Associated Factors With the Prosthetic Vocal Rehabilitation Outcome in Older Patients (Over 70 Years).

INTRODUCTION: Tracheoesophageal puncture (TEP) with voice prosthesis (VP) is considered the gold standard in vocal rehabilitation of total laryngectomized patients, for generating better speech intelligibility and good vocal result. The aspects of aging that may be related to the success of this method of rehabilitation are rarely discussed in the literature. OBJECTIVE: To describe the factors that influence the rehabilitation outcome of the total laryngectomized older patients with voice prosthesis. METHODS: A retrospective cohort study enrolled in the Head and Neck Cancer Surgery Section of the Brazilian National Cancer Institute. Secondary data were collected through physical and electronic medical records of patients undergoing vocal rehabilitation using tracheoesophageal prosthesis, from 2006 to 2019. Descriptive analysis presented the distribution of the demographic and clinical characteristics of this population. RESULTS: Thirty patients rehabilitated with VP over 70 years old (mean age: 73.7 years), of which 93.3% were male. Married (73.3%), with low education (70%) and had a tumor of size T4a (60%). Adjuvant radiotherapy was performed in 66.7% of patients, 16.7% to previous radical radiotherapy, Complication rate was 53.3%, (68.7% granuloma and 18.7% shunt enlargement). All patients with shunt enlargement removed the prosthesis, whereas the prevalence of removal among those patients without complications was 14.3%. Logistic regression indicated that secondary TEP had 96% less chance of failure for phonation than primary TEP. CONCLUSIONS: Patients with more complications are more likely to have phonation issues and to remove the prosthesis. Older patients with larger tumors and who underwent salvage laryngectomy or were submitted to a primary puncture seem to be more likely to have complications and/or aphonia.

Avaliação videofluoroscópica no pós-operatório tardio de pacientes submetidos à laringectomia supracricoidea com cricohioidoepiglotopexia / Videofluoroscopic evaluation in the late postoperative period of patients undergoing supracricoid laryngectomy with cricohyiodopexy

Introdução: A laringectomia parcial supracricóidea comcricohioidoepiglotopexia (CHEP) é uma alternativa no tratamentode lesões malignas da laringe para evitar a laringectomiatotal e a presença definitiva da traqueostomia e consequenteperda da voz laríngea. Objetivo: O objetivo deste trabalho éavaliar os distúrbios de deglutição em pacientes submetidosà laringectomia supracricóide com cricohióidoepiglotopexia,por meio da videofluoroscopia Método: Foram avaliados 58pacientes da Seção de Cirurgia de Cabeça e Pescoço doInstituto Nacional de Câncer (INCA), com idade entre 45 e 70anos, com carcinoma epidermóide primário de laringe glótica esupraglótica, e submetido à laringectomia supracricóide comcricohióoidoepiglotopexia (LSC-CHEP). Resultados: Observouseque em 19 (42%) pacientes que não apresentavam queixaprévia relacionada à disfagia foram registradas aspirações durantea deglutição, e em 6 (31%), pneumonia de repetição. Cinco (83%)deles necessitaram intervenção imediata com introdução de dietaenteral e fonoterapia, e um foi submetido à laringectomia total.Conclusão: Constatou-se presença de distúrbios importantesde deglutição em pacientes assintomáticos, com laringectomiaparcial supracricóidea com cricohioidoepiglotopexia, fato queaponta para a necessidade da inclusão da videofluoroscopia narotina de atendimento desses pacientes.