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Improving the functional outcome of Tucker's reconstructive laryngectomy
- Source :
- Head & Neck. 23:871-878
- Publication Year :
- 2001
- Publisher :
- Wiley, 2001.
-
Abstract
- BACKGROUND: The goal of reconstructive laryngectomy addressing glottic carcinoma, as described by Tucker, is twofold: achieve local control and preserve as much as possible the physiological laryngeal function. METHODS: The study consisted of long-term assessment of oncological, deglutitory, and vocal outcome in 34 patients following Tucker's reconstructive laryngectomy. Postoperative follow-up included fiberscopic examination, videoradiography, and voice assessment after speech rehabilitation. RESULTS: The 5-year overall survival rate was 92% +/- 5%. Fiberscopic examination and videoradiography contributed to observing and understanding the rehabilitation process and impairment to its progress. Two main compensatory movements were identified: the anticipatory backward movement of the tongue base (50%) and the anticipatory upward laryngeal motion (15%). Both movements occurred simultaneously at the beginning of the pharyngeal stage of the swallow (35%). The median duration prior to tracheostomy tube removal was 14 days. Swallowing of solids resumed on day 9 (median), and liquid intake (water and soup) resumed on day 12 (median). The median duration of hospitalization was 16 days. Following speech rehabilitation, the latest follow-up visit measured as follows: the mean conversational voice intensity at 64 dB (range, 57-79 dB); the mean maximum intensity at 87 dB (range, 78-96 dB); the minimum intensity at 54 dB (range, 45-65 dB); the mean maximum phonation time at 16 seconds (range, 10-29 seconds); and the mean phonation quotient at 284 mL/second (range, 205-341 mL/second). According to our classification, voice spectral analysis revealed 19 class-III patients, 12 class-II patients, and three class-I patients. CONCLUSION: Tucker's reconstructive laryngectomy is reliable in terms of both the oncological and functional outcome. Fiberscopic examination and videoradiography are two complementary methods for assessing postoperative deglutition.
- Subjects :
- Adult
Glottis
medicine.medical_specialty
Voice Quality
medicine.medical_treatment
Oral Surgical Procedures
Laryngectomy
Swallowing
medicine
Humans
Phonation
Laryngeal Neoplasms
Aged
Rehabilitation
business.industry
Length of Stay
Middle Aged
Plastic Surgery Procedures
Deglutition
Surgery
Intensity (physics)
Plastic surgery
Treatment Outcome
medicine.anatomical_structure
Otorhinolaryngology
Glottic cancer
business
Subjects
Details
- ISSN :
- 10970347 and 10433074
- Volume :
- 23
- Database :
- OpenAIRE
- Journal :
- Head & Neck
- Accession number :
- edsair.doi.dedup.....54625364b834a699c69dcababfc858e5