RESUMEN
BACKGROUND: Post-radiotherapy laryngeal edema may affect the patients' quality of life, leading to repeated treatment attempts, which include massage/physical therapy, inhalations, and/or tracheostomy. CASE PRESENTATION: We report the surgical treatment approach of a 69-year-old patient with severe persistent post-radiotherapy laryngeal edema. After multiple inpatient admissions and failed conservative therapy, we used the erbium laser to treat the arytenoid edema. After repeated procedures, no complications were observed. The patient remained free of symptoms after 30 months of follow-up. CONCLUSIONS: The authors provide an easy-to-perform, safe, and quick surgical technique without non-severe or severe complications. Using this technique repeatedly, complications from excessive thermal damage with CO2 laser or unpleasant solutions such as tracheostomy can be avoided.
Asunto(s)
Carcinoma de Células Escamosas/terapia , Edema Laríngeo/cirugía , Terapia por Láser , Láseres de Estado Sólido/uso terapéutico , Neoplasias Orofaríngeas/terapia , Radioterapia/efectos adversos , Cuidados Posteriores , Anciano , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirugía , Glucocorticoides/administración & dosificación , Humanos , Edema Laríngeo/tratamiento farmacológico , Edema Laríngeo/etiología , Masculino , Microcirugia , Disección del Cuello , Neoplasias Orofaríngeas/radioterapia , Neoplasias Orofaríngeas/cirugía , Pronóstico , Calidad de Vida , Reoperación , Resultado del TratamientoRESUMEN
PURPOSE: The aim of this explorative study was to evaluate the impact of selenium in the treatment of lymphedema after radiotherapy. MATERIALS AND METHODS: Between June 1996 and June 2001, 12 patients with edema of the arm and 36 patients with edema of the head-and-neck region were treated with selenium for therapy-related lymphedema. Of these 36 patients, 20 had interstitial endolaryngeal edema associated with stridor and dyspnea. All patients received sodium selenite over 4 to 6 weeks. RESULTS: Self-assessment using a visual analog scale (n = 48) showed a reduction of 4.3 points when comparing pre- and posttreatment values (p < 0.05). Of 20 patients with endolaryngeal edema, 13 underwent no tracheostomy, 5 underwent a temporary tracheostomy, and only 2 underwent a permanent tracheostomy. Ten of 12 patients with arm edema showed a circumference reduction of the edematous limb and improvement in the Skin-Fold Index by 23.3 points. An improvement of one stage or more was shown by the Földi or the Miller score (n = 28) in 22 (Földi score) and in 24 (Miller score) patients. CONCLUSIONS: Treatment with sodium selenite is well tolerated and easy to deliver. Additionally, our results suggest that sodium selenite has a positive effect on secondary-developing lymphedema caused by radiation therapy alone or by irradiation after surgery.