Atypical neoglottis after supracricoid laryngectomy: a morphological and functional analysis

Abstract

The objective of this study was to analyze atypical neoglottis after supracricoid subtotal laryngectomy (SSL) from a morphological and functional point-of-view using retrospective case series reviewin a Tertiary university referral center setting. From May 2003 until January 2010, 106 patients underwent SSL (CHEP, CHP, THEP, THP) for laryngeal cancer, in the Otolaryngology Department of the University Hospital of Modena. We performed a retrospective analysis of recorded videos in our database of patients who underwent SSL. Patients with atypical neoglottis were included in the study. Six patients with atypical neoglottis were identified and morphologically evaluated. The functional outcomes were collected and analyzed. Atypical neoglottis may form after SSL, in particular in the case of CHEP. In most cases, these atypical conformations are due to anomalous positioning of the epiglottis, or involvement of the lateral pharyngeal wall in the sphincteric and vibratory function of the neoglottis. Atypical neoglottis formation seems to guarantee adequate functional outcomes in terms of vocal and swallowing performance.

Desvantagem vocal e estratégias de enfrentamento nas disfonias após laringectomias

“…Its results have been satisfactory either for the preservation of the organ as for the functional benefits (1,2,3,4,5,6,7) . However, despite such reports, the subjects' vocal self-assessment and the analysis related to the vocal handicap did not reveal differences between both groups.…”

“…Self-assessment of vocal quality performed by groups supracricoid partial laryngectomy and total laryngectomy Studies show divergences of opinions concerning vocal quality, considering that communication goes beyond an impaired voice (24,25,26) . Some authors defended the patients' satisfaction with their voice in the presence of an intelligible communication (4,24,27) . Others defended that the most affected aspect was communication, which is responsible for the worst impacts upon quality of life (8) .…”

“…Supracricoid partial laryngectomy (SCPL) has been pointed out as advantageous when compared to total laryngectomy (TL), especially considering that it aims to preserve part of the organ (1,2,3,4,5,6,7) . Survival rates of SCPL are similar to the TL ones (6,8) , although it may benefit the patient by not using permanent tracheostomy.…”

“…Survival rates of SCPL are similar to the TL ones (6,8) , although it may benefit the patient by not using permanent tracheostomy. The vocal quality after SCPL is characterized as hoarse and breathy (2) , however intelligible, allowing the patient to keep an effective voice for his communication (1) and has low impact on social activities, contributing for a better quality of life (1,3,4,5,9,10) . The TL, however, is still one of the main procedures in the treatment of laryngeal cancer and the patient needs to learn a new way of verbal communication and deal with breathing and swallowing changes, which will certainly interfere in his life (11) .…”

Supracricoid laryngectomy and dysphagia: A systematic literature review

“…Other limitations of this literature search result from our inclusion and exclusion criteria. A lot of studies were excluded because of their limited patient population, whereas a few studies were excluded because TNM stage was not well documented or the study was published in or before 1990 …”