[Case report on traumatic complete laryngotracheal separation with a positive outcome]. / Fallbericht zum traumatischen Totalabriss der Trachea vom Kehlkopf mit positivem Ausgang.

HISTORY: A 21-year-old female was injured by accidental strangulation. Dyspnea and stridor occurred with delay, and led to emergency intubation. FINDINGS: Physical examination showed strangulation marks and neck emphysema. Computed tomography confirmed laryngotracheal separation and revealed misplacement of the ventilation tube. DIAGNOSIS: Further surgical exploration revealed complete laryngotracheal (cricotracheal) separation. TREATMENT: After initial emergency tracheotomy, cricotracheal reanastomosis was achieved by a two-stage surgical approach. CONCLUSION: Laryngotracheal separation is associated with high mortality. In the case presented herein, the patient survived and was discharged from hospital without a tracheostomy tube despite bilateral recurrent laryngeal nerve palsy.

Course of social support and associations with distress after partial laryngectomy.

PURPOSE: Social support has been shown to be positively associated with quality of life and adjustment after a cancer diagnosis. The present study investigates the course of social support up to one year after partial laryngectomy and its association with distress. DESIGN: Longitudinal questionnaire study. SAMPLE: A total of 428 patients after partial laryngectomy (mean age: 64, SD = 11, 91% male). METHODS: Patients completed questionnaires before treatment (t1), one week after a partial laryngectomy (t2), 3 months (t3), and one year (t4) thereafter. Social support was evaluated at t2, t3, and t4 using a brief version of the Social Support Questionnaire. Distress was measured at t2, t3, and t4 using the HADS. Descriptive statistics for social support were computed across the three measurement points. Changes were analyzed by Wilcoxon signed-rank tests. Associations with distress were identified using linear regression analyses. FINDINGS: Social support increased between t2 and t3 and decreased to baseline level between t3 and t4. Distress at t2 was associated with social support at t2 (B = -0.15, p < 0.01) and distress at t3 with social support at t3 (B = -0.19, p < 0.01). Distress at t4 was related to social support at t2 (B = -0.10, p = 0.05). CONCLUSIONS: Although perceived social support increases after partial laryngectomy, it decreases again during the course of aftercare. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS OR POLICY: Social support resources should be assessed to identify patients at risk for worse psychological well-being.

[A group intervention to promote work ability in patients with head and neck cancer]. / Eine Gruppenintervention zur Förderung der Arbeitsfähigkeit für Patienten mit Kopf-Hals-Tumoren.

INTRODUCTION: Despite high distress the majority of head and neck cancer patients does not use any psycho-oncological counselling or psychotherapeutic support. Additionally, patients with head and neck cancer have an increased risk of not returning to work compared to other cancer patients. Therefore, we have developed a group intervention program which aims at improving work ability in patients with head and neck cancer as well as their quality of life, self-efficacy and psychological well-being. MATERIAL AND METHODS: In a randomized controlled trial head and neck cancer patients either receive a group intervention or socio-legal counselling. Male head and neck cancer patients with elevated levels of psychological and work-related distress are included. The group intervention consists of eight sessions. Groups are led by both a psychotherapist and a former head and neck cancer patient (peer). Feasibility and acceptability of the group intervention were tested by means of a pilot group. Each session was evaluated by pilot group participants. Semi-structured interviews were used to assess relevance of content and practicability. RESULTS: 113 patients were personally addressed, of which four patients participated in the pilot group. Patients reported that the intervention fit very well with their daily life and expressed satisfaction with it. Three patients emphasized the importance of the peer. DISCUSSION: The presence of the peer as identification figure seems to be of crucial importance. To increase recruitment numbers inclusion criteria will be modified and participation costs will be reduced.

[Speech Intelligibility and Marital Quality in Couples after Total Laryngectomy - Partners' View]. / Sprechverständlichkeit und Partnerschaftsqualität bei Paaren nach einer Laryngektomie ­ Die Sicht der Partner.

BACKGROUND: Following the total removal of the larynx (TL) as a result of laryngeal cancer, both, patients and partners face significant challenges caused by altered speech intelligibility. We analysed effects of the altered speech intelligibility on dyadic communication and marital quality from the partners' point of view. METHODS: 70 partners of cancer patients with laryngectomy from 13 hospitals in Central Germany were interviewed 2 (t1) and 3 (t2) years after laryngectomy. Partners were administered a battery of questionnaires to assess speech intelligibility, coping with altered speech intelligibility and post-laryngectomy dyadic communication pattern. Hahlwegs Partnership Questionnaire (PFB) was used to analyse martial quality. Patients with laryngectomy completed Post-Laryngektomie-Telefonverständlichkeits-Test (PLTT) to measure speech intelligibility. RESULTS: Speech intelligibility was classified by partners as 'good' in 37% (t1) and 57% (t2). Female partners did not generally indicate an increased dispute behavior, compared with woman in general. However, dyadic communication and mutual activities were less satisfactory. Partners of aphonic patients argued more frequently, coped less adequately with the altered dyadic communication and perceived more frequently a decline in marital quality since the onset of the disease. CONCLUSION: Results indicate need and importance of logopaedic support also with respect to marital quality. Further, interventions which emphasize the improvement of dyadic communication and enhancement of mutual activities should be stimulated.

Quality of life during the first year after partial laryngectomy: Longitudinal study.

BACKGROUND: This prospective study was conducted to assess changes in quality of life (QOL) of patients who undergo a partial laryngectomy. METHODS: The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaires Core and Head and Neck (EORTC-QLQ-C30, QLQ-H&N35) were used preprocedure (n = 218), 1 week (n = 159), 3 months (n = 122), and 1 year after partial laryngectomy (n = 88). Changes over time were analyzed with the Wilcoxon signed rank test and the Holm-Bonferroni method, and interpreted regarding clinical relevance. RESULTS: Most subscales worsened 1 week postprocedure, but many recovered to baseline level after 1 year. Dyspnea and cognitive functioning deteriorated over time, with worst scores recorded after 1 year. Financial difficulties and fatigue increased after surgery and maintained that level throughout the follow-up period; sticky saliva remained worse than at baseline, despite some improvements over time. CONCLUSION: The discovered limitations of QOL should be observed more closely during follow-up treatment, and patients should be informed about these potential effects before partial laryngectomy.

Concept of patient-specific shape memory implants for the treatment of orbital floor fractures.

PURPOSE: We will aim to develop implants made of a Ni-Ti shape memory alloy which can be applied for the treatment of midface fractures, such as isolated orbital floor fractures. These can then be implanted in a compressed form and unfold automatically in the body. With the help of newly developed application instruments, the implants can be applied along transnasal and transantral approaches into the maxillary sinus. Our objective is to evaluate the operation process and the functionality of these implants, already in a pre-investigation by an experienced surgeon on a phantom. METHODS: The functionality of the surgical procedure and an implant prototype were both evaluated with the help of a realistic phantom. The minimally invasive application was carried out using the transnasal and transantral approach. Instruments and implant were rated individually on a scale, from -2 (not at all) to +2 (very good) for vaious criteria, such as the implants functionality or the ergonomics of the entire procedure. For a geometric comparison between the manufactured implant and the planned target geometry, the implants were scanned by micro-computed tomography. CAD models were derived from the scans by using reverse engineering. RESULTS: Both the implants and the application procedure were assessed as good; thus, the implant concept is suitable for further development. CONCLUSIONS: Implants made of shape memory alloys could allow in the future and allow less invasive access to treat orbital floor fractures. The implant design has to be modified that the implant can be stabilized and fixed with screws or a suture to avoid dislocation or implant loosening. The complication rates and risks of conventional orbital reconstructions should be lowered by this new method.

Tobacco and alcohol consumption after total laryngectomy and survival: A German multicenter prospective cohort study.

BACKGROUND: We examined the relation of tobacco and alcohol consumption after total laryngectomy with overall survival (OS). METHODS: Tobacco and alcohol consumption was assessed at 5 time points after total laryngectomy. Patients were followed up for survival until December 31, 2014. A multivariate Cox regression was fitted to test for differences in OS. RESULTS: Three hundred fifty-nine patients were included in this study. Compared to former smokers, never smokers had hazard ratios (HRs) of 0.88 (95% confidence intervals [CIs] = 0.50-1.59), and continuous smokers 1.31 (95% CI = 0.87-1.96). Constantly high alcohol consumption after total laryngectomy had an HR of 2.19 (95% CI = 1.30-3.67). Duration of smoking (HR = 1.00; 95% CI = 0.99-1.01) and last known status of alcohol consumption (HR = 1.00; 95% CI = 0.76-1.33) was not related to OS. CONCLUSION: Patients who smoke after total laryngectomy have a 30% higher risk of dying than people who gave up smoking, and constant high alcohol consumption is also a strong risk factor for dying. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1324-1329, 2016.

Quality of life before and after total laryngectomy: results of a multicenter prospective cohort study.

BACKGROUND: The purpose of this study was to determine what quality of life (QOL) areas improve and deteriorate during the first year after total laryngectomy and to identify predictors of these changes. METHODS: One hundred seventy-four patients completed the European Organization for Research and Treatment of Cancer (EORTC) QOL questionnaires before laryngectomy, n = 133 before discharge from hospital, n = 110 at the end of rehabilitation, and n = 86 1 year after laryngectomy. Multivariate regression analysis was performed to estimate the effect of potential predictors on QOL. RESULTS: Areas that did not recover to baseline level were physical functioning, role functioning, social functioning, fatigue, dyspnea, appetite loss, financial difficulties, senses, speech, and social contact, whereas global health status, coughing, and weight improved. There was no evidence for predicting effects of age, sex, education, and tumor site. Tumor stage, recurrent disease, radiotherapy, and mental health did display predicting effects. Smoking status before the treatment had marginally significant effects. CONCLUSION: QOL decreases initially after laryngectomy; some QOL areas recover slowly over the course of the year after surgery, and some remain significantly worse than at baseline.

A 10-year analysis of cutaneous mesenchymal tumors (sarcomas and related entities) in a skin cancer center.

BACKGROUND: Mesenchymal neoplasms (sarcomas) of skin are rare. Patients with sarcomas were analyzed over the last decade. METHODS: Over a 10-year period, we conducted a retrospective analysis of patients diagnosed and treated in an urban academic teaching hospital in Saxony, Germany. Clinical and pathologic files were used. RESULTS: We identified 65 adult patients with 67 primary cutaneous sarcomas. The mean age was 73.1 (± 15.5) years with a male predominance (78.5%). None of the sarcomas was detected by a skin cancer screening program. The diagnosis was atypical fibroxanthoma (n = 41 patients with 43 tumors), cutaneous angiosarcoma (eight), dermatofibrosarcoma protuberans (two), nodular epithelioid cell sarcoma (one), Kaposi sarcoma (three), leiomyosarcoma (five), malignant fibrous histiocytoma (two), fibromyxoid sarcoma (one), and cutaneous angiomyxoma (two). The preferred tumor localization was the head and neck area (44 patients). Follow-up was 0.5-5.5 years (mean 18 ± 12 months). We observed metastatic spread of atypical fibroxanthoma in 12.5%, demonstrating that this type of sarcoma can run an aggressive course. Mohs surgery is still the cornerstone of treatment, although new options in palliative or adjuvant treatment are available. CONCLUSIONS: Mesenchymal neoplasms (sarcomas) are an important group of cutaneous malignancies. Awareness needs to be improved.

Monoclonal anti-CD20 Antibody Therapy in Cicatrical Pemphigoid with Oral and Hypopharyngeal Involvement and Related Conditions.

Mucous membrane pemphigoid is a rare blistering autoimmune disorder that can lead to significant disability. Recently, the monoclonal anti-CD20 antibody rituximab has shown efficacy in pemphigus and pemphigoid, but the data for pemphigoid are relatively sparse. The authors report a series of four patients with severe cicatrical pemphigoid treated with rituximab. All of these patients responded and two of them had a complete remission. Rituximab is a second-line treatment for severe and recalcitrant cicatrical pemphigoid.

Motivation as a predictor of speech intelligibility after total laryngectomy.

BACKGROUND: It has often been argued that if patients' success with speech rehabilitation after laryngectomy is limited, it is the result of lacking motivation on their part. This project investigated the role of motivation in speech rehabilitation. METHODS: In a multicenter prospective cohort study, 141 laryngectomees were interviewed at the beginning of rehabilitation and 1 year after laryngectomy. Speech intelligibility was measured with a standardized test, and patients self-assessed their own motivation shortly after the surgery. Logistic regression, adjusted for several theory-based confounding factors, was used to assess the impact of motivation on speech intelligibility. RESULTS: Speech intelligibility 1 year after laryngectomy was not significantly associated with the level of motivation at the beginning of rehabilitation (odds ratio [OR], 1.3; 95% confidence interval [CI], 0.7-2.3; p = .43) after adjusting for the effect of potential confounders (implantation of a voice prosthesis, patient's cognitive abilities, frustration tolerance, physical functioning, and type of rehabilitation). CONCLUSIONS: Motivation is not a strong predictor of speech intelligibility 1 year after laryngectomy.

Speech rehabilitation during the first year after total laryngectomy.

BACKGROUND: Gaining a new voice is one of the major aims after total laryngectomy. The objective of this study was to describe the process and results of speech rehabilitation during the first year after surgery. METHODS: Speech intelligibility was measured 6 months (n = 273) and 1 year (n = 225) after total laryngectomy. RESULTS: Objective (23.4 to 47.5 points, p < .0001) and subjective (51.6 to 64.7 points, p < .0001) speech intelligibility improved between 6 months and 1 year after total laryngectomy. Patients who used tracheoesophageal puncture (TEP) had the best results in speech intelligibility 6 months and 1 year after total laryngectomy. In all, 12% of the patients who used TEP initially no longer used it 1 year later. Patients who had received rehabilitation had better objective speech intelligibility than those who did not. CONCLUSIONS: Speech improves considerably between 6 months and 1 year after total laryngectomy. Nonattendance of rehabilitation is associated with a worse functional outcome in speech rehabilitation.

Sexual problems after total or partial laryngectomy.

OBJECTIVES: To investigate sexual problems that can occur after laryngeal and hypopharyngeal cancer surgery and to specify possible influencing factors. STUDY DESIGN: Multi-institutional cross-sectional study. METHODS: Two hundred six patients were interviewed in person using the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire, Head and Neck Module (EORTC QLQ-H&N35), the Hospital Anxiety and Depression Scale, and a structured interview assessing alcohol and tobacco consumption, sociodemographic data, and specific sexual problems. Type of surgery, tumor site, and tumor stage were documented according to the participants' medical records. Multivariate analysis of variance was used to assess the independent impact of each factor. RESULTS: More than half of the patients in our study reported having reduced libido and sexual enjoyment after treatment. Sixty percent considered it an important issue for their contentment with life. Sexual difficulties were found to be unrelated with gender, formal education, alcohol and tobacco consumption, type of surgery (partial vs. total laryngectomy), radiotherapy, and tumor site. Psychological distress (F = 46.27, P < .001) was seen to have a strong independent impact on the occurrence of sexual difficulties and stage of disease (F = 4.50, P < .05) and age (F = 4.79, P < .05), a moderate independent impact. CONCLUSIONS: Reduced libido and sexual enjoyment is a common problem after laryngeal and hypopharyngeal cancer surgery. However, it is not caused by the oncological treatment but rather by the cancer itself. Depression is often associated with sexual problems. Both should be discussed in medical consultations with head and neck cancer patients when appropriate to provide adequate treatment.

Effects of a professional solo singer education on auditory and kinesthetic feedback--a longitudinal study of singers' pitch control.

The significance of auditory and kinesthetic feedback to pitch control in singing was described in a previous report of this project for students at the beginning of their professional solo singer education.(1) As it seems reasonable to assume that pitch control can be improved by training, the same students were reinvestigated after 3 years of professional singing education. As in the previous study, the singers sang an ascending and descending triad pattern with and without masking noise in legato and staccato and in a slow and a fast tempo. Fundamental frequency and interval sizes between adjacent tones were determined and compared with their equivalents in the equally tempered tuning. The average deviations from these values were used as estimates of intonation accuracy. Intonation accuracy was reduced by masking noise, by staccato as opposed to legato singing, and by fast as opposed to slow performance. The contribution of the auditory feedback to pitch control was not significantly improved after education, whereas the kinesthetic feedback circuit was improved in slow legato and slow staccato tasks. The results support the assumption that the kinesthetic feedback contributes substantially to intonation accuracy.

Significance of auditory and kinesthetic feedback to singers' pitch control.

An accurate control of fundamental frequency (F0) is required from singers. This control relies on auditory and kinesthetic feedback. However, a loud accompaniment may mask the auditory feedback, leaving the singers to rely on kinesthetic feedback. The object of the present study was to estimate the significance of auditory and kinesthetic feedback to pitch control in 28 students beginning a professional solo singing education. The singers sang an ascending and descending triad pattern covering their entire pitch range with and without masking noise in legato and staccato and in a slow and a fast tempo. F0 was measured by means of a computer program. The interval sizes between adjacent tones were determined and their departures from equally tempered tuning were calculated. The deviations from this tuning were used as a measure of the accuracy of intonation. Statistical analysis showed a significant effect of masking that amounted to a mean impairment of pitch accuracy by 14 cent across all subjects. Furthermore, significant effects were found of tempo as well as of the staccato/legato conditions. The results indicate that auditory feedback contributes significantly to singers' control of pitch.