Functional outcomes after different types of transoral supraglottic laryngectomy

Abstract

4 Laryngoscope, 126:1131-1135, 2016.

Transoral laser microsurgery as primary treatment for selected T3 glottic and supraglottic cancers

“…Moreover, salvage surgery after failed TLM in supraglottic tumors may be performed by all types of open partial laryngectomies, including horizontal supraglottic and supracricoid procedures, whereas in case of recurrent T3 glottic lesions the most frequent salvage surgical procedure is still total laryngectomy. 23,24 Even though this study was not specifically designed for evaluation of functional outcomes, addressed in other reports from our institutions, 9,25,26 it clearly confirms how reduced morbidity of TLM in early T categories does not seem to be greatly influenced by its application in more advanced lesions, such as those described in the present report. Undoubtedly, the incidence of major surgical and medical complications is lower than those commonly reported after open partial laryngectomies and nonsurgical organ preservation protocols.…”

“…Even though this study was not specifically designed for evaluation of functional outcomes, addressed in other reports from our institutions, it clearly confirms how reduced morbidity of TLM in early T categories does not seem to be greatly influenced by its application in more advanced lesions, such as those described in the present report. Undoubtedly, the incidence of major surgical and medical complications is lower than those commonly reported after open partial laryngectomies and nonsurgical organ preservation protocols .…”

Clinical relevance of endoscopic three‐dimensional imaging for quantitative assessment of phonation

“…The clinical measurement of these irregular and asymmetric vocal fold vibrations is affected by the lack of absolute two‐dimensional (2D) measurements and the lack of 3D imaging techniques that are essential to examine the 3D phonation process appropriately. A direct comparison of absolute sizes and amplitudes is not only highly desirable for an evaluation of the vocal folds, but equally for substitute voice generation in the case of laryngectomy …”

Could laser‐assisted dissection of the pre‐epiglottic space affect functional outcome after ESL?

“…Comparing our matched groups, 0 of 15 (0%) ESL patients and one of 15 (6%) treated with OPHL type I developed postoperative ab ingestis pneumonia. In the available literature on the topic, the rate of secondary total laryngectomy for persistent aspiration is in the range of 3.5% to 12.5% after OPHL type I, and 0% to 1% after ESL . None of the patients considered in our sample underwent total laryngectomy due to functional failure after conservative surgery.…”

“…The airway is invariably damaged, making a temporary tracheostomy unavoidable (standard surgery). The advantages of endoscopic surgery also naturally imply lower healthcare costs …”