Long-term performance of indwelling tracheoesophageal speaking valves in Chinese patients undergoing laryngectomy.

OBJECTIVES: To assess the use of indwelling tracheoesophageal speaking valves in Chinese patients undergoing laryngectomy, to identify the clinicopathologic factors for favorable outcome, and to evaluate the factors that determine prosthesis lifetime. DESIGN: Retrospective review. SETTING: Tertiary care institution. PATIENTS: Sixty consecutive patients with total laryngectomy were included. All had indwelling tracheoesophageal speaking valves for voice restoration. INTERVENTION: Anterograde replacement of voice prosthesis in case of failure of functional speech production or leakage of saliva. MAIN OUTCOME MEASURES: Incidence of successful tracheoesophageal speech rehabilitation for daily communication, influence of different clinicopathologic factors on the outcome, and prosthesis lifetime and its relationship to different clinicopathologic factors. RESULTS: The success rate of speech rehabilitation was 78%. Age younger than 60 years was the only clinicopathologic factor associated with successful speech rehabilitation (P = .04, Fisher exact test). The median device lifetime was 8.2 months. Both age of 60 years or older and the use of subsequent prosthetic valves were identified as risk factors for valve failure on univariate analysis (n = 192; log-rank test; P = .02 and P = .03, respectively), with age of 60 years or older as the only risk factor that reduced the device lifetime in the Cox proportional hazards model (P = .03; relative hazard ratio, 1.5; 95% confidence interval, 1.1-2.4). CONCLUSIONS: Our success rate in using indwelling tracheoesophageal speaking valves was comparable to that reported in the Western literature. The median device lifetime of 8.2 months was satisfactory. Patient age was found to be a significant predictor of successful tracheoesophageal speech rehabilitation, with age of 60 years or more adversely affecting device lifetime.

Thyroid dysfunction in laryngectomees-10 years after treatment.

BACKGROUND: Hypothyroidism is 1 of the complications that follow treatment of various head and neck cancers. In the literature, reviews using different primary sites and differences in treatment modalities make comparison of post-treatment hypothyroidism not possible. The objective of this study was to evaluate the incidence of hypothyroidism in a homogenous group of patients who were treated with total laryngectomy and irradiation for laryngeal carcinoma and to assess the importance of different variables in the occurrence of hypothyroidism. METHODS: A retrospective review of 147 total laryngectomy patients between 1993 and 2003 was carried out. Serum thyroxine level and free T4 levels were assessed in all patients. Hypothyroidism was classified as subclinical (increased thyroid-stimulating hormone and normal free T4 levels) and clinical (increased thyroid-stimulating hormone and decreased free T4 levels). RESULTS: The results showed that the overall incidence of hypothyroidism was 49% (44% subclinical and 5% clinical). Hemithyroidectomy and advanced tumor staging were risk factors for the development of hypothyroidism in these patients (p < .05) with a relative risk of 2.1 (CI 95%, 1.4-3.1) and 1.3 (CI 95%, 1.1-1.6), respectively. During follow-up, 19.9% of patients developed hypothyroidism at 3 years, 38.6% at 6 years; at 10 year follow-up, 93.3% of them had hypothyroidism. CONCLUSIONS: In conclusion, hypothyroidism is a frequent complication in patients treated with radiotherapy and total laryngectomy for laryngeal cancer, especially when treatment includes hemithyroidectomy. These patients should have their thyroid function evaluated periodically even 10 years after treatment.

Preoperative measurement of tumor thickness of oral tongue carcinoma with intraoral ultrasonography.

BACKGROUND: Tumor thickness of oral tongue carcinoma is an important independent prognostic factor for local recurrence, subclinical nodal metastasis, and survival. An accurate preoperative assessment of tumor thickness is therefore essential in optimizing treatment algorithm. The present study aims at evaluating the accuracy of intraoral ultrasonography in preoperative measurement of tumor thickness. METHODS: Forty-five patients with oral tongue carcinoma had intraoral ultrasonography to document tumor thickness using a 7.5 MHz right angle probe. The ultrasonic tumor thickness was correlated with the fresh unpreserved surgical specimen pathologic tumor thickness. RESULTS: Ultrasonic tumor thickness had significant correlation with pathologic tumor thickness. The accuracies of ultrasonic measurement of tumor thickness in staging of tumor thickness at cutoff values between 3 and 15 mm were above 91%. CONCLUSION: Intraoral ultrasonography had satisfactory accuracy in the measurement of tumor thickness and is a useful adjunct in assisting pretreatment staging and prognosis evaluation of oral tongue carcinoma.