Abstract
We investigated the problems affecting functional outcomes of near-total laryngectomy and their solutions. A retrospective analysis about complications (i.e., aspiration, pharyngocutenous fistula, shunt stenosis, etc.) that affect postoperative functions was made by using the medical records of 23 male patients (mean age: 56.6, range: 35 to 72 years) who underwent near total laryngectomy. Maximal phonation times of 17 patients and fundamental frequencies of 10 patients were measured and compared with control groups consisting of sex- and age-matched normal laryngeal speakers. Pharyngocutenous fistula occurred in five cases and closed by secondary wound healing. The incidence of aspiration was 42%. Shunt stenosis wasn’t observed in our cases, but loss of phonation occurred because of tumor recurrence at the neoglottal region in the 1st postoperative year of one patient. All patients were able to produce voice, and communicable speech was achieved by 19 (82.6%). Measurements of maximal phonation time indicated a significant decrease in the NTL group. The increase in fundamental frequency values of the near total laryngectomy group was also found significant in relation to the control group. After careful patient selection, extreme effort should be made to create a dynamic shunt and complete mucosal covering of the inner surface of the shunt in near total laryngectomy, thus not only producing voice without aspiration or shunt stenosis, but also providing oncologic safety in the patients with sufficient vital capacity.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
American Joint Committee on Cancer (1992) Manual for staging of cancer, 4th edn. Lippincott, Philadelphia
Aslan I, Başarer N, Yazicioğlu E Oysu C, Tinaz M, Kiyak E, Biliciler N (2002) Near total laryngectomy for laryngeal carcinomas with subglottic extension. Arch Otolaryngol Head Neck Surg 128:177–180
Coniglio JU, Winkle MR, Bennett GH, Martin B, Pacella SJ (1999) Myomucosal shunt plugging to prevent aspiration after near-total laryngectomy. Laryngoscope 109:1167–1169
Cummings CW, Purcell LL, Flint PW (1993) Hydroxylapatite laryngeal implants for medialization preliminary report. Ann Otol Rhinol Laryngol 102:843–851
DeSanto LW, Pearson BW, Olsen KD (1989) Utility of near-total laryngectomy for supraglottic, pharyngeal, base of tongue and other cancers. Ann Otol Rhinol Laryngol 98:2–7
Gavilan J, Herranz Z, Prim P, Rabanal I (1996) Speech results and complications of near-total laryngectomy. Ann Otol Rhinol Laryngol 105:729–733
Hallen L, Testad P, Sederholm E, Dahlquist A, Laurent C (2001) DiHA(dextranomers in hyaluronan) injections for treatment of insufficient closure of the vocal folds: early clinical experiences. Laryngoscope 111:1063–1067
Hanamitsu M, Kataoka H, Takeuchi E, Kitajima K (1999) Comparative study of vocal function after near-total laryngectomy. Laryngoscope 109:1320–1323
Hoasjoe DK, Martin GF, Doyle PC, Wong FS (1992) A comparative acoustic analysis of voice production by near-total laryngectomy and normal speakers. J Otolaryngol 21:39–43
Keith RL, Leeper HA, Doyle PC (1995) Microanalytic acoustical voice characteristics of near-total laryngectomy. Otolaryngol Head Neck Surg 113:689–694
Laccourreye O, Laccourreye L, Crevier BL, Brasnu D, Weinstein GS (1997) Supra cricoid hemi laryngopharyngectomy to Pearson’s near-total laryngectomy, a case report. Head Neck 19:232–234
Laccourreye O, Buchman LC, Muscatello L, Hans S, Ménard M, Brasnu D (1998) Speech and voice characteristics after near-total laryngectomy. A preliminary prospective study. Ann Otol Rhinol Laryngol 107:1061–1065
Leipzig B (1980) Neoglottic reconstruction following total laryngectomy: a reappraisal. Ann Otol Rhinol Laryngol 89:534–537
Loré JM (1988) An atlas of head and neck surgery, 3th edn. Saunders, Philadelphia, p 927
Pearson BW (1981) Subtotal laryngectomy. Laryngoscope 91:1904–1912
Pearson BW, Woods RD, Hartman DE (1980) Extended hemilaryngectomy for T3 glottic carcinoma with preservation of speech and swallowing. Laryngoscope 90:1950–1961
Pearson BW, De Santo LW, Olsen KD, Salassa ZR (1998) Results of near-total laryngectomy. Ann Otol Rhinol Laryngol 107:820–825
Pradhan SA, D’cruz AK, Pai PS, Mohiyuddin A (2002) Near-total laryngectomy in advanced laryngeal and piriform cancers. Laryngoscope 112:375–380
Shenoy AM, Plinkert PK, Nanjudappa N, Premalata S, Arunodhay GR (1997) Functional utility and oncologic safety of near-total laryngectomy with tracheopharyngeal shunt in a third world oncologic center. Eur Arch Otorhinolaryngol 254:128–132
Shenoy AM, Sridharan S, Srihariprasad AV, Ready, Anand VT, Premalatha BS, Nanjudappa N (2002) Near-total laryngectomy in advanced cancers of the larynx and pyriform sinus: a comparative study of morbidity and functional and oncological outcomes. Ann Otol Rhinol Laryngol 111:50–56
Seikaly H, Park P (1995) Gastroesophageal reflux prophylaxis decreases the incidence of pharyngocutaneous fistula after total laryngectomy. Laryngoscope 105:1220–1222
Singh W, Hardcastle P (1985) Near-total laryngectomy with myo-mucosal valved neoglottis. J Laryngol Otol 99:581–588
Su CY, Hwang CF (1993) Near-total laryngopharyngectomy with pectoralis major myocutaneous flap in advanced piriform carcinoma. J Laryngol Otol 107:817–820
Suits GW, Cohen JI, Everts EC (1996) Near-total laryngectomy. Patient selection and technical considerations. Arch Otolaryngol Head Neck Surg 122:473–475
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Cakli, H., Ozudogru, E., Cingi, E. et al. Near total laryngectomy: the problems influencing functions and their solutions. Eur Arch Otorhinolaryngol 262, 99–102 (2005). https://doi.org/10.1007/s00405-004-0751-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-004-0751-y