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2.
Artigo em Chinês | MEDLINE | ID: mdl-38310369

RESUMO

Loss of laryngeal function is a primary problem faced by patients after total laryngectomy. Although the voice function of the larynx can be partially compensated by some methods(such as implanting a voice prosthesis, using an electrolarynx and so on), and swallowing dysfunction can be improved by postoperative rehabilitation training, patients still need to breathe through the tracheostoma for life. Laryngeal transplantation, as the only therapeutic measure that has the potential to completely restore laryngeal function, has been the focus of attention in the field of otorhinolaryngology head and neck surgery both at home and abroad. In this article, we review a case of human laryngotracheal allotransplantation that was successfully completed in West China Hospital of Sichuan University, including case presentation, preoperative evaluation and preparation, surgical procedure, and postoperative management, which will provide a reference for the future development of clinical laryngeal transplantation.


Assuntos
Neoplasias Laríngeas , Laringe Artificial , Laringe , Humanos , Laringectomia/métodos , Laringe/cirurgia , China , Neoplasias Laríngeas/cirurgia
3.
Head Neck ; 46(4): 973-978, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38278774

RESUMO

Tracheoesophageal puncture (TEP) performed during total laryngectomy in the primary treatment of laryngeal cancer is the standard method for voice restoration. Following adjuvant radiotherapy, the TEP site can experience complications resulting in a tracheoesophageal fistula (TEF) with chronic leakage making oral alimentation unsafe due to aspiration. Here, we describe a technique using chimeric ulnar artery perforator forearm free flaps (UAPFF) in the reconstruction of these complex deformities. Four patients underwent chimeric UAPFF reconstruction of TEP site TEFs following primary TL with TEP and adjuvant radiotherapy. No flap failures or surgical complications occurred. Average time from end of radiotherapy to persistent TEF was 66 months (range 4-190 months). All patients had resolution in their TEF with average time to total oral diet achievement of 22 days (14-42 days). Chimeric UAPFF reconstruction is a safe and effective method to reconstruct recalcitrant TEP site TEFs.


Assuntos
Neoplasias Laríngeas , Laringe Artificial , Fístula Traqueoesofágica , Humanos , Fístula Traqueoesofágica/etiologia , Fístula Traqueoesofágica/cirurgia , Antebraço/cirurgia , Resultado do Tratamento , Estudos Retrospectivos , Laringectomia/efeitos adversos , Laringectomia/métodos , Neoplasias Laríngeas/radioterapia , Neoplasias Laríngeas/cirurgia , Punções/métodos , Traqueia/cirurgia
4.
Head Neck ; 46(2): 435-438, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37989711

RESUMO

In Video S1, a new surgical technique for hybrid primary tracheoesophageal (TE) puncture in stapler-assisted total laryngectomy is shown. The video describes the surgical steps of the procedure and illustrates some tips and tricks. The procedure incorporates an upper mini-pharyngotomy to enable retrograde placement of the voice prosthesis (VP), eliminating the need for rigid esophagoscopy. This has made it possible to exploit, without additional risks, the potential of the stapler combined with primary TE puncture and VP placement. In our experience, this hybrid procedure in stapler-assisted total laryngectomy is not related to adverse events such as pharyngocutaneous fistula (PCF), hypertonicity, and functional complications. Therefore, it can be considered a valid technique that allows for easy insertion of a primary voice prosthesis also in case of mechanical sutures.


Assuntos
Neoplasias Laríngeas , Laringe Artificial , Humanos , Laringectomia/métodos , Esôfago/cirurgia , Traqueia/cirurgia , Neoplasias Laríngeas/cirurgia , Neoplasias Laríngeas/etiologia , Punções/métodos
5.
Eur Arch Otorhinolaryngol ; 281(1): 351-357, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37776343

RESUMO

PURPOSE: The use of tracheoesophageal prostheses has become the gold standard in vocal rehabilitation of patients undergoing total laryngectomy. However, this method also has limitations, such as the need for frequent replacement of prostheses due to leakage or other complications. We have designed a study to access the clinical profile of patients using tracheoesophageal prostheses as vocal rehabilitation after total laryngectomy and to determine the average rate of changes, as well as the main causes of prostheses replacement. METHODS: A retrospective cohort study was performed based on patients who underwent rehabilitation with voice prostheses after total laryngectomy between 2008 and 2017. RESULTS: The sample consisted of 93 patients and 432 vocal prostheses replacement events. The median change of prostheses per patient was 210.25 days, (range 57.33 to 651.50). The most frequent cause of prostheses replacement was leakage through the prostheses, 218 (50.46%). Lower level of education was associated to higher prostheses replacement rate. CONCLUSION: The results of this study show that the median of prostheses durability is higher than that presented in the literature, the main cause of replacement was protheses leakage and that low educational level is associated to higher replacement rate.


Assuntos
Neoplasias Laríngeas , Laringe Artificial , Humanos , Laringectomia/reabilitação , Estudos Retrospectivos , Falha de Prótese , Neoplasias Laríngeas/cirurgia
6.
Laryngoscope ; 134(1): 198-206, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37366287

RESUMO

Management of Enlarging tracheoesophageal fistula (TEF) with Voice Prosthesis in Laryngectomized Head and Neck Cancer Patients. OBJECTIVES: An enlarging TEF following voice prosthesis placement impacts patient quality of life, risks airway compromise, and can lead to aspiration pneumonia. Pharyngoesophageal strictures have previously been reported to be associated with TEF enlargement and leakage. We describe a series of patients with enlarging TEFs after Tracheoesophageal puncture (TEP) for voice prosthesis who required pharyngoesophageal reconstruction. METHODS: Retrospective case series of laryngectomized H&N cancer patients with primary or secondary TEP who underwent surgical management for enlarging TEF site between 6/2016-11/2022. RESULTS: Eight patients were included. The mean age was 62.8 years old. Seven patients had a history of hypothyroidism. Of seven with prior H&N radiation history, two had both historical and adjuvant radiation. Two of the eight TEPs were placed secondarily. Mean time from TEP to enlarging TEF diagnosis was 891.3 days. Radial forearm-free flaps were used in five patients. Six had stenosis proximal to the TEF whereas one had distal stenosis and one had no evidence of stenosis. Mean length of stay was 12.3 days. Mean follow-up was 400.4 days. Two required a second free flap for persistent fistula. CONCLUSION: Surgical reconstruction of enlarging TEFs due to TEP/VP placement is effective in combination with addressing underlying pharyngeal/esophageal stenosis contributing to TEF enlargement and leakage. Radial forearm-free flaps have the additional benefit of a long vascular pedicle to access more distant and less-irradiated recipient vessels. Many fistulae are resolved after the first flap reconstruction, but some may require subsequent reconstruction in case of failure. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:198-206, 2024.


Assuntos
Retalhos de Tecido Biológico , Laringe Artificial , Doenças Faríngeas , Fístula Traqueoesofágica , Humanos , Pessoa de Meia-Idade , Fístula Traqueoesofágica/cirurgia , Laringectomia/efeitos adversos , Estudos Retrospectivos , Constrição Patológica/cirurgia , Qualidade de Vida , Doenças Faríngeas/cirurgia , Traqueia/cirurgia , Resultado do Tratamento
7.
Am J Otolaryngol ; 45(1): 104026, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-37634302

RESUMO

OBJECTIVE: Tracheoesophageal puncture with voice prosthesis (TEP) is considered the gold standard for voice rehabilitation after total laryngectomy; however, there is debate as to whether it should be inserted concurrently with removal of the larynx (primary TEP), or as a separate, additional procedure at a later date (secondary TEP). We utilized the National Surgical Quality Improvement Program Database (NSQIP) to compare postoperative complications, readmission rates, and reoperation rates among individuals who underwent total laryngectomy with or without concurrent TEP placement. METHODS: We conducted a retrospective study using the American College of Surgeons National Surgical Quality Improvement Program database (ACS-NSQIP) from 2012 to 2019. Patients were categorized into primary and non-primary TEP groups using a variation of CPT codes for total laryngectomy, tracheoesophageal prosthesis, and type of reconstruction. Univariate analyses were performed and significance was determined at p < 0.05. RESULTS: A total of 1974 patients who underwent total laryngectomy were identified from the database: 1505 (77.3 %) in the non-primary TEP group and 442 (22.7 %) in the primary TEP group. Patients in the non-primary TEP group were more likely to have an ASA class greater than or equal to three (91.2 % primary vs. 84.6 % non-primary, p < 0.001). Patients in the non-primary TEP group were also more likely to require intraoperative or postoperative blood transfusions within the first 72 h of surgery (20.5 % non-primary vs. 15.3 % primary, p = 0.016). Both groups had similar rates of wound breakdown and dehiscence. There remained no significant difference based on type of reconstruction. CONCLUSIONS: This study suggests that patients receiving primary TEPs are not at a greater risk of developing wound complications such as pharyngocutaneous fistulas in the 30-day postoperative period. This remained true when patients were stratified by type of flap reconstruction. Patients in the non-primary TEP group were more likely to have an ASA category of 3 or greater, which may explain why they experienced higher rates of complications such as blood transfusions intra-operatively or post-operatively.


Assuntos
Neoplasias Laríngeas , Laringe Artificial , Humanos , Laringectomia/métodos , Estudos Retrospectivos , Melhoria de Qualidade , Traqueia/cirurgia , Resultado do Tratamento , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgia , Neoplasias Laríngeas/cirurgia
8.
J Otolaryngol Head Neck Surg ; 52(1): 74, 2023 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-37990258

RESUMO

BACKGROUND: Biofilm formation on voice prostheses disrupts the function and limits the lifespan of voice prostheses. There is still no effective clinical strategy for inhibiting or removing these biofilms. Silver sulfadiazine (SSD), as an exogenous antibacterial agent, has been widely used in the prevention and treatment of infection, however, its effect on voice prosthesis biofilms is unknown. The purpose of this study was to explore the effect of SSD on the mature mixed bacterial biofilms present on voice prostheses. METHODS: Quantitative and qualitative methods, including the plate counting method, real-time fluorescence quantitative PCR, crystal violet staining, the 2,3-bis(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide) (XTT) reduction assay, scanning electron microscopy, and laser confocal microscopy, were used to determine the effect of SSD on the number of bacterial colonies, biofilm formation ability, metabolic activity, and ultrastructure of biofilms in a mature mixed bacterial (Staphylococcus aureus, Streptococcus faecalis and Candida albicans) voice prosthesis biofilm model. The results were verified in vitro on mature mixed bacterial voice prosthesis biofilms from patients, and the possible mechanism of action was explored. RESULTS: Silver sulfadiazine decreased the number of bacterial colonies on mature mixed bacterial voice prosthesis biofilm, significantly inhibited the biofilm formation ability and metabolic activity of mature voice prosthesis biofilms, inhibited the formation of the complex spatial structure of voice prosthesis biofilms, and inhibited the synthesis of polysaccharides and proteins in the biofilm extracellular matrix. The degree of inhibition and removal effect increased with SSD concentration. CONCLUSIONS: Silver sulfadiazine can effectively inhibit and remove mature mixed bacterial voice prosthesis biofilms and decrease biofilm formation ability and metabolic activity; SSD may exert these effects by inhibiting the synthesis of polysaccharides and proteins among the extracellular polymeric substances of voice prosthesis biofilms.


Assuntos
Laringe Artificial , Sulfadiazina de Prata , Humanos , Sulfadiazina de Prata/farmacologia , Laringe Artificial/microbiologia , Biofilmes , Bactérias , Polissacarídeos/farmacologia
9.
BMJ Case Rep ; 16(11)2023 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-37977831

RESUMO

Speech restoration after total laryngectomy may be achieved in different ways, the gold standard being tracheoesophageal puncture (TPE) with the positioning of a speech prosthesis. TPE is not immune to complications, the most common of which being leakage through or around the prosthesis. When dealing with an enlarged tracheoesophageal fistula, the management can be either conservative or surgical. In the following case report, we present a particularly challenging case, in which every conservative strategies failed and a major surgery was required to close the fistula.


Assuntos
Neoplasias Laríngeas , Laringe Artificial , Fístula Traqueoesofágica , Humanos , Fístula Traqueoesofágica/cirurgia , Fístula Traqueoesofágica/complicações , Traqueia/diagnóstico por imagem , Traqueia/cirurgia , Neoplasias Laríngeas/cirurgia , Laringectomia , Estudos Retrospectivos
10.
Acta Otolaryngol ; 143(8): 721-729, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37656679

RESUMO

BACKGROUND: The Provox Vega High Performance (PVHP) is a newly developed voice prosthesis (VP) with an aim to achieve a longer and more predictable lifetime. OBJECTIVES: This feasibility study aims to assess patient acceptance of the PVHP VP, evaluate adverse events, voice quality, and device lifetime. METHODS: Laryngectomized patients previously using a Provox Vega or ActiValve Light were included. Acceptance and voice outcomes were evaluated at two-time points with a 2-week interval. Baseline measurements were taken with the standard VP, followed by placement of the PVHP for the 2-week assessment. RESULTS: Fifteen participants completed the study, with thirteen being initial Vega-users. PVHP acceptance was 87% 2 weeks after placement. Median device lifetime for all VPs was 64 d (range 14-370). In the subgroup without periprosthetic leakage, the median device lifetime was 101 d (range 31-370). Acceptance dropped to 40% after device failure. Voice quality did not differ between PVHP and baseline VP. The most reported adverse event was PVHP valve stickiness (46%). CONCLUSION AND SIGNIFICANCE: Acceptance of the PVHP is largely dependent on device lifetime, decreasing from 87% to 40% after leakage or replacement. Voice quality remains consistent across different VPs. Developing a long-lasting VP remains a challenge.


Assuntos
Laringe Artificial , Voz , Humanos , Qualidade da Voz , Estudos de Viabilidade , Cateteres
11.
Head Neck ; 45(10): 2657-2669, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37646494

RESUMO

OBJECTIVE: We aimed to determine patterns of alaryngeal voice acquisition and predictive factors of vocal rehabilitation (VR) failure following total laryngectomy (TL) at a large Canadian tertiary care center. METHODS: All consecutive patients having undergone a TL between January 1st, 2011 and December 31st, 2019, at the Centre Hospitalier de l'Université de Montréal were included. RESULTS: One hundred and ninety-seven laryngectomized patients were identified. Successful VR was achieved in 86 (59.0%) patients, while 59 (41.0%) failed to use a method of alaryngeal voice as their principal means of communication at 1 year postoperatively. The use of tracheoesophageal puncture (TEP) was associated with higher VR success rates (70.6%) when compared with the artificial larynx (48.6%), and esophageal voice (18.8%). The only independent predictor of VR failure on multivariate analysis at all time points was a low socioeconomic status. CONCLUSION: Failure to adopt an alaryngeal voice following TL is highly prevalent, despite comprehensive and free speech language pathologist services being offered at our center. A low resort to TEP at our institution and a poor acceptability and accessibility of alternative VR methods may contribute to this trend. The challenges of VR may be further exacerbated by the barriers linked to a lower socioeconomic status, which in turn may contribute to reduced candidacy for TEP.


Assuntos
Laringe Artificial , Voz , Humanos , Laringectomia , Canadá , Idioma
12.
Otolaryngol Head Neck Surg ; 169(6): 1499-1505, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37422889

RESUMO

OBJECTIVE: Speech rehabilitation following a total laryngectomy significantly impacts the quality of life. Indwelling prosthetic voice restoration provides optimal outcomes; however, the long-term maintenance of these devices carries considerable financial costs, which are not universally covered by insurance. This investigation aimed to analyze associations between socioeconomic factors and outcomes in postlaryngectomy speech rehabilitation. STUDY DESIGN: Retrospective cohort analysis. SETTING: Academic tertiary-care center from May 2014 to September 2021. METHODS: In patients undergoing total laryngectomy, the incidence of tracheoesophageal puncture with indwelling vocal prostheses (TEP-VP) placement within the first postoperative year was compared among household income, demographic factors, and disease characteristics. Functional and maintenance outcomes served as secondary endpoints. RESULTS: Seventy-seven patients were included. Forty-five (58%) underwent indwelling TEP-VP (41 primaries). Eighty-nine percent of patients with annual incomes greater than $50k underwent TEP-VP compared to only 35% with incomes less than $50k/year. TEP-VP was performed in 85% of patients with commercial insurance, 70% with Medicare, 42% with Medicaid, and 0% with no insurance. On multivariate analysis, annual household incomes greater than $50k were predicted for TEP-VP placement (odds ratio: 12.7 [2.45-65.8], p = .002). The utilization of postoperative speech therapy and functional communication outcomes were similar among socioeconomic groups. Twelve patients were unable to afford supplies within the first year, with differences noted among insurance (p = .015) and income status (p = .003). CONCLUSION: Disparities in vocal and speech rehabilitation following laryngectomy may disproportionally affect underserved patients.


Assuntos
Neoplasias Laríngeas , Laringe Artificial , Estados Unidos , Humanos , Idoso , Laringectomia/reabilitação , Fonoterapia , Estudos Retrospectivos , Qualidade de Vida , Fala , Resultado do Tratamento , Medicare , Neoplasias Laríngeas/cirurgia , Traqueia/cirurgia
13.
Laryngorhinootologie ; 102(6): 416-422, 2023 06.
Artigo em Alemão | MEDLINE | ID: mdl-37267965

RESUMO

The implantation of a voice prosthesis has become a standard procedure during a laryngectomy. A voice prostheses enables patients to develop speech shortly after surgery, which strongly improves rehabilitation and quality of life.The lifetime of a voice prosthesis is limited and highly variable due to different causes. A replacement is usually necessary several times a year and can easily been done in an outpatient setting with surface anesthesia. In some cases, replacing the prosthesis becomes difficult. This article will take a closer look at different reasons that can lead to difficulties in prostheses replacement and discuss possible solutions, thereby focusing especially on a retrograde technique. The aim of this article is to help colleagues that already have experience with voice prostheses and want to expand their therapeutic armamentarium.


Assuntos
Laringe Artificial , Humanos , Qualidade de Vida , Laringectomia , Implantação de Prótese , Treinamento da Voz
14.
J Acoust Soc Am ; 153(6): 3428, 2023 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-37350623

RESUMO

Tracheoesophageal (TE) speech is an important method of speech rehabilitation for those who undergo a total laryngectomy. Despite the many advantages over other methods, there is still room for improvement in terms of the overall quality of the TE voice as well as its success rate. These points could be greatly assisted by an improved knowledge on the mechanics of TE speech. Here, an experimental model of the pharyngoesophageal segment (PES), based on the idea of a collapsible tube, is proposed. To implement the model, considerable simplifications had to be made, most notably in the use of a thin flexible tube to represent the PES. The model was used to assess the minimum amount of tonicity required for the onset of phonation in terms of the flow rate and longitudinal tension. Additionally, comparisons with a mathematical model [Tourinho, da Silva, dos Santos, Thomaz, and Vieira, J. Acoust. Soc. Am. 149, 1979-1988 (2021)] have been made, yielding similar trends for sufficiently large flow rates. The measurements also suggest that the phonation frequency is most affected by the tonicity of the PES, which highlights the question of which physiological mechanism is responsible for the control of the fundamental frequency of phonation.


Assuntos
Esôfago , Laringe Artificial , Humanos , Esôfago/fisiologia , Qualidade da Voz/fisiologia , Traqueia , Voz Esofágica/métodos , Fonação/fisiologia , Laringectomia/reabilitação , Modelos Teóricos
16.
Acta Otolaryngol ; 143(5): 440-445, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-37158444

RESUMO

BACKGROUND: Vocal rehabilitation post total laryngectomy (TL) lacks clinical guidelines, especially with the presence of multiple modalities. OBJECTIVES: To describe the tendencies of vocal rehabilitation post TL in France and compare it with other countries. We try to identify the most practiced modalities and recognize statistically significant influencing factors. MATERIALS AND METHODS: An electronic anonymous survey was answered by 75 ENT surgeons from France. The survey outlined the common practiced vocal rehabilitation modalities and had two versions depending on if the participant practices the tracheoesophageal speech (TES) or not. RESULTS: 96% use TES in their practice. Single modality TES and double modality TES with esophageal speech (ES) are the two most practiced modalities. 99% agreed that there is no age limit for the TES. Single modality ES was offered 92% more when more than 10 TL were performed per year (p < .05). No influencing factors found for single modality TES or double modality TES with ES (p > .05).Conclusion: In line with tendencies from other countries, the TES is the most practiced modality of vocal rehabilitation coupled or not with the ES. TES has no age limit as per our participants. The least practiced modality is the singe modality ALS.


Assuntos
Neoplasias Laríngeas , Laringe Artificial , Voz , Humanos , Laringectomia/reabilitação , Voz Esofágica , Inquéritos e Questionários , Neoplasias Laríngeas/cirurgia
17.
J Acoust Soc Am ; 153(5): 2973, 2023 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-37212513

RESUMO

Esophageal (ES) speech, tracheoesophageal (TE) speech, and the electrolarynx (EL) are common methods of communication following the removal of the larynx. Our recent study demonstrated that intelligibility may increase for Cantonese alaryngeal speakers using clear speech (CS) compared to their everyday "habitual speech" (HS), but the reasoning is still unclear [Hui, Cox, Huang, Chen, and Ng (2022). Folia Phoniatr. Logop. 74, 103-111]. The purpose of this study was to assess the acoustic characteristics of vowels and tones produced by Cantonese alaryngeal speakers using HS and CS. Thirty-one alaryngeal speakers (9 EL, 10 ES, and 12 TE speakers) read The North Wind and the Sun passage in HS and CS. Vowel formants, vowel space area (VSA), speaking rate, pitch, and intensity were examined, and their relationship to intelligibility were evaluated. Statistical models suggest that larger VSAs significantly improved intelligibility, but slower speaking rate did not. Vowel and tonal contrasts did not differ between HS and CS for all three groups, but the amount of information encoded in fundamental frequency and intensity differences between high and low tones positively correlated with intelligibility for TE and ES groups, respectively. Continued research is needed to understand the effects of different speaking conditions toward improving acoustic and perceptual characteristics of Cantonese alaryngeal speech.


Assuntos
Laringe Artificial , Voz Alaríngea , Humanos , Voz Alaríngea/métodos , Voz Esofágica , Fala , Acústica , Inteligibilidade da Fala , Acústica da Fala
18.
Otolaryngol Clin North Am ; 56(2): 361-370, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-37030948

RESUMO

Voice restoration following laryngectomy has a significant influence on quality of life (QOL). Three main techniques exist to provide voice: esophageal speech (ES), artificial larynx (electrolarynx [EL]), and tracheoesophageal puncture (TEP). Although the EL was historically the most used technique, TEP has quickly become the gold standard. ES remains the least frequently used technique in developed countries. Technique selection must be made on an individual basis, considering the patient's cancer history and comorbidities. Ultimately, the choice in voice-restoration technique requires joint decision making with the surgeon, speech pathologist, and patient.


Assuntos
Neoplasias Laríngeas , Laringe Artificial , Humanos , Neoplasias Laríngeas/cirurgia , Qualidade de Vida , Laringectomia , Voz Esofágica/métodos
19.
Clin Otolaryngol ; 48(4): 515-526, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-37012583

RESUMO

OBJECTIVES: Tracheoesophageal puncture (TEP) is considered the gold standard for voice rehabilitation after total laryngectomy. One of the main causes of treatment failure, and a potentially serious complication, is the TEP enlargement and/or leakage around the voice prosthesis. The injection of biocompatible material to increase the volume of the puncture surrounding tissue has been studied as a popular option for conservative treatment of enlarged tracheoesophageal fistula. The aim of this paper was to perform a systematic review of the efficacy and safety of such treatment. DESINGN: Search conducted in PubMed/MEDLINE, the Cochrane Library, Google Scholar, Scielo and Web of Science and through the meta-searcher Trip Database based on Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA) statement. SETTINGS: Human experiments published in peer-reviewed journals, where investigators assessed the use of peri-fistular tissue augmentation for periprosthetic leakage were evaluated. PARTICIPANTS: Laryngectomized patients with voice prosthesis, presenting periprosthetik leak due to enlarged fistula. MAIN OUTCOMES MEASURES: mean-duration without new leak. RESULTS: A total of 196 peri-fistular tissue augmentation procedures in 97 patients were found in the 15 selected articles. The 58.8% of patients had a time without periprosthetic leak after treatment of >6 months. The 88.7% of tissue augmentation treatments resulted in periprosthetic leakage cessation. The general level of evidence of the studies included in this review was low. CONCLUSIONS: Tissue augmentation treatment is a minimally invasive, biocompatible and safe solution that temporarily resolves periprosthetic leaks in many cases. There is no standard technique or material, and treatment needs to be individualised according to the experience of the practitioner and the characteristics of the patient. Future randomised studies are needed to confirm these results.


Assuntos
Neoplasias Laríngeas , Laringe Artificial , Fístula Traqueoesofágica , Humanos , Neoplasias Laríngeas/cirurgia , Laringectomia/métodos , Laringe Artificial/efeitos adversos , Punções/efeitos adversos , Estudos Retrospectivos , Fístula Traqueoesofágica/cirurgia
20.
Vestn Otorinolaringol ; 88(1): 64-70, 2023.
Artigo em Russo | MEDLINE | ID: mdl-36867146

RESUMO

The literature review presents historical and modern aspects of the rehabilitation of vocal function after laryngectomy, in particular, external devices, tracheopharyngeal bypass surgery, esophageal speech, tracheoesophageal bypass surgery without the use of a prosthetic device, voice prostheses are described. The advantages and disadvantages of each voice restoration technique, functional results, complications, prosthesis designs, their service life, bypass techniques, methods of prevention and treatment of damage to the valve apparatus of the prosthesis by colonies of microorganisms, fungal flora are analyzed.


Assuntos
Laringe Artificial , Medicina , Voz , Humanos , Cateteres , Laringectomia
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