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Prothetische Stimmrehabilitation nach Laryngektomie

Komplikationen und Misserfolge nach vorheriger Bestrahlung

Prosthetic voice rehabilitation after laryngectomy

Failures and complications after previous radiation therapy

  • Phoniatrie und Pädaudiologie
  • Published:
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Zusammenfassung

Hintergrund

Stimmventilprothesen sind „state of the art“ der Stimmrehabilitation nach Laryngektomie. In dieser Studie wurde der Einfluss einer der Protheseneinlage vorausgehenden Bestrahlung auf Erfolg und Komplikationen der Versorgung untersucht.

Patienten/Methoden

Retrospektiv ausgewertet wurden die Krankenakten von 145 Patienten, die mit Stimmventilprothesen (Provox® und Provox2®) versorgt wurden, 17 davon nach vorheriger Bestrahlung.

Ergebnisse

Nach einer Bestrahlung nahm nicht nur das Risiko eines funktionellen Misserfolgs um 2,9 (p=0,023) zu, sondern auch das Risiko shuntassoziierter Komplikationen wie Aspiration neben der Prothese (1,51; p=0,046), Shunterweiterung (2,32; p=0,014), ösophageale (2,51; p=0,013) oder tracheale Dislokation der Prothese (3,29; p=0,0023) und in deren Folge ein spontaner (2,51; p=0,047) oder chirurgischer Shuntverschluss (3,76; p=0,037).

Fazit

Die Protheseneinlage sollte bei nicht vorbestrahlten Patienten grundsätzlich im Rahmen der Laryngektomie erfolgen, v. a. wenn eine Nachbestrahlung absehbar ist. Bei vorbestrahlten Patienten verringern sich die prinzipiell sehr guten Ergebnisse einer prothetischen Stimmrehabilitation, ohne dass sich daraus eine absolute Kontraindikation ergibt. Dies berührt auch das Konzept der „salvage surgery“.

Abstract

Background

Indwelling voice prostheses are state of the art for postlaryngectomy voice rehabilitation. The aim of this study was to identify the impact of radiation prior to tracheoesophageal puncture on success rate and complications.

Patients and methods

We undertook a retrospective study of 145 patients who had undergone prosthetic voice restoration between 1990 and 2002 (Provox® and Provox2®). Risks of functional failure and complications in 17 patients with previous radiation therapy were compared to those of 128 patients without such therapy.

Results

Previous radiation increased not only the risk of functional failure by 2.9 (P=0.023), but also the risk of shunt-related complications such as aspiration around the prosthesis (1.51; P=0.046), widening of the shunt (2.32; P=0.014), esophageal (2.51; P=0.013) or tracheal (3.29; P=0.0023) dislocation of the prosthesis and spontaneous (2.51; P=0.047) or surgical closure (3.76; P=0.037) of the shunt.

Conclusion

Primary tracheoesophageal puncture during laryngectomy is recommended in cases without previous radiation therapy, especially when postlaryngectomy radiation is likely. In patients with previous radiation therapy, generally good success rates decrease, however, without absolute contraindication of tracheoesophageal puncture. These results may affect salvage surgery concepts.

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Danksagung

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Authors and Affiliations

  1. Abteilung für Phoniatrie und Pädaudiologie, Universitätsklinikum Erlangen

    P. Kummer, M. Chahoud, M. Schuster, U. Eysholdt & F. Rosanowski

  2. Abteilung für Phoniatrie und Pädaudiologie, Universitätsklinikum Erlangen, Bohlenplatz 21, 91054, Erlangen

    P. Kummer

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  1. P. Kummer
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  2. M. Chahoud
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  3. M. Schuster
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  4. U. Eysholdt
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  5. F. Rosanowski
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Correspondence to P. Kummer.

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Kummer, P., Chahoud, M., Schuster, M. et al. Prothetische Stimmrehabilitation nach Laryngektomie. HNO 54, 315–322 (2006). https://doi.org/10.1007/s00106-005-1259-5

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  • DOI: https://doi.org/10.1007/s00106-005-1259-5

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