TLM as a primary treatment for advanced oropharyngeal malignancy confers excellent survival and swallowing proficiency.

Patients: A total of 117 patients with pathologically confirmed T2 to T4 lesions, stage III or stage IV, glottic or supraglottic carcinoma of the larynx were treated with TLM from 1997 to 2004. All patients had a minimum follow-up period of 2 years. Interventions: Transoral laser microsurgery in 117 patients, neck dissection in 91 patients, and adjuvant radiotherapy in 45 patients. Main Outcome Measures: End points analyzed included laryngeal preservation, overall survival, diseasefree survival, local control, locoregional control, and distant metastases. Postoperative complications, tracheotomy rate, and feeding-tube dependence were also examined. Results: The median follow-up period among surviving patients was 5 years. At 2 years, the percentage of patients with an intact larynx after treatment was 92%. The 2-year local control and locoregional control rates were 82% and 77%, respectively. The 2-year disease-free and overall survival rates were 68% and 75%, respectively. The 5-year Kaplan-Meier estimates were local control, 74%; locoregional, control, 68%; disease-free survival, 58%; overall survival, 55%; and distant metastases, 14%. Four patients (3%) experienced treatment-related deaths. Seven patients (6%) experienced a postoperative hemorrhage. Of those patients with organ preservation and no disease recurrence, 2 patients (3%) were tracheotomy dependent, and 4 patients (7%) were feedingtube dependent. Conclusions: In patients with advanced laryngeal cancer, TLM with or without radiotherapy is a valid treatment strategy for organ preservation. Furthermore, low morbidity and mortality and excellent oncologic and functional outcomes make TLM an attractive therapeutic option.

Objective: To develop a simple and straightforward functional outcome swallowing scale (FOSS) for patients with oropharyngeal dysphagia to determine the severity of the disorder and the effectiveness of therapy or outcome. Design: Five years ago, the author developed a dysphagia staging scale based on personal experience and a review of the English literature. This scale was shared with colleagues from the specialties of otolaryngology, speech pathology, neurology, and gastroenterology, both within and outside the author’s institution. Minor modifications have been made. The scale has been used in clinical management and retrospective studies. Setting: Patients were seen in a multispecialty, tertiary care, academic center. Patients: The patient population included the full spectrum of oropharyngeal dysphagia in adults, but was weighted heavily toward aging patients and patients with head and neck cancer, neurologic disorders, gastroesophageal conditions, and psychiatric problems. Results: The stages are as follows: stage 0 = normal function and asymptomatic; stage I = normal function but with episodic or daily symptoms of dysphagia; stage II = compensated abnormal function manifested by significant dietary modifications or prolonged mealtime (without weight loss or aspiration); stage III = decompensated abnormal function with weight loss of 10% or less of body weight over 6 months due to dysphagia, or daily cough, gagging, or aspiration during meals; stage IV = severely decompensated abnormal function with weight loss of more than 10% of body weight over 6 months due to dysphagia, or severe aspiration with bronchopulmonary complications, nonoral feeding recommended for most of nutrition, and stage V = nonoral feeding for all nutrition. Conclusions: The FOSS was successful for staging various adult patients with dysphagia into clinically useful, overall performance categories. It has been applied successfully to retrospective outcome studies and to clinical management by clinicians from different specialties.

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Transoral laser surgery is a safe and effective treatment for select early and advanced previously untreated squamous cell cancer of the tongue base. In addition, the low morbidity and mortality and shortened duration of hospitalization associated with TLM make it an attractive therapeutic alternative.

Transoral laser microsurgery is one of the options to be considered for the treatment of squamous cell cancer involving the anterior commissure of the larynx.

Transoral laser microsurgery offers select patients an attractive alternative salvage surgical therapy to the recurrent and second primary tumor site.

The clinical records of 225 patients undergoing primary or salvage near-total laryngectomy (NTL) for laryngeal and pyriform cancer were analyzed for local control and morbidity. If the primary cancer was laryngeal in origin, patients underwent a simple NTL; if it was pyriform, a minor modification called near-total laryngopharyngectomy (NTLP) was used. When NTLP was extended to include necessary portions of the tongue base or posterior pharyngeal wall, pharyngeal reconstructions were added. The principal outcomes studied were 1) 5-year local control of the primary cancer, 2) achievement of lung-powered shunt speech, and 3) incidence of aspiration. The local control of cancer was similar to that expected with total laryngectomy or laryngopharyngectomy. Conversational voice was achieved in 85% of patients surviving beyond 1 year. Some patients required additional surgery for voice -- usually endoscopic dilation. Aspiration was absent if primary healing was achieved. It was troublesome in wound breakdown if the shunt was directly affected. Secondary anti-aspiration procedures were required in 9% of our patients -- usually preserving shunt speech.