Emergency treatment of tracheal tear during pharyngolaryngectomy.
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Longitudinal tracheal tear (of the trachealis muscle), an unusual but acknowledged complication of pharyngolaryngectomy, was encountered during a total pharyngo-oesophagolaryngectomy with gastric replacement. Due to serious ventilatory difficulties a rapid repair was required to obtain an airtight seal to allow continued mechanical ventilation. A reinforced polytetrafluoroethylene (PTFE) vascular graft was used as an intratracheal stent to seal the air leak. This technique proved effective and the tracheal defect had healed by the time the stent was removed 10 days later. (+info)
Management of hypopharyngeal carcinoma: a 6-year review.
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A retrospective review of 16 consecutive cases of squamous carcinoma of the hypopharynx treated by pharyngo-laryngo-oesophagectomy (PLO) and gastric transposition with a thoracotomy as part of the surgical technique is presented. An operative mortality of 6% and a hospital mortality of 12% occurred. Other complications are discussed. No significant morbidity or mortality occurred as a result of the thoracotomy. A comparison is made with the extra-thoracic technique of gastric transposition. (+info)
Synovial sarcoma: a rare tumor of larynx.
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Synovial sarcoma is a soft tissue sarcoma of unknown histogenesis and occurs predominantly in the lower extremities of young adults. The head and neck is a relative rare location. There are about 10 cases with laryngeal localization in the literature. We present a 24 year-old male with an endolaryngeal mass. Incisional biopsy and the hemilaryngectomy material revealed a biphasic synovial sarcoma. One year later a local recurrence occurred. Tumor excision and neck dissection were performed. Radiotherapy was added. Six months later lung metastases was discovered on thoracic CT. The patient received chemotherapy for 6 courses. The metastases responded well to chemotherapy and the patient is now alive without tumor on radiological and clinical examination after 3.5 years of follow-up. (+info)
Vocal analysis after vertical partial laryngectomy.
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It is generally believed that a reconstruction of the glottic region after a vertical partial laryngectomy (VPL) can improve the glottic and supraglottic function. However, there is a paucity of reports on secondary healing without a glottic reconstruction after a VPL. The aim of this study was to obtain objective phonatory data after a VPL without a glottic reconstruction. From 1993 to 2001, 13 patients, who had been treated with VPL without a glottic reconstruction, were enrolled in this study. Patients with a postoperative follow up of less than 12 months were excluded. Seven lesions were classified as T1 glottic cancer and six as T2 glottic cancer- standard VPL (11 cases) and frontolateral VPL (2 cases). Acoustic ((fundamental frequency, Fo), jitter, shimmer, the noise to harmonic ratio (NHR)), aerodynamic (maximal phonation time (MPT), mean flow rate (MFR)) analysis and videostroboscopy were performed to evaluate the voice. There were significant differences in the Fo, jitter, shimmer, NHR, MPT and MFR between the VPL group and normal control group. In videostroboscopy, the following tendencies were observed in many cases: incomplete glottic closure, a decreased and irregular mucosal wave and amplitude, supraglottic voicing, abnormal arytenoid movement and anterior commissure blunting. Objective phonatory data after VPL without a glottic reconstruction was obtained. The voice quality after a VPL without a glottic reconstruction was somewhat unsatisfactory. A further comparison with other different surgical techniques of a VPL would help determine a better way of improving the voice quality in these patients. (+info)
Grouped skin metastases from laryngeal squamous cell carcinoma and overview of similar cases.
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Cutaneous metastases from internal malignancies or primary skin cancers are uncommon, particularly in a grouped pattern. We report a 58-year-old man with a known case of laryngeal squamous cell carcinoma who underwent radiotherapy after surgical excision of the tumor. Unilateral, grouped, red-brown, vesicle-like nodules appeared on his shoulder 9 months after the laryngeal surgery. The pathologic diagnosis of an excised nodule was metastatic squamous cell carcinoma. (+info)
Management of T1-T2 glottic carcinomas.
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T1-T2 glottic carcinomas may be treated with conservative surgery or radiotherapy. The goals of treatment are cure and laryngeal voice preservation. The aim of the current study was to review the pertinent literature and discuss the optimal management of early-stage laryngeal carcinoma. Literature review indicated that the local control, laryngeal preservation, and survival rates of patients were similar after transoral laser resection, open partial laryngectomy, and radiotherapy. Voice quality depended on the extent of resection for patients undergoing surgery; results for patients undergoing laser resection for limited lesions were comparable to the corresponding results for patients receiving radiotherapy, whereas open partial laryngectomy yielded poorer results. Costs were similar for laser resection and radiotherapy, but open partial laryngectomy was more expensive. Patients with well defined lesions suitable for transoral laser excision with a good functional outcome were treated with either laser or radiotherapy. The remaining patients were optimally treated with radiotherapy. Open partial laryngectomy was reserved for patients with locally recurrent tumors. (+info)
Tobacco use outcomes among patients with head and neck carcinoma treated for nicotine dependence: a matched-pair analysis.
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BACKGROUND: The current study described tobacco use outcomes among patients with head and neck carcinoma who underwent treatment for nicotine dependence at the Mayo Clinic Nicotine Dependence Center (NDC; Rochester, MN). METHODS: Using a 1:1 matched-pair design, conditional logistic regression was employed to compare the 6-month tobacco abstinence outcomes of patients with head and neck carcinoma (n = 101) with controls (n = 101) from the general patient population treated for nicotine dependence between 1988 and 2001. The two groups were matched with regard to age, gender, date of treatment, and type of NDC treatment service. RESULTS: Baseline demographics were similar between both groups. However, patients with head and neck carcinoma smoked significantly more cigarettes per day (cpd) than controls (P = 0.003). The self-reported tobacco abstinence rate at the 6-month follow-up was 33% for patients with head and neck carcinoma compared with 26% for matched controls (P = 0.279; after adjusting for baseline cpd and stage of change, P = 0.205). Among patients with head and neck carcinoma, the tobacco abstinence rates were 47%, 22%, and 19%, respectively, for those receiving an NDC consult within 3 months, between 3 months and 5 years, and > 5 years after their diagnosis (P = 0.021). Furthermore, the patients with head and neck carcinoma treated within 3 months of diagnosis who received surgery (with or without radiation therapy) were more likely to be tobacco abstinent than those who received primary radiation therapy (P = 0.042). CONCLUSIONS: These findings suggested that nicotine dependence treatments were effective among patients with head and neck carcinoma, particularly when delivered shortly after initial diagnosis and for those who received surgery as their primary treatment. (+info)
The information needs of head and neck cancer patients prior to surgery.
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OBJECTIVE: To describe the common themes in the experiences and expressed information needs of patients undergoing head and neck surgery. Summary background data : Patients who suffer head and neck cancers and undergo surgery often report considerable psychological distress and impaired social functioning. To optimise survival, the decision about what treatment option to follow is often made quickly, with little support in terms of counselling or the provision of information. There is inadequate previous work exploring the content and delivery of information required by patients at this time. PATIENTS AND METHODS: Participants included patients who had undergone surgery for head or neck cancer (n=29) and their immediate relatives who were present at the initial consultation with the surgeon (n=13). Patients were recruited from out-patient departments in two hospitals in the north of England. All interviews were conducted in participants' homes and were guided by a semistructured interview schedule devised both from literature and a pilot study. RESULTS: Whilst most participants felt well informed about the surgical procedure they were undergoing, many reported feeling unprepared for the long-term lifestyle changes that occurred. Information, support and advice throughout the 3-6 months postoperative period was reported to be inadequate. The majority of participants did not ask any questions and did not perceive there was a choice regarding treatment. Individuals who wanted to take an active role in decision-making reported difficulties accessing information to enable them to do so. CONCLUSION: The findings of this study emphasise the need for individualised information provision defined not exclusively by the surgical procedure. (+info)