[Objective assessment of the respiratory function of the larynx after fronto-lateral laryngectomy with epiglottoplasty and after supracricoid laryngectomy with CHP or CHEP]. / Obiektywna ocena funkcji oddechowej krtani po laryngektomii fronto-lateralnej poszerzonej z epiglottoplastyka oraz nadpierscieniowej z CHP lub CHEP.

Enlarged fronto-lateral laryngectomy with epiglottoplasty and supracricoid laryngectomy with cricohyoidopexy (CHP) or cricohyoidoepiglottopexy (CHEP) differ from each other as regards surgical technique, extent of the resection and method of reconstruction. Despite of that, selected carcinomas of the true vocal cord staged as T2N0, which are included in indications to all mentioned laryngectomies, can be equally treated with each of these methods. The aim of this study is objective evaluation of the respiratory function of the larynx after three types of operation and comparison of the results. Material included 64 patients treated during the period of 1993-2002: 39 patients after supracricoid laryngectomy (18 with CHP and 21 with CHEP) and 25 after enlarged fronto-lateral laryngectomy with epiglottoplasty. Spirometry was performed before and after the operation in 27 cases and only after the operation in 34 cases. The shapes of flow-volume loops and 32 spirometric parameters were evaluated. The decannulation rates were: a) 98,5% after enlarged fronto-lateral laryngectomy with epiglottoplasty, b) 80,6% after supracricoid laryngectomy with CHP, c) 70,1% after supracricoid laryngectomy with CHEP. Although the decannulation rate was better after CHP than after CHEP the spirometric parameters were better in patients after CHEP than in those after CHP. The airflow similar to normal was found in 15% patients after CHEP as well as after CHP and in 28% patients after epiglottoplasty. There were no restrictive abnormalities in the whole group of operated patients, but occurrences of obturation, especially inspiratory, were quite often. In conclusion, which follows from the comparison of three types of reconstructive laryngectomies, better results of respiratory function of the larynx were found after epiglottoplasty than after supracricoid laryngectomy with CHEP or CHP.

[Analysis of pharyngeal phase of swallowing after supracricoid partial laryngectomy with cricohyopexia (CHP) and cricohyoepiglottopexia (CHEP)]. / Analiza fazy gardlowej aktu polykania po laryngeimiach nadpierscieniowych z rekonstrukcja typu cricohyopexia (CHP) i cricohyoepiglottopexia (CHEP)

The analysis of efficiency and timing of pharyngeal phase events after supracricoid reconstructive laryngectomy was presented. Material consist of 15 patients after partial laryngectomy with cricohyopexia (CHP) and 19 with cricohyoepiglottopexia (CHEP) in average age of 53 (41-66) years. The video-radiographic examination of swallowing was done in the early period (max. 120, average 72 days) and in the late period (min. 10, average 24 months) after surgery. The larynx closure improved and the wide of upper oesophageal sphincter (UES) increased in the late period comparing to first examination. The duration of UES relaxation and the duration of pharyngeal phase were similar to physiological status but the time of larynx closure was longer in both periods.

[Supracricoid partial laryngectomy with CHP and CHEP for local recurrence following irradiation of vocal cord carcinoma]. / Laryngektomia czesciowa nadpierscieniowa z nastepowa CHP i CHEP w leczeniu wznowy miejscowej po napromienianiu raka faldu glosowego.

The cases of CHEP and CHP following supracricoid partial laryngectomy in the treatment of the local recurrence after irradiation of vocal cord carcinoma were reported. In both cases the wound was healed by first intention. The cannula was not removed in the patient after CHEP, although the wide of neolarynx and spirometry parameters showed such a possibility. That patient with a huge obesity developed progressive coronary disease after surgery. Sometimes he needs to open the plugged cannula. The spirometry parameters confirmed that the patient after CHP could be decannulationed in the third month after surgery. Because of his psychological resistance that was delayed to the sixth month. The deglutition is efficient in both patients. The oesophagus tube was removed in sixth and seventh weeks after the operation. The patient after CHEP was carried out the objective evaluation of deglutition in the videoroentgenokinematography which showed a small aspiration. In spite of that he didn't develop any pulmonary complication during 2.5 years after surgery. A few cases and short time of observation doesn't allowed us to draw the objective conclusions to the presented question.

[Horizontal glottectomy--oncologic and functional results. Part I. Horizontal glottic laryngectomy--oncologic results and assessment of the protective and respiratory function of the larynx]. / Laryngektomia pozioma glosniowa-- wyniki onkologiczne i funkcjonalne. Czesc I. Laryngektomia pozioma glosniowa--wyniki onkologiczne, ocena funkcji ochronnej i oddechowej.

INTRODUCTION: In the Otolaryngology and Laryngological Oncology Department of the Pomeranian Medical University in Szczecin (Poland) horizontal glottectomy is executed from 1985. MATERIAL AND METHODS: Material consists of 27 patients (26 males and 1 female; an average age 57 min. 40, max.). We evaluated: 1) oncological results, 2) 3 and 5-years survival rate without recurrence of the cancer, 3) evaluation of the protective and respiratory function. Protective function was evaluated basing on: a) period after operation when feeding tube was removed, b) subjective assessment of swallowing liquid and solid food. For evaluating respiratory function we stated period after operation to decannulation and also spirometric investigations were done. RESULTS: From among 27 operated patients died 4 (15%)--one on the second day after operation. Recurrence of the cancer (local or into lymph nodes) were observed in 5/26 (19.2%). Three years without symptoms of recurrence survived 89% (17/19), five years--80% (12/15). Swallowing through natural way was possible during the first 24 hours after operation in 13 of 26 (50%) patients. In the remaining 13 only 2 feeding tubes were removed on the 35th day after operation. Decannulation was possible at 92% (24/26) patients. 15 (58%) patients were decannulated in the first two week after operation. Spirometric investigation (n = 10) showed no restriction and very small obturation on the larynx - very good laryngeal flow nearing to normal. CONCLUSIONS: Oncologic results, protective and respiratory function after horizontal function results are satisfactory and comparable to the other researchers.

[Horizontal glottectomy--oncological and functional results. Part II. Morphology of the glottis and perceptive-acoustics characteristic of the voice and speech after horizontal glottectomy]. / Laryngektomia pozioma glosniowa-- wyniki onkologiczne i funkcjonalne. Czesc II. Morfologia glosni i charakterystyka percepcyjno-akustyczna glosu i mowy po laryngektomii poziomej glosniowej.

INTRODUCTION: The authors showed findings concerning glottis morphology and perceptual-acoustic characteristics of voice and speech after partial classical (PCGLg) and extended glottic partial laryngectomy (PEGLg). MATERIAL AND METHODS: 10 patients (9 M., 1 F. average age 56 (min. 47 max. 65) were examined. All patients were undergone glottic partial laryngectomy: a) classical (n = 5) b) extended of vocal process (n = 3) with (n = 2) or without (n = 1) the removal of the mucous false folds, c) extended of part of arytenoid cartilage with (n = 2) or without (n = 1) the removal of the mucous of the false folds. The following examinations were executed: phoniatric, videolaryngoscopic and perceptual-acoustic analysis. RESULTS: After PCGLg and one extended of vocal process, voice and speech has mostly characterized of features of hypofunction dysphonia. Hyperfunction was found in patients after removal of the mucous of the false folds due to leucoplakia. In case of removing of a part of arythenoid cartilage the notable or entire standstill or lack of full phonatory closure were found. The phonetical-acoustic analysis showed that in patients using melodious voice, the character of the source of actuating was periodically-noise, with the component of noise in all range of the course of the acoustic signal of voice. The parameters such as F0, jitter, shimmer does not make coherent conclusions and are less useful in the assessment of the quality of voice. CONCLUSIONS: In case of the resection of the part of the arythenoid cartilage during glottis laryngectomy, we take into account lack of full phonatory closure and using whisper by the patients. Obtaining the reliable conclusions needs continuations of the investigations and increasing number of patients. These researches are in progress.

[Factors influencing pharynx' and pharyngoesophageal sphincter's morphology and their function after total laryngectomy]. / Czynniki wplywajace na morfologie i funkcje gardla oraz zwieracza gardlowo-przelykowego po laryngektomii calkowitej.

The usefulness of the videolaryngoscopy in patients after total laryngectomy/laryngopharyngectomy was discussed. They serve for: a) evaluation of the pharynx and of the pharyngoesophageal sphincter (pes) morphology, b) prognosis of the esophageal speech developing. In the study videolaryngoscopy was done in 82 patients (7 female and 75 male). In 62 of them total laryngectomy was done (among them in 50/62--with standard pharynx suture, in 9/62--with the pes plasty, and 3/62--with simple pes myotomy). In 20 case of laryngopharyngectomies--4/20 standard pharynx suture was done, 12/20 were reconstructed with tongue flap, 3/20--with pes plasty, and in 1/20 simple myotomy was performed. The investigations were carried out between 1 to 36 months after total laryngectomy and 24 month after laryngopharyngectomy. The analysis of the videolaryngoscopy imagings revealed that the pharynx and pes morphology after laryngectomy/laryngopharyngectomy (shape, thickness of the mucose, weakened wall peristalsis, secretion retention, lack or presence of the pes relaxation at the time of examination) correlates with the rest pressure in the pes area, measured by Seeman's method and with the occurrence of the esophageal speech mastering. The most significant changes in morphology and function of the pharynx (irregular shape, weakened wall peristalsis, retention of secretion) as well as the highest pressure in the area (5.1 +/- 3.33 kPa-38 +/- 25 mm Hg) was found after pharyngolaryngectomy. The shape of the pharynx in all the patients after laryngectomy with plasty or simple myotomy of the pes was regular, with thin and smooth mucosa while the rest pressure was low (3.0 +/- 1.18 kPa(-)+/- 22.5 +/- 8.8 mm Hg). In the analyzed material at the rest pressure in the sphincter area from 0.7 to 4kPa (from 5 to 30 mm Hg), 93% (41/44) of the patients have mastered the esophageal speech. It was stressed that videolaryngoscopy is entirely sufficient for the approximate assessment of the rest pressure in the pes area and prognosis of the esophageal speech development process.

[Factors influencing morphology and function of the pharynx and pharyngoesophageal sphincter after total laryngectomy. Part II. The impact of degenerative changes in the neck segment of the vertebral column on the rest pressure within pharyngoesophageal sphincter after laryngectomy]. / Czynniki wplywajace na morfologie i funkcje gardla oraz zwieracza gardlowo-przelykowego po laryngektomii calkowitej. Czesc II. Wplyw zmian zwyrodnieniowych w szyjnym odcinku kregoslupa na cisnienie spoczynkowe w obrebie zwieracza gardlowo-przelykowego po laryngektomii calkowitej.

Radiological examinations of the vertebral column neck segment were done in 41 patients after total laryngectomy (n = 29) and laryngopharyngectomy (n = 12). Degeneration changes of different degree (from I degree to IV degree) were stated in 37 cases. Criteria of assessment were as follows: a) the width of the intervertebral space b) appearance and degree of the exostoses c) the length of the degenerative process in vertebral segment of the neck. The advanced degenerative changes in the vertebral column (IV degree) included all neck segment and were characterized by significant narrowing of the intervertebral spaces and exostoses longer than 0.5 cm. These changes were seen statistically more often in the patients after 50. The pharyngoesophageal sphincter's (p.e.s.) rest pressure was statistically rising significantly with the degree of the degeneration changes in the vertebral column. The high pressure in p.e.s. (5.7 + 2.85 kPa--43 + 21 mm Hg) was seen only in the cases of the IV degree degree. In the patients with the IV degree degree of degenerative changes in 67% retention of saliva in the hypopharynx was seen. Probably it was due to irritation of the sympathetic part of the autonomic system. The statistically significant correlation between the degree of the degenerative changes and the complains like pain during the head movement and limitation of the neck motion was also observed. In IV degree degree these complains were noted in 57% cases. The results of the investigations prove the hypothesis of influence of the sympathetic part of the autonomic system on the pharyngoesopghageal sphincter rest pressure.