) with preservation of the epiglottis, maintaining two or only one CAU.[17,18] In cases in which resection is broader than that predicted by the described technique, as in STL reports with extension to the base of tongue, adjacent tissue or arytenoids, we add to the nomenclature the term “extended” or “modified” STL.[19,20,21]
There is evidence of functional complications following horizontal partial laryngectomies, in regarding to breathing, voice and swallowing, with a low incidence of permanent tracheostomies.[9,22] the correlation of functional effects on quality of life (QoL) of patients undergoing STL, to date, has only been suggested in a single study, conducted in 2015.(23) Their preliminary findings described the effectiveness of the technique in a group of 22 patients, in Italy, with exclusive maintenance of oral feeding in 20 patients, and better results in voice and QoL compared to swallowing scores due to changes in diet.[23]. It is of paramount importance that the population of developing countries is described/ included with respect to their real conditions and socio-economic and demographic contexts
Summary
Laryngeal cancer is the second most common respiratory malignancy in the world, and has one of the highest incidences of head and neck tumors It is present mostly in men aged over 40 years and its most prevalent histological type is squamous cell carcinoma, confirmed in more than 90% of cases.[1,2] The prognosis is limited when the disease is diagnosed in the advanced stages, impairing quality of life (QoL), with regard to speech and swallowing disorders.[1,3,4,5,6]. In view of the failure of RT treatment and low efficacy of non-surgical protocols with high levels of toxicity, open horizontal partial laryngectomies are performed in specialized centers as a viable alternative to the other procedures.[10] This conservative surgical technique for laryngeal carcinoma removes the tumor and its safety margin free of the disease, reconstructing a functional neolarynx.[3,10,11]. It is of paramount importance that the population of developing countries is described/ included with respect to their real conditions and socio-economic and demographic contexts
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