Frontolateral Laryngectomy Research Articles

LARYNGEAL CANCER SURGICAL RESULTS; 10 YEARS OF EXPERIENCE

OBJECTIVE: In this study, it was aimed to present the patients who underwent open laryngectomy in a tertiary otolaryngology clinic with current literature information in terms of age, gender, first symptom and duration, histopathological diagnosis, localization of the primary disease, neck condition, and our surgical treatment approach and results. MATERIAL AND METHODS: In this study, the retrospective analysis of the files of 70 patients who underwent open surgical treatment for laryngeal cancer between 2011 and 2021 in a tertiary otorhinolaryngology clinic is discussed. RESULTS: Of our laryngeal cancer cases, 68 (97.1%) were male, 2 (2.9%) were female, and their mean age was 64.9 (48-89 years). Thirty-four (48.57%) of our cases were glottic, 23 (32.9%) supraglottic, and 11 (15.7%) transglottic. There were 2 (2.85%) cases with isolated subglottic locations. Total laryngectomy was performed in 38 (54.3%) cases and partial laryngectomy was performed in 32 (45.7%) cases. Vertical laryngectomy in 1 (1.42%) of patients, subtotal laryngectomy in 1 (1.42%), frontolateral laryngectomy in 6 (8.57%), supraglottic horizontal laryngectomy in 10 (14.28%), supracricoid in 14 (20%) patients laryngectomy was performed. As a histopathological diagnosis; 3 (4.2%) cases of baso-squamous carcinoma, and the remaining 67 (95.8%) cases were squamous cell carcinoma. CONCLUSIONS: Surgery has an important place in the treatment of laryngeal cancers and neck dissection is complementary to regional control. Occult metastases in the cervical region cannot be determined using noninvasive methods, neck dissection is required to identify them. Detailed histopathological evaluation of lymph nodes removed during neck dissection is currently the most reliable method available for accurate diagnosis of lymph nodes.

Association of the Specimen and Tumor Bed Margin Status with Local Recurrence and Survival in Open Partial Laryngectomy.

Background/Objectives: Positive margins are associated with locoregional recurrence in early laryngeal cancer. The aim of this study was to evaluate the impacts of specimen-driven (ex vivo) positive margins on patients with early-stage laryngeal cancer whose tumor bed (defect-driven) margins had been negative. Methods: A retrospective study was performed on 60 consecutive T1b/T2 glottic cancer patients who underwent open frontolateral laryngectomy. The intraoperative margins were obtained from the tumor bed. Their recurrence and disease-free survival were evaluated. In all cases, negative margins were obtained from the surgical bed. The impact of positive margins from the specimen was evaluated in a paraffin study. Results: Among 10 patients with positive margins in the specimen, six experienced local relapse, and among 50 patients with negative margins in the specimen, three developed recurrence. The 5-year disease-free survival rates were 37.5% and 93.9%, respectively (p < 0.001; log-rank). Even with negative margins in the surgical bed, patients with positive margins in the specimen at the final histopathological examination had a 3.5-fold higher chance of developing local recurrence than those with negative margins (HR = 13.993; 95% CI: 3.479-56.281; p < 0.001; univariate Cox regression). Conclusions: Specimen-driven positive margins represent a significant risk factor for local recurrence, even under negative margins at the tumor bed.

Deglutition Assessment, Using Fiberoptic Endoscopic Evaluation of Swallowing in Patients underwent Frontolateral Laryngectomy

Objective: To assess the long-term deglutition in patients undergone frontolateral laryngectomy (FL) by fiberoptic endoscopic evaluation of swallowing (FEES) and to identify factors that might influence the swallowing outcomes of these patients Materials and Methods: A cross-sectional descriptive study in patients undergone FL between 2004 and 2014 with postoperative time of 6 months or more. Three parameters: premature spillage of material, retention/pooling of material, and the presence of penetration or aspiration were evaluated. All parameters were graded from one (severe) to five (normal). Results: Total of 36 patients, 31 male and 5 female, with mean age of 58±12.9 years were included in the present study. Twenty-nine cases (80.6%) presented with stage I glottis cancers and 7 cases (19.4%) presented with stage II glottis-subglottic cancers. For their treatment by surgery, 30 cases (83.3%) underwent FL and 6 cases (16.7%) underwent extended FL. Swallowing function was determined to be normal in 27 cases (75%), however, 6 cases (16.7%) had mild residue accumulation after food swallowing, whereas 3 cases (8.3%) had moderate symptoms of either minimal pharyngeal stasis plus unsafe airway or moderate pharyngeal residue accumulation. When considering each factor that may worsen post-operative swallowing function, the results suggested that there were significant associations with age of ≥65 years old (p=0.036), tumor stage II (p=0.049), and the presence of postoperative wound infection (p=0.012). Conclusion: In the present study, the authors confirmed that FL had minimal impacts on swallowing functions as the majority of patients who underwent FL recovered normal or near-normal swallowing function after 6 months as determined by FEES. However, long-term swallowing functions should be monitored especially in older patients (≥65 years of age), or patients with tumor stage II or postoperative wound infection. Keywords: Frontolateral laryngectomy; Glottic cancer; Fiberoptic endoscopic evaluation of swallowing; FEES; Penetration and aspiration; Deglutition

COMPARISON OF SWALLOWING IN DIFFERENT TYPES OF PARTIAL LARYNGECTOMIES

Objective: We designed this study to assess and compare the effects of different partial laryngectomy (PL) techniques on swallowing. Material and Methods: Ten patients had laryngofissure with cordectomy, ten had frontal anterior laryngectomy with epiglottic reconstruction (FAL), ten had frontolateral laryngectomy (FLL), ten had cricohyoidopexy (CHP), ten had cricohyoidoepiglottopexy (CHEP), and ten had supraglotic laryngectomy. Swallowing was assessed with flexible endoscopy. Results: Mild or moderate dysphagia for solid foods was discovered significantly more often in CHP patients compared to FLL and FAL (p&lt;0.05) patients. Dysphagia discoveries for semi-solid and liquid food didn’t significantly differ among PL’s (p&gt;0.05). Compared to other PLs, the penetration-aspiration test with 10 ml of water was distinctly lower in cordectomy and FLL patients (p&lt;0.05). Conclusion: Penetration and aspiration with 10 ml of water was marked lower in cordectomy and FLL patients matched to other PL patients. With studies involving more patients, it will be possible to increase the evidence value of our results.

Clinical results of partial frontolateral laryngectomy in our therapy facility

Clinical results of partial frontolateral laryngectomy in our therapy facility

Morphological Evaluation of Thyroid Cartilage Invasion in Early Glottic Tumors Involving the Anterior Commissure

Introduction: The anterior commissure is an area of glottic cancer infiltration, even in early stages. Objective: To evaluate the invasion by tumors into the anterior commissure cartilage in surgical specimens of frontolateral laryngectomy. Methods: Forty-eight patients who had undergone frontolateral laryngectomy for T1b/T2 squamous cell carcinoma were included. Epidemiological and clinical aspects as well as morphological histopathological analysis were evaluated. Results: Of the 48 patients, 42 (87.5%) had T1b lesions and 6 (12.5%) had T2. Thirty-four cases (70.8%) showed healthy tissue between the tumor and the thyroid cartilage, 10 cases (20.8%) had a tumor in close proximity to the cartilage, and in 4 cases (8.3%) there was cartilage invasion. There was no major risk of adverse outcome in the groups with infiltration or tumor adjacent to the cartilage. Level of differentiation, mitotic index, nuclear irregularity, and the presence of nucleolus and tumor necrosis were not related to cartilage invasion. Conclusion: The infiltration of thyroid cartilage occurred in 8.3% of tumors and did not change the outcome in patients submitted to frontolateral laryngectomy. The morphological characteristics did not present any statistical significance.

Vertical partial frontolateral laryngectomy with simultaneous pedunculated sternothyroid muscle flap reconstruction of the vocal fold - surgical procedure and treatment outcomes.

The aim of the study was to present the treatment outcomes after vertical partial laryngectomy with or without pedunculated sternothyroid muscle flap reconstruction following the resection of neoplasm-infiltrated vocal fold. The procedure was used in a patient with glottic cancer. Oncological outcomes, morphology of neo-vocal fold and the act of swallowing were evaluated. 45 patients with T1-T2 glottic cancer were subjected to vertical partial laryngectomy with 26 patients undergoing a procedure with pedunculated sternothyroid muscle flap reconstruction and the remaining 19 patients undergoing a procedure without such a reconstruction. Two female and 43 male patients aged 35-82 years (mean age of 62.5 years) were enrolled in the study. Local tumor spread and the condition of reconstructed vocal fold were assessed in sequential videofiberoscopy examination conducted each month after surgery whereas the regional spread was assessed in ultrasound scans. Postoperative aspiration was graded according to the Pearson's scale. Six patients experienced local recurrence while 2 patients experienced regional recurrence of the tumor. The pedunculated sternothyroid muscle flap neo-fold was structurally resemblant of the non-affected vocal fold. Episodic, daily dysphagia was observed in 1 patient while normal act of swallowing with no Pearson's scale symptoms was observed in the remaining 44 patients. No necrosis of pedunculated flap was observed. Vertical partial laryngectomy with or without pedunculated sternothyroid muscle flap reconstruction is a good method for the treatment of low- or intermediate-stage glottic cancer, especially when endoscopic access to the tumor is limited and when CO2 laser cannot be used. No significant functional disorders were observed in operated larynges.

Analysis of Recurrence after Frontolateral Laryngectomy.

This study aimed to evaluate the recurrence and survival of patients treated with frontolateral laryngectomy for T1 and T2 glottic laryngeal carcinoma. Patients who underwent frontolateral laryngectomy for glottic laryngeal carcinoma at a tertiary hospital between March 2009 and June 2014 were included. Patient demographics, tumor stage, treatment and histopathological examination data, and adjuvant therapy details were evaluated. Thirty patients with T1aN0, T1bN0, and T2N0 vocal fold carcinoma were examined. The mean follow-up duration was 40 months. Of the 30 patients, nine (30%) were stage T1 and 21 (70%) were in stage T2. Twenty-nine patients were males and one was female, and the mean age was 59 (range, 42-81) years. During follow-up, local recurrence was observed in four patients following frontolateral laryngectomy. Six patients continued smoking after frontolateral laryngectomy, of which three developed tumor recurrence. The local control rate was poor in patients with anterior commissure involvement (66.6%) compared with those with no involvement (95.2%). Two of four patients with local recurrence were treated with salvage total laryngectomy and adjuvant postoperative radiotherapy; the remaining two were treated with only radiotherapy. One patient who was treated with only radiotherapy developed lung metastasis during follow-up and died because of distant metastasis. Frontolateral laryngectomy is an efficient choice of treatment for selected cases of T1 and T2 glottic laryngeal carcinoma.

A pilot study about speech changes after partial Tucker’s laryngectomy: the reduction of regressive voicing assimilation

Partial frontolateral laryngectomy (PL) is performed to remove larynx tumor while preserving its main functions. So far, the speech changes induced by difficulties of voicing and the alterations to the vocal tract due to PL have been seldom addressed. The goal of our study was to make an acoustic analysis of regressive voicing assimilation (RVA) among patients after PL and to study the relationship with rates of speech. A retrospective study was conducted from January to April 2013. 11 subjects treated by partial frontolateral laryngectomy, and ten healthy subjects were included. Functional recordings of voice were analyzed and compared. For assimilation sequences we found a significant modification of voicing ratio in healthy subjects (p < 0.05) and PL patient at accelerated speaking rate only (p < 0.05). The vowel duration is significantly modified only for healthy subjects. For all subjects (PL patients and healthy) the duration of C1 consonant was not significantly modified. Our results highlight the presence of RVA in healthy subjects, but also in PL patients in the rapid speaking mode.

Comparative videostroboscopic analysis after different external partial laryngectomies

After external partial laryngectomias, videostroborscopy is very usefull in evaluation of postoperative phonatory mehanisms showing the "slow motion" of the vibrations of the remaining laryngeal structures. The aim of this paper was to compare the videostroboscopic characteristics of the vibration and to establish the differences in the phonation mechanisms depending on the type of external partial laryngectomy performed. This prospective study was conducted during the period 2003-2009 at the Ear, Nose and Throat Clinic, Clinical Center of Vojvodina, Novi Sad, including 99 patients with laryngeal carcinoma, treated with open surgical approach using different types of vertical and horizontal partial laryngectomy. Videostroboscopy was used to analyse vibrations of the remaining laryngeal structures. The dominant vibration structure after partial horizontal laryngectomy, chordectomy, frontolateral laryngectomy and three quarter laryngectomy was the remaining vocal fold, after hemilaryngectomy it was the false vocal fold and after subtotal and near total laryngectomy it was the arythenoid. In patients with supracricoid hemilaryngopharyngectomy performed, many different structures were involved in the vibration. After most of the partial laryngectomies, vibrations can be found in the reconstructed part of the defect. In both horizontal and vertical partial laryngectomies movements of the larynx during phonation were mostly medial, while in cricohyoidoglottopexies they were anterior-posterior. Most of the operated patients (72.7%) had insufficient occlusion of the neoglottis during the phonation. Videostroboscopy is a useful method in examining the phonation mechanisms of reconstructed laryngeal structures after partial laryngectomy as well as in planning postoperative voice therapy.

Analysis of swallowing after partial frontolateral laryngectomy with epiglottic reconstruction for glottic cancer

The aim of the study was to evaluate swallowing using a reproducible objective methodology and to seek preoperative factors that could influence swallowing outcomes in patients operated on for partial laryngectomy. Twenty-four patients who underwent partial frontolateral laryngectomy with epiglottic reconstruction for T1bN0 or T2N0 glottic carcinoma between 2008 and 2012 were retrospectively evaluated. Using fiberoptic endoscopic and videofluoroscopic evaluation, early (15 days postoperatively) and late (2 months postoperatively) scores were obtained for all patients to quantify their swallowing skills. Eighty-three percent of patients achieved at least partial oral feeding at time of hospital discharge and 87.5% achieved exclusive oral feeding within 2 months postoperatively. Early score was good or excellent in 50%, average in 4.2% and poor in 41.8%. Regarding late scores, 63% were classified as having a good or excellent late score, 7 patients (29%) were classified as "middle result" because their time to recover was longer (i.e. between 1 and 2 months postoperatively), and two patients had a poor late score. Finally, at last follow-up, only one patient was partially fed by gastrostomy (180 days after surgery). T stage (p = 0.04) was the only factor influencing early swallowing outcomes and length of hospital stay was longer for poor scores than for good late results (p = 0.02). Our findings show good outcomes in terms of postoperative swallowing. Objective assessment of deglutition is essential for a better understanding of the mechanisms of postoperative swallowing disorders and for patient selection.

Frontolateral Laryngectomy with Imbrication Laryngoplasty for Stage I Glottic Carcinoma

Frontolateral Laryngectomy with Imbrication Laryngoplasty for Stage I Glottic Carcinoma

An Unusual Cause of Hoarseness: Rhabdomyosarcoma of the Larynx

Laryngeal sarcomas account for <1% of laryngeal malignancies. Laryngeal spindle cell rhabdomyosarcomas (RMS) are rare with only a few reports in the literature. Presenting symptoms vary from hoarseness or dysphagia to respiratory failure. Four subdivisions of rhabdomyosarcomas exist including embryonal, alveolar, pleomorphic, and botryoid variant. Worse outcomes have been found in adults versus children. Multimodality therapy remains the mainstay of treatment. Our report describes a case of a 30 year old man with hoarseness discovered to have glottic spindle cell rhabdomyosarcoma. He underwent frontolateral partial laryngectomy followed by chemotherapy and radiation.

Structures Constituting the Sound Source After the Treatment of Early Glottic Cancer

We indicate the exclusive radiation therapy as initial approach for T1a glottic tumors, and the frontolateral laryngectomy for the tumors staged as T1b and selected T2 glottic tumors. The videolaryngostroboscopy is a useful tool to analyze the laryngeal structural changes and compensatory motion after the therapeutic approach. To evaluate the endolaryngeal structures of patients who participate in the vibratory sound source after the early glottic cancer treatment through the videolaryngostroboscopy. It was a retrospective transversal study in which 20 patients who underwent exclusive radiation therapy and 25 patients who underwent frontolateral laryngectomy were analyzed by means of videolaryngostroboscopy. The radiation doses ranged from 5000 to 7020 cGy in the radiation therapy group. The mucosal wave and the vibratory source components were evaluated. All of the irradiated patients presented vibratory behavior, and hyperfunction was occasionally observed in four cases. The mucosal wave source was glottic in 18 cases and mixed in two cases. In the laryngectomy group, 10 supraglottic sources, 10 glottic sources, and five mixed sources were identified. Among the 10 cases of supraglottic source, eight patients presented global constriction and two patients presented medial constriction. Among the five cases of mixed source, two patients presented global constriction, one patient presented medial constriction, and one patient presented anteroposterior constriction. Regarding the number of anatomical structures presenting vibratory pattern, five patients had two structures, four patients had three structures, and one patient had four structures. Patients who underwent radiation therapy recruit less supraglottic structures as vibratory source than the patients undergoing vertical laryngectomy.

Modified fronto-lateral laryngectomy in treatment of glottic T1(a-b) cancer with anterior commissure involvement

Objective Evaluation of clinical and oncological safety of the modified fronto-lateral laryngectomy in the treatment of T1a-b glottic cancer. Methods Retrospective review of charts of patients managed with classical fronto-lateral laryngectomy or with our modified technique using a cervical fascia flap and a false cord flap to reconstruct the defect. Results No recurrence of cancer was observed in the present series and slight dysphonia was present in all cases. The patients managed with classical technique required a revision surgery for granulations or anterior synechia in 4 cases; those managed with modified technique did not need a second intervention. Conclusion The fronto-lateral laryngectomy should be present in the head-neck surgeon armamentarium. In T1a-b glottic cancer this technique gives a good oncological resection, but the postoperative period requires an intensive rehabilitation process. The modification of the classical technique reduces the incidence of a second intervention.

Morfologia głośni i charakterystyka percepcyjno-akustyczna głosu i mowy po laryngektomii fronto-lateralnej poszerzonej z następową epiglotoplastyką

For optimalisation glottis morphology and its phonatory function after frontolateral laryngectomy (FLL) the reconstruction of larynx is made; in Clinic of Otolaryngology the most common is using epiglottis wit or without its vertical incision. the influence of widening laryngeal resection and epiglottis incision on shape of reconstructed glottis, level and degree of phonatory closure and perceptive--acoustic characteristic of voice and speech. 39 patients (38 M and 1 F) after FLL widened of false vocal cord (n = 11), false vocal cord and part of cricoid cartilage (n = 22), whole cricoid cartilage (n = 6). Vertical incision of epiglottis was made in 31 cases. Mean age was 52 (min.-39, max.-70) years. METHODICS: videolaryngoscopic examination, subjective voice estimation using GRBAS scale, objective phonetic--acoustic voice analysis. In videolaryngoscopic examination the most common shape of glottis was irregular triangle (n = 24), rhombus (n = 7), half--moon (n = 2), irregular (n = 6). 2 patients were using whisper. In spectrographic recordings (n = 39) only noise character of stimulation source was in 2 patients, noise--periodic with noise component present in whole acoustic spectrum in 37. F0 for single word and sentence vocalized in affirmative and interrogative form had the value of male voices and its changes during speaking were well noted. In subjective and objective estimation, the worse voice quality was after FLL widened of false vocal cord, part or whole cricoid cartilage. 1) FLL with subsequent epiglottoplasty in 94% of patients makes satisfactory morphologic and biophysical conditions for production of voice and sociological efficient speech. 2) Widening resection of false vocal cord, part or whole cricoid cartilage has unbeneficial influence on perceptive--acoustic characteristic of voice and speech.

Fatores prognósticos e impacto da comorbidade na laringectomia fronto-lateral

To evaluate the survival rates, comorbidity impact, complications, and treatment failure facts. 38 patients clinically staged as T1b / T2N0M0 glottic tumors were analyzed. They underwent frontolateral laryngectomy with reconstruction, from January, 1995 to December, 2006. The oncological outcome, comorbidity (through the Adult Comorbidity Evaluation -27 ACE-27 scale) and complications were studied and correlated to the demographic data and tumor characteristics. Eight patients presented local recurrence being surgically salvaged. Complications were not observed in 33 patients. There was no significant difference on the global and free of disease 5-year survival regarding the diverse comorbidity categories. Only the pathological margins spread of the tumor presented significant difference on the global (p=0.0033) and free of disease survival (p<0.0001). The 5-year global survival was 67.6% whereas the free of disease survival was 73.7%; the comorbidity did not represent independent prognostic factor; the postoperative complications rate was 13.2%; and only the pathological margin spread showed significant difference on the global and free of disease survival rates.

The Relationship Between the Glottic Configuration After Frontolateral Laryngectomy and the Acoustic Voice Analysis

The relative measurement of the anterior commissure synechia (S) is a crucial factor worsening voice quality and the perceptual analysis score has a strong correlation to the synechia's impact. The aim of this study is to correlate the laryngeal configuration regarding the anterior commissure synechia and its relationship with the acoustic vocal parameters. Fifteen male patients underwent frontolateral partial vertical laryngectomy and reconstruction with bipedicle sternohyoid muscle flap for the treatment of T1b/T2 glottic cancer. The patients were free of disease, and the evaluation was performed after a minimum postoperative period of 12 months. Measurements of the anterior commissure synechia and the free border of both the preserved and the reconstructed vocal folds were simultaneously performed with the acoustic analysis of the voice. We calculated the mathematical proportion between the midsagital dimension of the synechia of the anterior commissure and the measurement of the free border of the intermembranous region of each vocal fold-the preserved one and that reconstructed with the bipedicle sternohyoid muscle flap. The acoustic evaluation showed an important increase in the fundamental frequency, and the values of all parameters were changed regardless of the anterior commissure synechia findings. These results suggest that the acoustic voice parameters are always changed because of the aperiodic pattern regardless of the anterior commissure synechia findings.

The Impact of the Glottic Configuration After Frontolateral Laryngectomy on the Perceptual Voice Analysis: A Preliminary Study

The Impact of the Glottic Configuration After Frontolateral Laryngectomy on the Perceptual Voice Analysis: A Preliminary Study

The Impact of the Glottic Configuration After Frontolateral Laryngectomy on the Perceptual Voice Analysis: A Preliminary Study

After the surgical treatment for early glottic carcinoma, the patients end up with voice disturbances in different grades. The aim of this study was to characterize the laryngeal configuration regarding the anterior commissure synechia and its relationship to the perceptual vocal quality. Twenty-five patients underwent frontolateral vertical partial laryngectomy and reconstruction with bipedicle sternohyoid muscle flap resulting from T1b/T2 glottic squamous cell carcinoma from January 1996 to December 2004. Of the 25 patients, 24 were male with a median age of 61 years. The patients were free of disease and the evaluation was performed after a minimum postoperative period of 12 months. Measurements of the anterior commissure synechia and the free border of both vocal folds were simultaneously performed with the perceptual analysis of the voice through GRBAS scale. We calculated the mathematical proportion between the midsagittal dimension of the synechia of the anterior commissure and the measurement of the free border of the intermembranous region of each vocal fold. The higher the relative measurement of the anterior commissure synechia, the worse the overall grade of hoarseness (G) for both vocal folds (P<0.001), the worse the roughness (R) for both vocal folds (P<0.001), and the worse the strained quality (S) for both the reconstructed (P=0.0086) and the preserved (P=0.0026) vocal folds. These results suggest that the relative measurement of the anterior commissure synechia is a crucial factor worsening voice quality and that the perceptual analyses score has a strong correlation to the synechia's impact.