Estudo funcional da voz e da deglutição na laringectomia supracricóide

Abstract

To identify the grade and evolution of dysphagia and dysphonia in patients undergoing supracricoid laringectomy, and to study the association of these findings with clinical and surgical variables. Method: The study included 22 cases undergoing supracricoid laringectomy at the Head and Neck Surgery and Otolaryngology Department of the Heliopolis Hospital -Brasil, and referred to speech therapy. Dysphagia and dysphonia were correlated with gender, age, stage T (T1, T2, T3, T4), primary site (supraglottis, glottis or subglottis), preservation of one or two arytenoids, reconstructive procedures (cricohyoidopexy or cricohyoido epiglotopexy), time to withdraw the naso-enteral tube, and time to close the tracheostomy. Statistical tests included the Chi-square and/or Fischer's exact test. Results: We observed an association between moderate grade dysphagia and the glottis as the primary site, cricohyoidoepiglotopexy as the type of reconstruction and naso-enteral tube removal within one month after the surgery. There was also an association between severe dysphagia and the supraglottis as the primary site. Dysphagia and dysphonia were associated in the degree of severity; however a larger number of patients had better progression of dysphagia compared to the progression of dysphonia. There was no statistical significance between other associations. Conclusion: Improvement of swallowing is more frequent than improvement of dysphagia. There is an association between moderate dysphagia and the glotttis as primary site, cricohyoidoepiglotopexy and naso-enteral tube removal within one month after surgery.

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

“…Regarding the characteristics of the neoglottis and its interference with voice production and deglutition functions, the literature has shown an association between these functions and the type of reconstruction; furthermore, published studies have analyzed the effects of the presence of one or two arytenoids on supracricoid laryngectomy outcomes. In a previous study, Nemr et al 11 observed 22 cases (7 CHP and 15 CHEP) and found that the glottis was the primary site associated with moderate dysphagia, and that the supraglottis was primarily associated with severe dysphagia. The progression of dysphagia was better than that of dysphonia; in addition, the degree of dysphagia and dysphonia was not associated with the presence of one or two arytenoids.…”

“…In the auditory-perceptual analysis of voice, strain and loudness deviation were considered severe, which corroborates the reports in the literature that patients who underwent subtotal laryngectomy maintain marked dysphonia. 7 11 23 Relative to the overall vocal deviation grade, the qualitative analysis showed that dysphonia was moderate among the participants who had not undergone arytenoidectomy, and that it was severe among those with a single preserved arytenoid. The difference in the overall voice deviation grade according to the functionality of the remaining arytenoid, in absolute numbers, was practically the same.…”

“…The sample consisted of male patients over 50 years old who had undergone supracricoid laryngectomy with reconstruction using CHEP, and the majority were classified as T2/T3 in accordance with the case series reported in the literature. 3 5 6 11 20 21 Schindler et al 6 published an extensive review of supracricoid laryngectomy procedures in which 28% of 25 articles had samples smaller than 20 cases. Many studies do not focus specifically on supracricoid laryngectomies, comparing them with other types of surgical procedures.…”

“…The literature indicates controversy regarding the impact of arytenoidectomy; the need for further studies to explore in detail the issue of preserving one or two arytenoids has been emphasized. 6 11 In addition, little is known about the functional conditions of the remaining arytenoid(s) in these cases.…”

Avaliação de voz e qualidade de vida após laringectomia supracricóide

“…The stage and localization of the larynx tumor is what defines the treatment (4) . The neoplasm resection through supracricoid laryngectomy was initially described by Majer and Rieder, in 1959 and later by Labayle and Bismuth, around 1972, being considered a subtotal laryngectomy (5,6) . It was idealized in order to avoid total laryngectomy in patients with tumor, in which traditional partial procedures would be contraindicated, including those advanced and recurrent from primary treatment (6) .…”