Complications and Functional Outcome after Supracricoid Partial Laryngectomy with Cricohyoidoepiglottopexy

Abstract

We present a review of the postoperative course, complications, and functional outcome of 190 patients consecutively treated with supracricoid partial laryngectomy with cricohyoidoepiglottopexy. The average times until removal of the tracheostomy and nasogastric feeding tubes were 9 and 16 days, respectively. The postoperative mortality rate was 1%. Major complications included pneumonia from aspiration, cervical wound infection, symptomatic laryngocele, ruptured pexis, laryngeal chondroradionecrosis, and laryngeal stenosis in 8.5%, 4.2%, 3.1%, 1%, 0.5%, and 0.5% of the patients, respectively. Completion total laryngectomy, permanent gastrostomy, and permanent tracheostomy were requested in 0.5% of the patients. Normal swallowing without gastrostomy and respiration without tracheostomy was achieved by the first postoperative year in 98.4% (187/190) of the patients. This article presents a univariate analysis of the potential correlation between various variables and the duration of tracheostomy and the length of time the nasogastric feeding tubes were inserted, the mortality incidence and causes, the incidence and type of the various complications, and the duration of hospitalization. Comparison of our data with the reported functional results after vertical partial laryngectomy suggested that supracricoid partial laryngectomy with cricohyoidoepiglottopexy does not result in an increased rate of postoperative complications.

Prognostic role of pneumonia in supracricoid and supraglottic laryngectomies

“…Despite this selection, PP still represents the most frequent potentially life-threatening complication in partial laryngectomized patients, requiring more intensive care, delay rehabilitation and discharge from the hospital and inevitably leading to greater health care costs. 3 In our series, PP had an incidence of 16.8%. Being postoperative deaths confined amongst PP patients with peri-operative mortality in this group of 4.2%, thus highlight the clinical relevance of such a complication.…”

“…The mean follow-up time was 67.9 months (range 60-300 months). We defined a patient affected by PP if at least three of the following conditions were found: temperature above 37.5°C, purulent sputum with an increase in volume (>20%), positive blood and/or sputum culture, white cell blood count more than 10,000/mm 3 or less than 3000/mm 3 , positive findings at chest X-rays, persistent localised signs on chest examination (crackles, bronchial breathing and wheeze).…”

“…1 Partial excision of the larynx with alteration of its physiological mechanisms affects not only the phonatory but also the swallowing function with possible aspiration that can lead to life-threatening complications, mainly pneumonia. 2,3 Despite any attempt to preserve and reconstruct a normal physiology of the larynx, conservative approaches, such as supraglottic and supracricoid partial laryngectomies cause a consistent alteration of the laryngeal anatomy and physiology affecting laryngeal elevation, laryngeal closure and bolus progression. These impaired function need to be managed by postoperative swallowing rehabilitation.…”

Estudo funcional da voz e da deglutição na laringectomia supracricóide

“…In some studies there are reports of normalization and/or significant improvements in voice and swallowing up to one year following surgery. 12,[18][19][20] In our series, the nasoenteric tube was removed in 9 patients within the first month after surgery; the nasoenteric tube was removed after the first postoperative month in the remaining 11 patients. Nasoenteric tube removal within one month following surgery has been reported in literature.15 Nasoenteric tube permanence is relevant as it affects the quality of life of patients as well as the clinical strategy.…”

Laringectomia supracricóide (chep) para câncer glótico

“…O tempo médio até a retirada da traqueostomia e cateter nasoenteral foi maior que de outros estudos [19][20][21][22] , este fato pode ser explicado pela baixa condição socioeconômica dos nossos pacientes.…”