RESUMO
BACKGROUND: The purpose of this study was to improve attachment of automatic tracheostoma valves, the knowledge on tracheostoma geometry, and its clinical influences preferred. This article investigates whether the number of removed trachea rings, incision of the sternocleidomastoid muscles, neck dissection, reconstruction, time after operation, and age have any effect on the (peri)stomal geometry of the patient. METHODS: (Peri)stomas of 191 patients from 10 institutes worldwide were photographed, measured, and compared. RESULTS: Paired comparisons between the number of trachea rings removed showed significant differences in horizontal and vertical trachea-opening diameters, but failed to demonstrate an effect in the depth of the stoma. T tests did not demonstrate significant differences in peristomal geometry between the sternocleidomastoid-cleaved and non-cleaved group. CONCLUSION: The number of removed tracheal rings during laryngectomy does not seem to influence stoma depth. However, this study does not demonstrate that cleaving the sternocleidomastoid muscle (SCM) at the time of a laryngectomy will result in a geometrically flatter stoma.
Assuntos
Neoplasias Laríngeas/reabilitação , Neoplasias Laríngeas/cirurgia , Laringectomia/métodos , Músculos do Pescoço/cirurgia , Traqueostomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Cooperação Internacional , Neoplasias Laríngeas/patologia , Laringectomia/reabilitação , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Países Baixos , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/terapia , Prognóstico , Qualidade de Vida , Medição de Risco , Perfil de Impacto da Doença , Medida da Produção da Fala , Estomas Cirúrgicos , Traqueostomia/reabilitação , Resultado do Tratamento , Qualidade da VozRESUMO
OBJECTIVES: We performed in vitro evaluation of a novel, disposable, automatic hands-free tracheostoma speech valve for laryngectomy patients based upon the principle of inhalation. The commercially available automatic speech valves close upon strong exhalation and open again when the pressure drops. This method makes long sentences or pauses difficult. The novel iValve is designed to allow almost natural speech, with mid-sentence pausing and whispering. METHODS: The inhalation closing flows and exhalation opening pressures of 6 iValve prototype versions at different settings were compared with physiological values. The airflow resistance at inhalation was compared to physiological values and to commercial valve values. RESULTS: The iValve prototypes showed flow and pressure ranges in concordance with the physiological values in the literature. The airflow resistance in the breathing mode was within the physiological airflow resistance range, yet above the values from the two commercial valves. The resistance in the speaking mode was above the physiological airflow resistance range. CONCLUSIONS: In vitro tests show that the iValve versions can be selected and adjusted to operate within the physiological range. The airflow resistance in the breathing mode is good. In speaking mode, inhalation should, and can, be decreased. The iValve should offer the patient a more intuitively useable alternative with more dynamic speech. Its low cost allows disposability and wider use.
