Frontolateral Partial Laryngectomy Research Articles

Voice disorder classification using speech enhancement and deep learning models

With the recent development of speech-enabled interactive systems using artificial agents, there has been substantial interest in the analysis and classification of voice disorders to provide more inclusive systems for people living with specific speech and language impairments. In this paper, a two-stage framework is proposed to perform an accurate classification of diverse voice pathologies. The first stage consists of speech enhancement processing based on the original premise, which considers impaired voice as a noisy signal. To put this hypothesis into practice, the noise lestral harmonic-to-noise ratio (CHNR). The second stage consists of a convolutional neural network with long short-term memory (CNN-LSTM) architecture designed to learn complex features from spectrograms of the first-stage enhanced signals. A new sinusoidal rectified unit (SinRU) is proposed to be used as an activation function by the CNN-LSTM network. The experiments are carried out by using two subsets of the Saarbruecken voice database (SVD) with different etiologies covering eight pathologies. The first subset contains voice recordings of patients with vocal cordectomy, psychogenic dysphonia, pachydermia laryngis and frontolateral partial laryngectomy, and the second subset contains voice recordings of patients with vocal fold polyp, chronic laryngitis, functional dysphonia, and vocal cord paresis. Dysarthria severity levels identification in Nemours and Torgo databases is also carried out. The experimental results showed that using the minimum mean square error (MMSE)-based signal enhancer prior to the CNN-LSTM network using SinRU, led to a significant improvement in the automatic classification of the investigated voice disorders and dysarhtria severity levels. These findings support the hypothesis that using an appropriate speech enhancement preprocessing has positive effects on the accuracy of the automatic classification of voice pathologies thanks to the reduction of the intrinsic noise induced by the voice impairment.

Local recurrence of iodine refractory thyroid cancers. Surgicaltherapy options for larynx and trachea infiltration

Local recurrence of thyroid carcinomas can result in tumor infiltration in the lower region of the larynx. Since these tumors typically no longer store iodine, treatment options are greatly limited. The present study describes our experience with laryngo-tracheal resection of such cases of local recurrence. From July 2019 to November 2020, we treated five patients with malignant infiltration of the trachea and larynx due to local recurrence of a thyroid carcinoma. We performed laryngo-tracheal resection with end-to-end anastomosis in four patients and frontolateral partial laryngectomy in one patient. The median length of hospital stay was 6 days (5-14). An R0 resection was performed in two patients. Problems with the anastomosis or bilateral recurrent laryngeal nerve paralysis was not seen in any of the patients. One patient had to be reintubated on the second postoperative day due to lung failure. He was able to be extubated after five days. High tracheal resection with partial resection of the larynx was able to be performed with minimal risk. Although radical resections are rare, they expand oncological treatment options in the case of local recurrence of thyroid carcinomas that are iodine-refractory. High tracheal resection could be part of the oncological treatment spectrum in the case of local recurrence of thyroid carcinomas that no longer store iodine.

Clinical results of partial frontolateral laryngectomy in our therapy facility

Clinical results of partial frontolateral laryngectomy in our therapy facility

Objective and Subjective Comparison of the Quality of Voice Between Two Available Surgical Approaches in T1b Glottic Cancer

Background: This study aimed to assess differences in the quality of voice results of open frontolateral partial laryngectomy with imbrications laryngoplasty and transoral laser microsurgery in T1b glottic carcinoma. Methods: In this randomized clinical trial, 20 patients with T1b glottic cancer who were candidates for surgery were randomly (using the blocked randomization method) assigned to schedule for frontolateral partial laryngectomy with imbrications laryngoplasty (n = 7) or transoral laser microsurgery (Va extended cordectomy) (n = 10). The objective and subjective voice results were assessed using voice analysis parameters (jitter, shimmer, harmonics to noise ratio, and maximum phonation time). The Voice Handicap Index (VHI) questionnaire was used with 30 statements consisting of three domains including functional, physical, and emotional aspects of voice disorders. Results: No statistically significant differences were noted between laser surgery and open procedure in objective voice analysis parameters. The voice was significantly disturbed after both procedures but subjective analysis of the voice by the VHI questionnaire showed more statistically significant patients’ satisfaction in the laser group. The mean VHI was 77.29 ± 8.51 after vertical hemilaryngectomy and 65.60 ± 13.08 after laser cordectomy that was significantly lower in the latter procedure (P = 0.042). Conclusions: Despite the imbrications of laryngoplasty in open surgery, no statistically significant differences were noted in objective voice parameters. However, more patients’ satisfaction was noted regarding voice in laser surgery. When considering modality, we need to assess factors such as individual anatomic factors, complete tumor exposure (depth of tumor in anterior commissure), professional needs, quality of life, and cost-effectiveness. With regard to the semi-invasive nature of laser use and more patients’ satisfaction based on the VHI questionnaire, this method is prioritized in comparison with the surgical procedure as vertical hemilaryngectomy.

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.

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.

A Clinical Study of 109 Cases of Glottic Squamous Cell Carcinoma

A total of 109 patients with glottic squamous cell carcinoma were retrospectively evaluated at Hyogo College of Medicine Hospital between 2003 and 2010; 106 patients were male and 3 patients were female, with a median age of 69 years (range, 51-90 years). According to the 7th edition of the Union for International Cancer Control TNM classification, the clinical TN stages were T1aN0 in 47 cases, T1aN1 in 1 case, T1aN2a in 1 case, T1bN0 in 19 cases, T3N0 in 11 cases, T4aN in 5 cases, and T4aN2b in 1 case. No distant metastasis was observed in any cases at initial treatment. Treatments were radiotherapy alone in 75 cases, concurrent chemo-radiotherapy in 20 cases, supra-cricoid laryngectomy in 1 case, and total laryngectomy in 13 cases. Salvage surgery was performed for 14 patients who had undergone radiotherapy or concurrent chemo-radiotherapy. Salvage surgeries included frontolateral partial laryngectomy in 8 cases, supra-cricoid laryngectomy in 2 cases, and total laryngectomy in 4 cases. The 5-year overall survival rate was 77.6%, and the 5-year disease-specific survival rate was 92.5%. The 5-year laryngeal preservation rate was 82.9%. With regard to T-stages, the laryngeal preservation rates were 100% for T1a, 89.5% for T1b, 91.5% for T2, 18.2% for T3, and 16.7% for T4a.

Voice Outcome of Modified Frontolateral Partial Laryngectomy in Excised Canine Larynges and Finite Element Model.

To evaluate vocal parameters after modified frontolateral partial laryngectomy (MFLPL) and frontolateral partial laryngectomy (FLPL) in both excised canine and finite element models. FLPL and MFLPL were compared, using a prospective paired case control laboratory study with excised canine larynx and computational modeling. Basic science study conducted in university laboratory. FLPL and MFLPL were performed serially on 9 excised canine larynges. The excised larynx bench apparatus was used to collect phonation threshold pressure (PTP) and high-speed video data. A finite element model was built to compare a normal vocal fold with applied tension, a cut fold with no applied tension (simulating FLPL), and a cut fold with applied tension (simulating MFLPL). Stress values and distributions across the 3 conditions were computed. The mean PTP increase after MFLPL (15.45-17.46 cmH2O) was not statistically significant. In the excised canine model, fundamental frequency (F0) showed a significant increase for the MFLPL (P = .039). Differences in vibration amplitudes were not statistically significant. Von Mises stress distribution was most similar between the MFLPL model and the normal fold. Maximum von Mises stresses at the midline were 17.56, 21.63, and 5.10 kPa for the normal, MFLPL, and FLPL, respectively, and 47.57, 63.98, and 101.97 kPa at the peripheries. From these results, we conclude that MFLPL has the potential to give a better voice outcome while avoiding tracheotomy in partial laryngectomy patients. In vivo study in canines to examine the healing process would lend further evidence-based support for this surgical method.

A modified false vocal fold flap for functional reconstruction after frontolateral partial laryngectomy: a comparison with conventional open resection and laser cordectomy.

Objective: To describe a modified flap technique (MFT) involving the use of a false vocal fold flap for glottic reconstruction and the removal of arytenoid cartilage and to compare it with conventional frontolateral partial laryngectomy (FLPL) and laser cordectomy (LC).Methods: Twenty-eight MFT, 13 FLPL and 12 LC patients completed a standardised questionnaire for assessing aspiration, respiration, quality of life, and subjective voice quality. We analysed vocal function in terms of roughness, breathiness and hoarseness, measured voice range profiles, and performed videoendoscopy. Results: No patient reported respiratory problems. Aspiration occurred in 33.3% (MFT), 41.6% (FLPL) and 16.6% (LC). Voice quality was rated as good/satisfactory by 17 MFT patients (62%), satisfactory/sufficient by 69% of FLKT patients, and sufficient/poor by 75% of LC patients.Conclusions: The modified false vocal fold flap effectively covers defects and creates a neocord that ensures good phonatory rehabilitation and has positive effects on postoperative quality of life.

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.

A Modified Frontolateral Partial Laryngectomy with Laryngeal Framework Reconstruction

Objectives: Endoscopic resection and radiotherapy are organ-preservation strategies for glottic cancer because of the high local control and quality of voice after the therapy. However, frontolateral partial laryngectomy is still needed in some cases. This procedure has the complication of hoarseness. Therefore, we applied the theories of laryngeal framework surgery to partial laryngectomy with reconstruction using strap muscles and skin flap in order to improve postoperative voice qualities. Methods: We performed a modified frontolateral partial laryngectomy in three selected cases (rT1a, T3 cases). The retrospective analysis of voice qualities (PPQ, APQ, NHR, MPT) was performed in 10 frontolateral partial laryngectomy cases (7 conventional and 3 modified methods). Surgical procedure: Frontolateral vertical partial laryngectomy with tumor-free margin was performed via laryngofissure approach. After tumor resection, approximation laryngoplasty was performed using sternothyroid muscle flap that was inserted into posterior dead space to gain better contact of the posterior vocal fold on the reconstructed vocal ridge. After these procedures, a reverted sternohyoid muscle was placed inside the preserved outer perichondrium to reduce dead space and externally medialize cervical skin flap, which shaped new vocal fold. Results: No recurrence was observed in any case. No aspiration and laryngeal stenosis were observed in any case. The postoperative voice qualities were improved over pretreatment qualities in modified cases. PPQ after modifying this method was better than conventional methods. Conclusions: It is better for voice quality to treat selected glottic cancers with this modified frontolateral partial laryngectomy.

Modified frontolateral partial laryngectomy operation: combined muscle-pedicle hyoid bone and thyrohyoid membrane flap in laryngeal reconstruction.

ObjectiveLaryngeal reconstruction is needed to preserve laryngeal function in patients who have undergone extensive vertical or frontal partial laryngectomy. However, the procedure remains a difficult challenge. Several reconstruction techniques have been described, but these techniques pose risks of complications such as laryngeal stenosis. This study aimed to evaluate the postoperative course and functional outcomes of a new technique that combined a muscle-pedicle hyoid bone and a thyrohyoid flap during laryngeal reconstruction after tumor resection.MethodsFour patients underwent extensive vertical partial or frontal partial laryngectomy for cancer. After tumor resection, laryngeal reconstruction was performed using the proposed technique. Postoperative recovery time, complications, and oncologic results were evaluated.ResultsThe four patients were successfully treated with the proposed technique. No dyspnea, dysphagia, or death occurred during the postoperative course. Decannulation was performed after a median of 3 days. The average postoperative hospital stay was 7 days. Short-term postoperative functional recovery was normal. No laryngeal stenosis or tumor recurrence was observed in any of the four patients after a follow-up period of more than 24 months.ConclusionThe combination of the muscle-pedicle hyoid bone and the thyrohyoid flap is a reliable procedure for laryngeal reconstruction after extensive vertical partial or frontal partial laryngectomy.

An empirical study of modified frontolateral partial laryngectomy without tracheotomy

The aim of this study was to validate the feasibility of modified frontolateral partial laryngectomy without tracheotomy using animal experiments. The glottic area before and after surgery of 6 excised canine larynges and 10 canine larynges in vivo were compared to observe whether the glottic area following modified frontolateral partial laryngectomy without tracheotomy is adequate for breathing. Significant differences were observed between the glottic areas of the excised larynges in the initial state and following modified frontolateral partial laryngectomy with the cartilage closed. However, no significant differences were observed between the glottic areas of the excised larynx in the initial state and following modified frontolateral partial laryngectomy with the cartilage open. The glottic area of the larynges in vivo in the initial state and following right chordectomy via laryngofissure were not observed to be significantly different. Furthermore, no significant differences were observed between the glottic areas of the larynges in vivo in the initial state and following modified frontolateral partial laryngectomy without tracheotomy. In conclusion, modified frontolateral partial laryngectomy without tracheotomy is a feasible and efficacious means of eradicating early and selected invasive carcinomas of the larynx, which is supported by animal experiments.

Frontolateral Laryngectomy with Imbrication Laryngoplasty for Stage I Glottic Carcinoma

Frontolateral Laryngectomy with Imbrication Laryngoplasty for Stage I Glottic Carcinoma

Comparison of different surgical approaches in T2 glottic cancer

The purpose of this study was to evaluate retrospectively the oncologic results of endoscopic and open surgical techniques in treating T2 glottic carcinomas. The medical chart of 354 patients with T2 glottic cancer managed with primary surgery were reviewed. Laser microsurgery and frontolateral partial laryngectomy were compared for disease-specific survival and local control rates, incidence of major complications, and related tracheostomies. Additionally, the influence of the anterior commissure invasion on these oncologic parameters was evaluated. No statistically significant differences were found between the surgical procedures regarding our oncologic parameters. A lower incidence of tracheotomies and complications were comparatively found for laser surgery. Tumor invasion of the anterior commissure did not seem to influence the oncologic results. Transoral surgery seems to be the treatment of choice for T2 glottic cancer. In our view, open partial laryngectomy should be reserved for those cases in which the lesion cannot be adequately exposed by direct microlaryngoscopy.

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.

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.

Comparison among different available surgical approaches in T1 glottic cancer

This study aims to assess the oncologic results of open and transoral surgical techniques in T1a and T1b category glottic carcinomas. Retrospective clinical study. The files of 438 T1a and T1b glottic cancer cases managed with primary surgery were reviewed. Transoral laser surgery and open surgical procedures used to treat these cases, including cordectomy, vertical partial laryngectomy, and frontolateral partial laryngectomy, were compared for disease specific survival and local control rates. In addition, all techniques were compared for incidence of major complications and related tracheotomies. No statistically significant differences were noted between laser surgery and open procedures with regard to disease specific survival and local control for both T1a and T1b cases. Laser surgery showed a significantly lower incidence of complications and tracheotomies. Laser surgery appears to be a very effective management modality for T1 glottic cancer with comparable results to open procedures and a lower incidence of complications. A transcervical approach should be reserved only for selected cases where individual anatomic factors do not permit complete tumor exposure during diagnostic microlaryngoscopy.

Modified frontolateral partial laryngectomy without tracheotomy

Objective To investigate the feasibility of modified frontolateral partial laryngectomy without tracheotomy for patients with early-stage laryngeal cancer or dysplasia of the true vocal cord. Study Design After frontolateral partial laryngectomy, the inner side of the sternohyoid muscle was drawn into the laryngeal lumen to suture it to the incisal margin of the uninjured side and to the false vocal cord on the side of the lesion to ensure the safety without tracheotomy. A reverted sternohyoid fascial flap was used to cover the anterior area to form a new laryngeal lumen in the shape of a ladder. Subjects and Methods A total of 65 patients with early glottic carcinomas or severe dysplasia of the true vocal cord were treated with modified frontolateral partial laryngectomy without tracheotomy. Ipsilateral false vocal cord flaps and cervical skin flaps were used in 63 patients and two patients respectively to reconstruct the defect. Results Deglutition and phonation were fully recovered after 7 to 10 days postsurgery. The only postoperative complication was subcutaneous emphysema noted in nine patients. The 1-, 3-, and 5-year survival rates were all 100 percent. Conclusion Modified frontolateral partial laryngectomy without tracheostomy is an effective surgical method for early glottic carcinomas and severe dysplasia of the true vocal cord.

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.