Complication Of Total Laryngectomy Research Articles

Complications of total laryngectomy in the Department of Otorhinolaryngology of the Hospital de Clínicas from 2015-2022

Introducción: El cáncer de laringe es la neoplasia maligna más común de las vías aerodigestivas, representa el 4,5% de los cánceres del organismo y el 30% del cáncer de cabeza y cuello. Las complicaciones postoperatorias de la laringectomía total son frecuentes y se conocen factores predisponentes para ello. Se estableció como objetivo conocer la prevalencia de las complicaciones de la laringectomía total, las medidas realizadas para su tratamiento, el sitio anatómico, la presencia o ausencia de tratamiento adyuvante previo. Materiales y métodos: Se realizó un estudio descriptivo y retrospectivo en el Hospital de Clínicas, Cátedra de Otorrinolaringología, del 2015 al 2022. El universo estuvo constituido por un total de 46 pacientes ingresados con el diagnóstico de cáncer de laringe, 21,7% (10) de los cuales se les realizó laringectomía total. Se excluyeron otras técnicas quirúrgicas. Resultados: 10pacientes sometidos a laringectomía total con un rango de edad de 31-70 años, todos de sexo masculino. El compromiso de la supraglotis fue del 30%. El 70% presentó complicaciones. La complicación más frecuente fue fistula faringocutánea, otras fueron sangrado en el postoperatorio inmediato e infección del sitio quirúrgico. El 71,4% de los pacientes con fistula se resolvieron únicamente con medidas conservadoras, 2 requirieron reintervención para el cierre del defecto. Conclusiones: Las complicaciones de la laringectomía total se presentan con mucha frecuencia, afectando a la calidad de vida, la evolución y recuperación post quirúrgica del paciente.

Intraoperative Autofluorescence Imaging for Parathyroid Gland Identification during Total Laryngectomy with Thyroidectomy.

Hypoparathyroidism is a known complication of total laryngectomy, although parathyroid preservation and/or reimplantation are not routine. Autofluorescence is a new technique for identifying parathyroid glands intraoperatively. The aim of this study was to evaluate the feasibility of autofluorescence in this context. A retrospective study of patients undergoing total laryngectomy/pharyngectomy with concomitant thyroidectomy using the Fluobeam® (Fluoptics, Grenoble, France) and frozen section of a parathyroid fragment in case of reimplantation. The rates of identification using autofluorescence, reimplantation, and hypoparathyroidism were evaluated. Eighteen patients (16 males, median age 67) underwent total laryngectomy/pharyngectomy with total thyroidectomy (n = 12) or hemithyroidectomy (n = 6). A median of 2 parathyroid glands were identified per patient. Ninety-two percent were identified by autofluorescence before visualisation. All parathyroids were reimplanted due to devascularization. Temporary hypoparathyroidism occurred in nine patients, and was permanent in one patient. After 34 months of median follow-up (range 1-49), no tumor recurrence was observed in the reimplantation sites. To our knowledge, this is the largest study to evaluate autofluorescence during total laryngectomy with thyroidectomy. No tumor recurrence occurred in the sites of parathyroid reimplantation.

Platelet-Rich Fibrin Enhances Surgical Wound Healing in Total Laryngectomy.

Autologous growth factor (AGF) is a cytokine that has gained medical research interest because it helps improve and accelerate the wound healing process. Platelet-rich fibrin (PRF) is the latest generation of platelet concentrate that can be obtained through a simple procedure known as AGF referencing. One of the most common complications of total laryngectomy (TL) is pharyngocutaneous fistula. To prevent this complication, health care providers must closely monitor the postoperative wound healing process.This study aimed to investigate the effectiveness of PRF application in enhancing wound healing after TL. A randomized controlled trial was conducted in the Department of Otorhinolaryngology - Head and Neck Surgery, Faculty of Medicine, Dr. Cipto Mangunkusumo Hospital Universitas Indonesia, Jakarta, Indonesia, from June 2019 to December 2019. We included 20 patients who underwent TL for laryngeal squamous cell carcinoma. They were divided into two groups (10 patients who received applied autologous PRF around the esophageal stoma during TL and another 10 patients as the control). These patients were observed for 2 weeks postoperatively. In the bivariate analysis performed using the chi-square test, the pain threshold and edema of postoperative wounds in the PRF-treated group demonstrated significant differences compared with those in the control group. PRF application in TL enhanced the postoperative wound healing process, especially with regard to edema and pain.

Complications of Total Laryngectomy

Objective: To observe Post-operative complications of Total Laryngectomy in advanced Laryngeal Carcinoma Patients.
 Methods: This prospective observational study was conducted in National Institute of ENT, Tejgaon, Dhaka. Study duration 3 years, from January 2015 to December 2017. 17 patients were selected who underwent total laryngectomy for histologically proven advanced carcinoma larynx. Patients were followed up monthly for 3 months & then after 6 months for life long.
 Results: The age of the patients ranged from 39 to 66 years. The mean age was 47 years. Most of the cases are supraglottic carcinoma 12 (70.59%), Glottic carcinoma in 5 (29.41%) & no subglottic carcinoma. In this study, out of 12 supraglottic cases, 4 patients were presented in stage III & 8 in stage IV. Among the glottic cases 1 patient presented in stage I, 2 in stage III & 2 patients presented in stage IV. Patients were followed up monthly for 3 months & then after 6 months for life long. 2 patients (11.76%) developed pharyngocutaneous fistula within 7th to 15th post-operative day & these patients were managed conservatively which involved adequate drainage, frequent dressing & fresh blood transfusion. With these conservative management fistula healed completely within 3 to 4 weeks. 3 patients (17.65%) developed wound infection. Wound swab was sent for culture & sensitivity and antibiotics changed accordingly. Wound healed within 2-3 weeks with conservative treatment & adequate aseptic dressing. 1 patient (5.88%) developed postoperative hematoma which was drained immediately. This patient developed wound infection later on & was managed conservatively. 2 patients (11.76%) developed stomal recurrence 4 months after surgery, which was confirmed by biopsy. The cases were inoperable & were sent for radiotherapy. 2 patients (11.76%) developed dysphagia due to pharyngeal stenosis 4 months after surgery.
 Conclusion: The most frequent troublesome immediate complication is pharyngocutaneous fistula all of which have been treated conservatively with satisfactory result. Preoperative radiotherapy is an important risk factor for the development of pharyngocutaneous fistula in total laryngectomy.
 Bangladesh J Otorhinolaryngol; April 2019; 25(1): 10-18

Comparison of pharyngocutaneous fistula closure with and without bacterial cellulose in a rat model

ObjectiveThe present study aimed to compare the effects of bacterial cellulose used for closure of pharyngocutaneous fistulae, a complication of total laryngectomy, with those of primary sutures in a rat model. MethodsThirty female Sprague-Dawley underwent experimental pharyngoesophagotomy and were grouped depending on the material used for pharyngocutaneous fistula closure: group I, which received primary sutures alone, group II, which received bacterial cellulose alone; and group III, which received both. After 7 days, the rats were sacrificed. Pharyngocutaneous fistula development was assessed, the gross wound was inspected, and histological examination was conducted. ResultsPharyngocutaneous fistulae developed in 12 rats (41%) in all: 6 from group I (21%), 4 from group II (14%) and 2 from group III (7%). ConclusionFibroblast density and inflammatory cell infiltration were significantly greater in group III than group I. We concluded that bacterial cellulose may be useful for pharyngocutaneous fistula closure.

Clinical profile of post-operative complications of total laryngectomy for laryngeal carcinoma: a 12-year observation in Sokoto, Nigeria

Background: Laryngeal carcinoma is the most common malignancy of the head and neck. Objective: To determine the pattern of post-operative complications following total laryngectomy and to highlight the predisposing factors in our centre. Methodology: This was a retrospective chart review of 30 patients who consented to total laryngectomy following histologically confirmed laryngeal carcinoma from December 2000 to December 2012. Results: In the 12years under review, 30 (58.8%) patients consented to total laryngectomy. Twenty-three (76.7%) were males, while 7 (23.3%) were females, with a male: female ratio of 3.3:1. The age range was 20–75years, with a mean age of 50.1years. Post-operative complications were observed in 20 (66.7%) patients. The most common post-operative complications in this study were wound infection and pharyngocutaneous fistula, 4 (20%) cases, each. Others were tracheostomal stenosis 2 (10%), carotid blow out haemorrhage 3 (15%), stomal recurrence 2 (10%), pharyngeal stenosis 3 (15%) and hypocalcaemia 2 (10%). Common organisms isolated from wound swab were the pseudomonas species, which were treated with appropriate antibiotics. Predisposing factors observed in this study were middle age, cigarette smoking, co-existing medical condition, clinical and histologically high-grade cancer. Conclusion: Meticulous pre-operative planning, good surgical technique and post-operative care will reduce these devastating complications. Keywords: Cigarette smoking, haemorrhage, otorhinolaryngology, pharyngocutaneous fistula

Transient hyperthyroidism after total laryngectomy for laryngeal cancer.

Thyroid damage is a complication of total laryngectomy (TL) and may be caused by manipulation of the gland. There are isolated descriptions in the literature related to transient hyperthyroidism (HT) post-head and neck surgery. The aim of this study was to determine the frequency of HT after TL and to evaluate its relationship with the surgical procedure. Retrospective cohort study. Forty-four patients were included and stratified in Group 1 (TL + pharyngectomy), and Group 2 (TL + neck dissection). Post-op thyroid function was measured in all patients. Results were analyzed with chi square plus Yates and OR (p<0.05). Twenty-four patients (54.6%) developed HT, with a mean TSH 0.11±0.09 uU/ml and a median FT4 1.5 ng/dl (1.2-1.8, IQR 0.30). Four patients (16.6%) required a pharmacological approach, because of their clinical course. Patients in Group 1 showed significantly more hyperthyroidism compared to Group 2 (p=0.04, OR 4, CI 95% CI,1.03-15.53). All became euthyroid before discharge. We found a high prevalence of HT after TL, and it was related indeed to the surgical procedure. All patients became euthyroid before discharge. We suggest to check thyroid function in routine lab tests in this setting. The hypothetical repercussion of these findings on resting energy expenditure and haemodynamics requires further studies.

Using a sternocleidomastoid muscle flap to prevent postoperative pharyngocutaneous fistula after total laryngectomy: a study of 88 cases.

Complications of total laryngectomy can have serious implications for the final outcome of treatment, including pharyngocutaneous fistula. We conducted a retrospective study of surgical techniques to determine how to best prevent or decrease the incidence of pharyngocutaneous fistula following total laryngectomy. We reviewed the hospital records of all patients who had undergone total laryngectomy for laryngeal carcinoma at Ghaem Hospital in Mashhad, Iran, from March 1989 through February 2005. We identified 88 such patients-80 men and 8 women. We divided this cohort into two groups according to the type of pharyngeal defect closure they received. A total of 37 patients-31 men and 6 women (mean age: 61.4 ± 5.9 yr) underwent primary closure along with a sternocleidomastoid muscle (SCMM) flap (flap group). The other 51 patients-49 men and 2 women (mean age: 61.3 ± 4.4 yr)-underwent standard primary closure without creation of an SCMM flap (nonflap group). Overall, postoperative pharyngocutaneous fistula occurred in 9 of the 88 patients (10.2%)-1 case in the flap group (2.7%) and 8 cases in the nonflap group (15.7%). The difference between the two groups was statistically significant (p < 0.001; odds ratio = 0.612, 95% confidence interval = 0.451 to 0.832), independent of other factors. We found no correlation between fistula development and age (p = 0.073), sex (p = 0.065), or tumor location (p = 0.435). Likewise, we found no correlation between tumor location and either sex (p = 0.140) or age (p = 0.241). We conclude that including an SCMM flap in the surgical process would significantly decrease the development of fistula, regardless of age, sex, and tumor site.

Emergency department care of a patient after a total laryngectomy

Patients who have undergone a total laryngectomy have altered anatomy and physiology. This results in unique and specific issues that must be recognized in order to ensure that this group of patients experience appropriate care. This article looks at the current literature and attempts to highlight specific areas of concern, so that emergency care providers can deliver an equally high standard of care to this patient group as they do to others. A Medline and Google scholar search was conducted using phrases associated with the complications of total laryngectomy. The results were analyzed to identify the most relevant articles that meet our objective. Articles were then organized into the different subheadings used within the article and reviewed. The most up-to-date articles or those that were in the opinion of the authors the most appropriate to convey our objective were included in our review.

Pharyngocutaneous fistula after salvage laryngectomy: Impact of interval between radiotherapy and surgery, and performance of bilateral neck dissection

Pharyngocutaneous fistula is a serious complication of total laryngectomy. The purpose of this study was to examine predisposing factors at our institution. We conducted a retrospective review of 94 consecutive patients undergoing total laryngectomy. Cases with hypopharyngeal primary tumors or undergoing extended hypopharyngeal resection with flap augmentation of the pharynx were excluded. Seventy-four cases met inclusion criteria. A total of 25.7% patients developed a pharyngocutaneous fistula. The fistula rate was higher after salvage laryngectomy than after primary surgery (34.0% vs 11.1%; p = .05). Among salvage laryngectomies, performance of laryngectomy within 1 year of completion of radiotherapy (p = .006) and performance of concomitant bilateral neck dissection (p = .02) were significant risk factors for development of a fistula. Radiation dose, addition of chemotherapy, use of pectoralis major myofascial flap, preoperative tracheostomy, primary puncture, primary tumor subsite, and initial T classification were not significant. Interval between completion of radiotherapy and surgery is significantly associated with pharyngocutaneous fistula after salvage total laryngectomy.

Complications of total laryngectomy in the era of chemoradiation

As more total laryngectomies (TLE) are nowadays performed as salvage procedures, the rate of postoperative complications increases. The primary aim was to report the rates of postoperative local complications for total laryngectomy in patients with previous radiotherapy or chemoradiotherapy (RT/CRT) in comparison with primary TLE data. We attempted to identify patient- and tumor-related factors predictive of postoperative pharyngocutaneous fistula (PCF) formation. The secondary aims were to analyze the survival rate in relation to postoperative complications and to study prognostic factors of survival in TLE patients. A retrospective study was conducted in 208 patients. Logistic regression was used to determine the most significant risk factors for fistula formation. Survival was analyzed by the Kaplan-Meier method, log-rank test, and Cox multivariate regression. PCF developed in 20.7% of cases. In the group of patients with previous RT/CRT, the fistula rate was significantly higher (34%). In multivariate analysis, significant risk factors for fistula formation were previous radiotherapy or chemoradiotherapy (p = 0.02), higher N classification (p = 0.03), and procedure performed by a less experienced surgeon (p = 0.003). The survival and recurrence rates were not influenced by PCF formation. The overall survival rates were lower in patients with previous RT/CRT and in patients with lymph node involvement.

Dilatation of the pharyngoesophagus following total laryngectomy; repair with fascia lata.

A REVIEW of the medical literature fails to reveal any specific reports of dilatation of the pharyngoesophagus as a complication of total laryngectomy. The condition is not rare, for one frequently encounters postlaryngectomy cases in which a bulging of the lower portion of the neck is seen on swallowing and on exercising esophageal speech. There is also a complaint of a gurgling sound on swallowing and speaking. While the dilatation of the pharyngoesophagus is relatively common, we had never seen a case that was severe enough to require repair. The patient we are reporting had such a large dilatation that he had difficulty in swallowing, which interfered with his nutrition. He also was unable to master esophageal speech. It is understandable that dilatation of the pharyngoesophagus occurs frequently following removal of the larynx. To a very great degree, if not completely, the extrinsic support of the pharyngoesophagus is removed by