Supracricoid Laryngectomy: The Function of the Remaining Arytenoid in Voice and Swallowing

Abstract

Introduction Supracricoid laryngectomy still has selected indications; there are few studies in the literature, and the case series are limited, a fact that stimulates the development of new studies to further elucidate the structural and functional aspects of the procedure. Objective To assess voice and deglutition parameters according to the number of preserved arytenoids. Methods Eleven patients who underwent subtotal laryngectomy with cricohyoidoepiglottopexy were evaluated by laryngeal nasofibroscopy, videofluoroscopy, and auditory-perceptual, acoustic, and voice pleasantness analyses, after resuming oral feeding. Results Functional abnormalities were detected in two out of the three patients who underwent arytenoidectomy, and in six patients from the remainder of the sample. Almost half of the sample presented silent laryngeal penetration and/or vallecular/hypopharyngeal stasis on the videofluoroscopy. The mean voice analysis scores indicated moderate vocal deviation, roughness and breathiness; severe strain and loudness deviation; shorter maximum phonation time; the presence of noise; and high third and fourth formant values. The voices were rated as unpleasant. There was no difference in the number and functionality of the remaining arytenoids as prognostic factors for deglutition; however, in the qualitative analysis, favorable voice and deglutition outcomes were more common among patients who did not undergo arytenoidectomy and had normal functional conditions. Conclusion The number and functionality of the preserved arytenoids were not found to be prognostic factors for favorable deglutition efficiency outcomes. However, the qualitative analysis showed that the preservation of both arytenoids and the absence of functional abnormalities were associated with more satisfactory voice and deglutition patterns.

RETRACTED: Effect of the Mendelsohn maneuver and swallowing training in patients with senile vascular dementia complicated with dysphagia

“…In our study, the serum levels of IL-1, IL-6, and TNF-a in the OG were decreased after the intervention and were lower than those in the CG, consistent with previous studies. 18 The reason might be that the Mendelsohn maneuver and swallowing training repeatedly stimulate the peripheral sensors, activate the neurons, promote microcirculation in ischemic areas of the brain, facilitate neuron regeneration, alleviate brain injury and local inflammatory responses, reduce the release of inflammatory factors, and consequently decrease the level of serum inflammatory factors. 19,20 As cerebrovascular diseases lead to hypoperfusion in the brain area that controls cognition and behavior, patients with vascular dementia complicated with dysphagia have neurological deficits, which cause cognitive dysfunction and reduce their ADL capability.…”

Swallowing, voice and quality of life of patients submitted to extended supratracheal laryngectomy

“…(5) The benefits of providing thin liquids and exclusive oral feeding are improvement in the QoL. (5,17) There was a greater impact on voice than on swallowing function, probably due to the resection of both vocal folds and vestibular folds. (3,23) The overall severity and roughness were considered moderate characteristics in CAPE V, due to the structural and functional remnants of the resection.…”

“…(12,13,16) Its reconstruction is described with two variations: tracheohyoidopexy (THP), which consists of the maintenance of both or only one cricoarytenoid unit (CAU); tracheohyoidoepiglottopexy (THEP) with preservation of the epiglottis, maintaining two or only one CAU. (17,18) In cases in which resection is broader than that predicted by the described technique, as in STL reports with extension to the base of tongue, adjacent tissue or arytenoids, we add to the nomenclature the term "extended" or "modified" STL. (19)(20)(21) In the specialized literature, there is evidence of functional complications following horizontal partial laryngectomies, in regarding to breathing, voice and swallowing, with a low incidence of permanent tracheostomies.…”

Supracricoid partial laryngectomy with cricohyoidoepiglottopexy for patients with laryngeal cicatricial stenosis: Safety and efficacy

“…SCL‐CHEP is a mature surgical procedure that has been widely used to treat malignant laryngeal tumors with good laryngeal function results 26‐31 . There are also limited reports of its use in laryngeal trauma 6,7 .…”