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Objective: To identify the most frequently asked questions regarding "laryngectomy" through an assessment of online search data., Methods: Google Search data based on the search term "laryngectomy" were analyzed using Google Trends and Search Response. The most common People Also Ask (PAA) questions were identified and classified by the concept. Each website linked to its respective PAA question was rated for understandability, ease of reading, and reading grade level., Results: Search popularity for the term "laryngectomy" remained stable between 2017 and 2022. The most popular PAA themes were post-laryngectomy speech, laryngectomy comparison to tracheostomy, stoma and stoma care, survival/recurrence, and post-laryngectomy eating. Of the 32 websites linked to the top 50 PAA's, eleven (34%) were at or below an 8 th grade reading level., Conclusion: Post-laryngectomy speech, eating, survival, the stoma, and the difference between laryngectomy and tracheostomy are the most common topics searched online in relation to "laryngectomy." These are important areas for both patient and healthcare provider education., Level of Evidence: N/A Laryngoscope, 133:2971-2976, 2023., (© 2023 The American Laryngological, Rhinological and Otological Society, Inc.)

Objectives: To investigate the effect of skin incision location for total laryngectomy with pharyngectomy (TLP) on postoperative outcomes including wound dehiscence and infection rate., Study Design: Case series with chart review., Setting: Academic tertiary care center., Methods: A retrospective analysis was conducted of all patients undergoing TLP with flap closure at Johns Hopkins Medical Institutes between August 2005 and February 2013. The effects of patient characteristics and skin incision technique on postoperative wound dehiscence and infection were analyzed using cross-tabulations and multivariate regression modeling., Results: A total of 49 patients were included in the analysis; 31 received low-neck apron (LNA) incisions with an incorporated tracheostoma, while the remaining 18 had mid-neck apron (MNA) incisions with separate tracheostoma fashioned inferior to their incisions. Of these patients, 17 experienced incisional wound dehiscence (35%), and 18 contracted postoperative infections (37%). Generalized linear regression models demonstrated a significantly increased odds of wound dehiscence for patients with LNA incisions (odds ratio 29.8; 95% CI, 1.4-631.5, P = .029). There were no significant predictive variables for postoperative infection., Conclusions: These results demonstrate that the use of a separately fashioned tracheostoma with MNA incision is associated with decreased rate of wound dehiscence in patients undergoing TLP., (© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.)

Post-operative complications can be attributed to technical aspects of surgery, yet no studies have investigated the mechanics behind commonly used incisions for total laryngopharyngectomies (TLP). This procedure, seen in head and neck cancer patients, necessitates free tissue transfer to construct a neo-pharynx, creating an inherently greater risk of complications. We sought to investigate the impact of neck incision location on these post-operative complications for TLP using finite element analysis (FEA). A nonlinear hyperelastic 2-D finite element model was used to evaluate the stress and strain along the incision line of two separate neck incision models commonly used for TLP: low-neck apron (LNA) incisions that incorporate the patient׳s tracheostoma and mid-neck apron (MNA) incisions that do not communicate with the tracheostoma. A constant displacement was applied to the incision to simulate normal neck extension experienced during the post-operative phase. Each neck incision was also modeled at varying strain energy densities to simulate various stages of wound healing. For a constant displacement of 40mm, the principal von Mises stress of the LNA incision varied between 5.87 and 6.41MPa, depending on the hyperelastic properties of the healing incision. This stress was concentrated at the junction of the incision and the fixed tracheostomal edge. The MNA model demonstrated a principal von Mises stress that varied between 0.558 and 0.711MPa and was concentrated along the midline of the neck incision. MNA incisions for TL patients result in principal von Mises stresses which are up to 11 times lower than those seen in LNA incisions. These results coincided with clinical observations from a concurrent study that showed a decrease in rate of wound dehiscence for patients undergoing TLP with an MNA incision., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Importance: The optimal reconstruction of total glossectomy defects with or without total laryngectomy is controversial. Various pedicled and free tissue flaps have been advocated, but long-term data on functional outcomes are not available to date., Objectives: To compare various total glossectomy defect reconstructive techniques used by multiple institutions and to identify factors that may lead to improved long-term speech and swallowing function., Design, Setting, and Participants: A multi-institutional, retrospective review of electronic medical records of patients undergoing total glossectomy at 8 participating institutions between June 1, 2001, and June 30, 2011, who had a minimal survival of 2 years., Intervention: Total glossectomy with or without total laryngectomy., Main Outcomes and Measures: Demographic and surgical factors were compiled and correlated with speech and swallowing outcomes., Results: At the time of the last follow-up, 45% (25 of 55) of patients did not have a gastrostomy tube, and 76% (42 of 55) retained the ability to verbally communicate. Overall, 75% (41 of 55) of patients were tolerating at least minimal nutritional oral intake. Feeding tube dependence was not associated with laryngeal preservation or the reconstructive techniques used, including flap suspension, flap innervation, or type of flap used. Laryngeal preservation was associated with favorable speech outcomes, such as the retained ability to verbally communicate in 97% of those not undergoing total laryngectomy (35 of 36 patients) vs 44% (7 of 16) in those undergoing total laryngectomy (P < .001), as well as those not undergoing total laryngectomy achieving some or all intelligible speech in 85% (29 of 34 patients) compared with 31% (4 of 13) undergoing total laryngectomy achieving the same intelligibility (P < .001)., Conclusions and Relevance: In patients with total glossectomy, feeding tube dependence was not associated with laryngeal preservation or the reconstructive technique, including flap innervation and type of flap used. Laryngeal preservation was associated with favorable speech outcomes such as the retained ability to verbally communicate and higher levels of speech intelligibility.

Background: Following total laryngectomy (TL) or laryngopharyngectomy (TLP), patients may develop strictures that require multiple dilations to treat. However, the risk factors associated with dysphagia refractory to a single dilation are unknown. Methods: Single‐institution retrospective review of patients who underwent at least one stricture dilation after TL/TLP between March 2013 and March 2022. Results: A total of 49 patients underwent stricture dilation after TL/TLP. Thirty‐five (71%) underwent multiple dilations. Pharyngocutaneous fistula, primary chemoradiation therapy, and a shorter time interval from TL/TLP to first dilation were independently associated with dysphagia requiring multiple dilations. Patients in the multiple dilations group had a higher rate of limited diet and G‐tube dependence compared to patients in the single dilation group. Conclusions: Shorter time interval to stricture formation is a prognostic indicator of the need for multiple dilations following TL/TLP. Patients requiring multiple dilations are at increased risk of persistent dysphagia long‐term. [ABSTRACT FROM AUTHOR]

• Similar response to induction selection protocols between T3 and T4 patients. • Induction selection did not compromise survival compared to total laryngectomy. • Select T4 patients may benefit from induction selection for organ preservation. Neoadjuvant chemotherapy for induction selection of definitive treatment (IS) protocols have shown excellent outcomes for organ preservation and survival in patients with T3 laryngeal squamous cell carcinoma (LSCC). We seek to evaluate survival and organ preservation outcomes in T4 LSCC patients treated with IS protocols. Retrospective cohort of advanced T3 and T4 LSCC patients who underwent IS protocols based upon potential for preserving a functional larynx. Patients received one neoadjuvant cycle of platinum-based chemotherapy with either 5-fluorouracil or docetaxel or with two cycles of platinum-based chemotherapy with docetaxel and a Bcl-2 inhibitor. Patients who achieved ≥ 50 % response as determined by radiographic review and/or endoscopic evaluation received definitive chemoradiation. Patients who had < 50 % response after IS underwent total laryngectomy (TL) followed by post-operative radiation +/- chemotherapy. Amongst T4 patients, 114 met inclusion criteria including 89 who underwent IS protocols and 25 who received an upfront TL. In total, 76.0 % of T3 patients and 71.9 % of T4 patients responded to IS and underwent definitive chemoradiation. There was no significant difference in hazard of death between T4 IS and T4 TL patients (HR: 0.9, p = 0.86). Among responders, there was no significant difference in 5-year laryngectomy-free survival (T3 – 59.6 %, T4 44.3 %, p = 0.15) or laryngeal preservation by T stage (T3 – 72.8 %, T4 – 73.0 %, p = 0.84). Select T4 patients may benefit from organ preservation using IS protocols with similar response rates to patients with T3 tumors, without compromising survival when compared to upfront TL. [ABSTRACT FROM AUTHOR]

Background: Although many patients achieve serviceable speech after total laryngectomy (TL), others are limited by un‐naturally low pitch. We describe a cadaveric study to provide proof of concept for a novel voice prosthesis after TL with free tissue laryngoplasty. Methods: Devices were implanted into fresh frozen cadavers after TL and free tissue laryngoplasty. Phonation pressures were measured using a custom Blom‐Singer Manometer (InHealth Technologies, Carpinteria, CA) and acoustic files were analyzed using Praat, a speech analysis software. Results: Two fresh frozen cadavers were implanted with the voice prosthesis. Both prostheses demonstrated appropriate stenting of the laryngoplasty. Successful sound production was achieved after airflow generation at the proximal trachea. An average phonation pressure of 3.5 cmH2O (SD 1.7 cmH2O) was necessary to generate a sound intensity of 80.6 dB (SD 0.2 dB) at an average fundamental frequency of 299.5 Hz (SD 112.6 Hz). Conclusions: The novel voice prosthesis described herein offers a feasible voice generation mechanism. [ABSTRACT FROM AUTHOR]