Rehabilitación del paciente laringectomizado. Recomendaciones de la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello / Rehabilitation of the laryngectomised patient. Recommendations of the Spanish Society of Otolaryngology and Head and Neck Surgery

La laringectomía total permanece como tratamiento fundamental para el carcinoma de laringe localmente avanzado asociándose a una mayor supervivencia. Sin embargo, supone para el paciente una serie de cambios, como la incapacidad de comunicarse verbalmente, la respiración o el cambio estético, que inciden en su calidad de vida y obligan a su rehabilitación integral. El presente documento ha sido elaborado por el grupo de trabajo de rehabilitación del paciente laringectomizado de la Comisión de Cabeza y Cuello y Base de Cráneo de la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello con el objeto de unificar las recomendaciones sobre materiales, técnicas y medidas que aúnen la rehabilitación integral del paciente sometido a una laringectomía total para la mejora de su calidad de vida y está destinado a especialistas en otorrinolaringología, a profesionales relacionados con el cuidado del paciente laringectomizado total y también a los propios pacientes. Las recomendaciones del documento tienen como objetivo mejorar la atención del paciente al cual se le ha realizado una laringectomía total teniendo en cuenta las necesidades de personal y material, las consideraciones sobre los procedimientos necesarios antes de la cirugía, durante el propio acto quirúrgico y tras el alta hospitalaria del paciente. Se dan también recomendaciones específicas sobre los tipos de rehabilitación y seguimiento de la misma, así como la necesidad de llevar un registro de dichas actividades. Las recomendaciones expuestas pretenden ayudar a los profesionales sanitarios relacionados con el tratamiento de los pacientes laringectomizados totales a llevar a cabo la tarea de hacer que la vida de estos pacientes sea lo más parecida posible a la vida que llevaban antes de realizarse una laringectomía total

Total laryngectomy remains essential treatment for locally advanced laryngeal carcinoma, related to better survival rates. However, it involves changes for the patient, such as the inability to communicate verbally, breathing or aesthetic changes, which affect their quality of life and require comprehensive rehabilitation. This paper was written by the total laryngectomy rehabilitation workgroup of the National Head and Neck and Skull Base working committee of the Spanish Society of Otolaryngology and Head and Neck Surgery. The purpose of the article is to combine materials, surgical procedures and means towards the comprehensive rehabilitation of total laryngectomy patients, so that they can achieve a good quality of life. This paper is aimed at all health care professionals caring for total laryngectomy patients. It is also aimed at the patients themselves, as well as ENT surgeons. We have considered staffing and material needs, all procedures before, during and after surgery and after hospital discharge. There are also detailed recommendations about types of rehabilitation and follow-up, and the need for recording these events. The comprehensive rehabilitation total laryngectomy patients is very important if we want to improve their quality of life. The recommendations we mention aim to help the healthcare professionals involved in the treatment of total laryngectomy patients to help them achieve a good quality of life, as similar as possible to the life they led before surgery

Anatomic Landmarks in Transoral Oropharyngeal Surgery.

INTRODUCTION: Minimally invasive transoral surgery for oropharyngeal cancer is a challenge for head and neck surgeons because of the inside-out anatomic presentation and the confined workspace. This study was performed to describe the main neurovascular and muscular landmarks in a transoral approach. The authors propose an anatomic stratification for this surgery. MATERIALS AND METHODS: Lateral wall of the oropharynx and base of the tongue of 15 formalin-fixed heads (30 sides) and 5 fresh cadaveric heads (10 sides) sagittal sectioned were dissected from the inside outwards. Dissection of 7 fresh cadaveric heads via an endoscopic transoral approach was also performed. RESULTS: The lateral oropharyngeal wall was divided into 3 layers from medial to lateral, based in the styloid muscle diaphragm. The first layer, medial to styloid muscles, includes the tonsillar vascularization and the lingual branch of the glossopharyngeal nerve. The second layer, lateral to constrictor muscles, includes the pharyngeal venous plexus, the glossopharyngeal nerve, and the lingual artery. The third layer, lateral to styloid diaphragm, includes the parapharyngeal and submandibular spaces, the carotid vessels and lingual, vagus, glossopharyngeal and hypoglossal nerves. The base of the tongue was divided into central and lateral parts, which contain the lingual artery and lingual branches of the glossopharyngeal nerve. The main landmarks to find the neurovascular structures in each layer are described. CONCLUSION: The authors propose an anatomic division, which helps to plan oropharynx and base of the tongue surgery. This anatomic stratification is useful to surgeons when performing a reconstruction of the oropharynx with a transoral approach.

Rehabilitation of the laryngectomised patient. Recommendations of the Spanish Society of Otolaryngology and Head and Neck Surgery. / Rehabilitación del paciente laringectomizado. Recomendaciones de la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello.

Total laryngectomy remains essential treatment for locally advanced laryngeal carcinoma, related to better survival rates. However, it involves changes for the patient, such as the inability to communicate verbally, breathing or aesthetic changes, which affect their quality of life and require comprehensive rehabilitation. This paper was written by the total laryngectomy rehabilitation workgroup of the National Head and Neck and Skull Base working committee of the Spanish Society of Otolaryngology and Head and Neck Surgery. The purpose of the article is to combine materials, surgical procedures and means towards the comprehensive rehabilitation of total laryngectomy patients, so that they can achieve a good quality of life. This paper is aimed at all health care professionals caring for total laryngectomy patients. It is also aimed at the patients themselves, as well as ENT surgeons. We have considered staffing and material needs, all procedures before, during and after surgery and after hospital discharge. There are also detailed recommendations about types of rehabilitation and follow-up, and the need for recording these events. The comprehensive rehabilitation total laryngectomy patients is very important if we want to improve their quality of life. The recommendations we mention aim to help the healthcare professionals involved in the treatment of total laryngectomy patients to help them achieve a good quality of life, as similar as possible to the life they led before surgery.

Clasificación de las resecciones transorales en la orofaringe: propuesta del grupo de trabajo de la Sociedad Catalana de Otorrinolaringología / Transoral oropharyngeal resection classification: Proposal of the SCORL working group

Introducción y objetivos: La cirugía mínimamente invasiva ha presentado una expansión muy importante en la última década. Con el objetivo de aportar un lenguaje común tras cirugía transoral de la orofaringe, se ha creado un sistema de clasificación de las resecciones en esta zona, independientemente de la instrumentalización utilizada. Métodos: Desde el Grupo de Trabajo en Oncología de la Sociedad Catalana de Otorrinolaringología, se presenta una propuesta de clasificación basada en una división topográfica de las diferentes zonas de la orofaringe, así como en la afectación de las estructuras anexas según las vías anatómicas de extensión de estos tumores. Resultados: La clasificación se inicia utilizando la letra D o I según la lateralidad sea derecha (D) o izquierda (I). A continuación se coloca el número del área resecada. Esta numeración define las zonas iniciando a nivel craneal donde el área I sería el paladar blando, el área II lateral en la zona amigdalina, el área III en la base de lengua, el área IV en los repliegues glosoepiglóticos, la epiglotis y repliegues faringoepiglóticos, el área V pared orofaríngea posterior y VI el trígono retromolar. Se añade el sufijo p si la resección afecta profundamente al plano submucoso de la zona comprometida. Las diferentes áreas propuestas tendrían, de una forma teórica, diferentes implicaciones funcionales. Conclusiones: Propuesta de sistema de clasificación por áreas que permite definir diferentes tipos de cirugía transoral de la orofaringe así como compartir los resultados y ayudar en la docencia de este tipo de técnicas (AU)

Introduction and goals: There has been a very significant increase in the use of minimally invasive surgery has in the last decade. In order to provide a common language after transoral surgery of the oropharynx, a system for classifying resections has been created in this area, regardless of the instrumentation used. Methods: From the Oncology Working Group of the Catalan Society of Otorhinolaryngology, a proposal for classification based on a topographical division of the different areas of the oropharynx is presented, as also based on the invasion of the related structures according to the anatomical routes of extension of these tumours. Results: The classification starts using the letter D or I according to laterality either right (D) or left (I). The number of the resected area is then placed. This numbering defines the zones beginning at the cranial level where area I would be the soft palate, lateral area II in the tonsillar area, area III in the tongue base, area IV in the glossoepiglottic folds, epiglottis and pharyngoepiglottic folds, area V posterior oropharyngeal wall and VI the retromolar trigone. The suffix p is added if the resection deeply affects the submucosal plane of the compromised area. The different proposed areas would, in theory, have different functional implications. Conclusions: Proposal for a system of classification by area to define different types of transoral surgery of the oropharynx, and enable as sharing of results and helps in teaching this type of technique (AU)

Transoral oropharyngeal resection classification: Proposal of the SCORL working group. / Clasificación de las resecciones transorales en la orofaringe: propuesta del grupo de trabajo de la Sociedad Catalana de Otorrinolaringología.

INTRODUCTION AND GOALS: There has been a very significant increase in the use of minimally invasive surgery has in the last decade. In order to provide a common language after transoral surgery of the oropharynx, a system for classifying resections has been created in this area, regardless of the instrumentation used. METHODS: From the Oncology Working Group of the Catalan Society of Otorhinolaryngology, a proposal for classification based on a topographical division of the different areas of the oropharynx is presented, as also based on the invasion of the related structures according to the anatomical routes of extension of these tumours. RESULTS: The classification starts using the letter D or I according to laterality either right (D) or left (I). The number of the resected area is then placed. This numbering defines the zones beginning at the cranial level where area I would be the soft palate, lateral area II in the tonsillar area, area III in the tongue base, area IV in the glossoepiglottic folds, epiglottis and pharyngoepiglottic folds, area V posterior oropharyngeal wall and VI the retromolar trigone. The suffix p is added if the resection deeply affects the submucosal plane of the compromised area. The different proposed areas would, in theory, have different functional implications. CONCLUSIONS: Proposal for a system of classification by area to definedifferent types of transoral surgery of the oropharynx, and enable as sharing of results and helps in teaching this type of technique.

Minimally invasive wire-guided balloon catheter puncture for voice prosthesis insertion.

BACKGROUND: Tracheoesophageal puncture is an effective and reliable method for voice restoration after total laryngectomy that may be performed as a primary or secondary procedure. METHODS: We describe our technique for secondary tracheoesophageal puncture using a wire-guided balloon catheter in an office setting. A 72-year-old patient with a total laryngectomy performed 2 years ago was selected for wire-guided balloon catheter puncture and voice prosthesis insertion. RESULTS: Successful tracheoesophageal puncture placement was achieved without complications and the patient tolerated the procedure well. The voice result was satisfactory and immediate. CONCLUSION: We conclude that balloon catheter tracheoesophageal puncture can be a simple and safe option for secondary voice prosthesis insertion in total laryngectomy for selected patients. It can be performed in an office setting using only local anesthetic for secondary puncture.

Hemorragia intralaberíntica / Intralabyrinthine haemorrhage

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Angioedema por inhibidores de la enzima convertidora de angiotensina / Angioedema caused by ACE inhibitor

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[Myringoplasty: auditory follow-up and study of prognostic factors]. / Miringoplastia: seguimiento auditivo y estudio de factores pronósticos.

OBJECTIVE: To perform a five-year study of hearing evolution in patients undergoing myringoplasty to determine whether eardrum repair correlates with improved hearing. We also studied factors that might predispose to failure and their usefulness as prognostic factors. MATERIAL AND METHOD: In a serial case study, we reviewed all myringoplasties performed at our centre during 2000, 2001, and 2002. We reviewed 83 case histories and studied the closure of the perforation, auditory function pre-operatively, postoperatively and after 5 years, as well as different associated factors. RESULTS: The perforation was closed in 75.9 % of cases. The mean gain of auditory function was 1.5 dB at five years, without statistical significance. The hearing evolution presented a post-surgical improvement and a subsequent deterioration, both statistically significant. We found a statistically significant relationship between the size of the perforation and the condition of the contralateral ear. CONCLUSIONS: Perforation closure in our series (75.9 %) is similar to that reported in the literature. We found contralateral ear pathology and the perforation extension to be associated with poor prognosis after myringoplasty.

Miringoplastia: seguimiento auditivo y estudio de factores pronósticos / Myringoplasty: auditory follow-up and study of prognostic factors

Objetivo: Realizar un estudio a 5 años de la audición de los pacientes sometidos a miringoplastia a fin de probar si la restitución timpánica tiene correlación con la mejora auditiva. Se investigan también posibles factores predisponentes al fracaso y averiguar si podemos describirlos como factores pronósticos. Material y método: Se realiza estudio tipo serie de casos y una revisión de las miringoplastias realizadas en nuestro centro en los años 2000, 2001 y 2002. Se revisaron 83 historias y se estudió el cierre de la perforación, la función auditiva prequirúrgica, posquirúrgica y a 5 años, así como diferentes factores relacionados. Resultados: Se obtiene un cierre de la perforación en el 75,9 % de los casos. En cuanto a la función auditiva, obtenemos una ganancia sin significación estadística de 1,5 dB a los 5 años. La evolución auditiva presenta una mejora posquirúrgica y un empeoramiento posterior, ambos estadísticamente significativos. Se ha obtenido una relación estadística en el tamaño de la perforación y el estado del oído contralateral. Conclusiones: Se presenta un resultado de cierre de la perforación acorde con la mayoría de las series. El estado patológico del oído contralateral y la extensión de la perforación son factores de mal pronóstico de la miringoplastia (AU)

Objective: To perform a five-year study of hearing evolution in patients undergoing myringoplasty to determine whether eardrum repair correlates with improved hearing. We also studied factors that might predispose to failure and their usefulness as prognostic factors. Material and method: In a serial case study, we reviewed all myringoplasties performed at our centre during 2000, 2001, and 2002. We reviewed 83 case histories and studied the closure of the perforation, auditory function pre-operatively, postoperatively and after 5 years, as well as different associated factors. Results: The perforation was closed in 75.9 % of cases. The mean gain of auditory function was 1.5 dB at five years, without statistical significance. The hearing evolution presented a post-surgical improvement and a subsequent deterioration, both statistically significant. We found a statistically significant relationship between the size of the perforation and the condition of the contralateral ear. Conclusions: Perforation closure in our series (75.9 %) is similar to that reported in the literature. We found contralateral ear pathology and the perforation extension to be associated with poor prognosis after myringoplasty (AU)