Subtotal laryngectomy with myomucosal shunt

Chandrachud, H. R.; Chaurasia, Madhup; Sinha, K. P.

doi:10.1017/s0022215100156725

Cited by 16 publications

(8 citation statements)

References 11 publications

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“…The second potential criticism of the NTL procedure is the technical challenge associated with any new technique. In fact, a review of the literature revealed only three other authors who reported experience with the NTL, all at European institutions 6‐8 . In this report, we describe three minor modifications of the NTL procedure.…”

Section: Discussionmentioning

confidence: 85%

“…The NTL is now an accepted alternative to TL for patients with glottic cancer, as well as supraglottic, base of tongue, and hypopharyngeal cancers 3 . Although quite good oncologic 4 and physiologic 5 results have been reported, the use of this technique has thus far been reported subsequently in only small series from the non‐American literature 6‐8 . One reason may be that at approximately the same time that the NTL was introduced, Singer and Blom 9 began popularizing the technique of tracheoesophageal puncture (TEP), 10 which has had a high success rate due in large part to newly developed silicone prostheses.…”

Section: Introductionmentioning

confidence: 99%

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Potential Success of Near‐Total Laryngectomy Despite Postoperative Radiation Therapy

Terris¹,

Fee²,

Goffinet³

1996

The Laryngoscope

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Advanced laryngeal cancers frequently require total laryngectomy (TL). Some of these cancers, however, are suitable for near-total laryngectomy (NTL). We review our experience with NTL over a 14-year period and compare the functional results with those obtained over the same period using TL followed by tracheoesophageal puncture (TEP). One particular interest was the results achieved when surgery was preceded or followed by radiation therapy. From January 1980 through December 1994, 22 patients underwent NTL. The mean age of the 19 men (86.4%) and 3 women (13.6%) was 61.1 +/- 9.9 years. Follow-up ranged from 4 to 109 months, with a mean of 26.5 months. The local control rate was 90.9% (i.e., 20 of the 22 patients). Over the same time period, 11 TEPs were performed in 7 men (63.6%) and 4 women (36.4%) who had a mean age of 60.4 +/- 7.2 years. Compared with the TEP group, the patients in the NTL group had higher mean scores for swallowing, aspiration, and voice quality evaluations, although the differences were not statistically significant. Notably, 21 of 22 patients (95.5%) received preoperative or postoperative radiotherapy. Complications in the NTL group included aspiration, dilated shunt appendix, and inadequate tracheopharyngeal shunt function. Slight modifications of the NTL technique, including routine entrance into the vallecula in uninvolved larynges, the use of contralateral pyriform mucosa flaps, and the performance of an H-flap tracheostomy are described. The NTL is a sound oncologic procedure for tumors causing vocal cord fixation, and it can be successful even when postoperative radiotherapy is administered. The quality of speech, the ease of swallowing, and the incidence of aspiration are similar to those in patients who have had a TEP following TL.

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Section: Discussionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Potential Success of Near‐Total Laryngectomy Despite Postoperative Radiation Therapy

Terris¹,

Fee²,

Goffinet³

1996

The Laryngoscope

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“…The incidence of successful speech outcomes ranges from 74 to 100 per cent. 4,8,9,11,12,[14][15][16][17][18]20,21,[23][24][25][26][27][28][29][30][31][32][33][34] The results of various studies are summarised in Table II. In the previously published series, we analysed the speech outcomes of 150 patients with carcinoma of the larynx and pyriform fossa who underwent neartotal laryngectomy at our institution. Intelligible speech was acquired by 90 per cent of these patients.…”

Section: Presence Of Speechmentioning

confidence: 99%

Current status of near-total laryngectomy: review

2012

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Concurrent chemoradiation is currently the accepted 'standard of care' for locally advanced laryngeal and hypopharyngeal cancers. However, there is a subset of patients not suitable for chemoradiation, in whom primary surgery is the best option. Speech preservation is of prime importance in these patients. Near-total laryngectomy is a voice-preserving procedure which can be considered as an alternative to total laryngectomy for selected patients with lateralised, locally advanced cancers of the larynx and hypopharynx. Although these patients are left with a permanent tracheostomy, lung-powered speech is maintained by way of a dynamic shunt created from the uninvolved tissues of the larynx. Since its first description in the early 1980s, the procedure has been shown by various authors to be oncologically sound, with high success rates. Unfortunately, the procedure has not gained wide acceptance due to perceived fears of surgical complexity. In this review, we discuss the various issues related to the procedure and we review the relevant literature.

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“…Near-total laryngectomy has not gained widespread approval, and few series have been published in the Englishlanguage literature. [9][10][11][12][13][14] The perception of the operative technique as complicated by many surgeons and the widespread and convenient application of tracheoesophageal puncture procedure are among possible causes for this reluctance to perform near-total laryngectomy.…”

mentioning

confidence: 99%