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1.
J Biomech ; 125: 110594, 2021 08 26.
Artigo em Inglês | MEDLINE | ID: mdl-34237659

RESUMO

The use of a tracheoesophageal valve, also known as voice prosthesis, is currently the most appealing solution for recovering the ability to speak in subjects who have undergone a total laryngectomy. The prosthesis allows the passage of air from the trachea to the esophagus, thereby promoting the flow-induced vibration of the subject's pharyngoesophageal segment. In turn, the pharyngoesophageal segment modulates the air flow from the lungs into the subject's vocal tract, acting as an alternative source of acoustic energy to generate voice. The vibration of the pharyngoesophageal segment will likely depend on the aerodynamic forces acting on its wall, which will be defined by the flow characteristics downstream from the valve's outlet. Previous works have investigated the pressure drop across different prosthesis designs with both in-vitro and in-vivo experiments. Nevertheless, the aerodynamic aspects of the flow in the tracheoesophageal region have only been investigated experimentally in an idealized geometry. This work investigates the influence of the prosthesis position on the aerodynamic behavior of the pharyngoesophageal segment in terms of wall pressure distribution and characteristics of the velocity field. The investigations were carried out with a static model of the tracheoesophageal region based on the finite volume method and a Reynolds-averaged Navier-Stokes solver. The geometry of the system was based on computed tomography images obtained from laryngectomized subjects during phonation at different voice registers and included the geometry of a commercially available voice prosthesis. The results suggest that the position and angulation of the voice prosthesis have a minor influence on the pressure loss along the tracheoesophageal segment and on the pressure distribution on the pharyngoesophageal segment's wall.


Assuntos
Laringe Artificial , Glote , Humanos , Laringectomia , Voz Esofágica , Qualidade da Voz
2.
J Laryngol Otol ; 135(7): E3, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34137368

RESUMO

I wish to thank the Semon Committee for inviting me to deliver the 2020 Semon lecture. This is a very special honour, as is evidenced by the list of distinguished lecturers dating back to the inaugural lecture delivered at University College London in 1913. I am not the first South African to deliver the Semon lecture, having been preceded by my previous chairman Sean Sellars in 1993, and by Jack Gluckman in 2001, who was South African raised and educated and who subsequently became the chairman of otolaryngology in Cincinnati, USA.


Assuntos
Neoplasias Laríngeas/cirurgia , Laringectomia/métodos , Complicações Pós-Operatórias/prevenção & controle , Traqueostomia/métodos , Pesquisa Biomédica , Fístula Cutânea/prevenção & controle , Nutrição Enteral/métodos , Recursos em Saúde , Humanos , Laringe Artificial , Recidiva Local de Neoplasia/epidemiologia , Tratamentos com Preservação do Órgão , Otolaringologia , Doenças Faríngeas/prevenção & controle , Cuidados Pós-Operatórios/métodos , Inibidores da Bomba de Prótons/uso terapêutico , Qualidade de Vida , Radioterapia , Classe Social , África do Sul , Voz Esofágica , Estomas Cirúrgicos , Tireoidectomia
3.
J Speech Lang Hear Res ; 64(7): 2668-2681, 2021 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-34185575

RESUMO

Purpose Our aim was to assess the different voice prostheses (VPs) to identify the most efficient, safest, patient-tailored, longest lifetime, and inexpensive VPs and assess the different factors affecting their quality. Method In September 2017, 15 databases were searched to include all randomized controlled trials. A new search was done in May 2019 to include all other study design articles, which include all the new-era VPs subtypes. Network meta-analysis (NMA) was applied to all 27 outcomes, besides NMA overall and partial order setting was done by using Hasse scatter plots. p values were used in NMA, where the best VPs are approaching one and the least approaches zero. Meta-analysis was done for the rest of the outcomes. Results Two hundred one articles were eligible for inclusion in our study (N = 11,918). Provox-2 was significantly the most efficient and safest device concerning the most patient preference (odds ratio [OR] = 33.88 [0.65, 1762.24]; p = .92), the least dislodgement (risk ratio [RR] = 0.27 [0.13, 0.57]; p = .79), the least airflow resistance (RR = 0.42 [0.08, 2.11]; p = .84), the least granulation formation (RR = 0.73 [0.02, 26.32]; p = .60), and the least VPs' inaccurate size (RR = 0.77 (0.23, 2.61); p = .66). Heat and moisture exchanger addition showed a significant increase in maximum phonation time and breathing experience, with p values (1 and .59), respectively. While heat and moisture exchanger addition showed a significant decline in stoma cleaning frequency, coughing frequency, forced expectoration, sputum production, sleeping problems, and loosening of adhesive, with p values (.99, .72, .69, .96, 1, and 0.96), respectively, Groningen low resistance and Nijdam were considered the worst devices with both overall mean p value of .44. Conclusions Provox-2 is considered the best choice as being the most preferable for patients, with the least airflow resistance, dislodgment, granulation formation, and prosthesis inaccurate size. Groningen low resistance and Nijdam were considered the worst devices according to our analysis. Supplemental Material https://doi.org/10.23641/asha.14802903.


Assuntos
Laringe Artificial , Voz , Humanos , Laringectomia , Metanálise em Rede , Treinamento da Voz
4.
Niger J Clin Pract ; 24(4): 470-475, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33851666

RESUMO

Objective: The aim of this study was to analyze the complications following secondary voice prosthesis insertion and impact of previous irradiation on their appearance. Methods: This study included 106 totally laryngectomized patients who underwent secondary Provox 2 voice prosthesis insertion. Among them, 79 (74.5%) were irradiated. Surgery, prosthesis, fistula, and voice-related complications were analyzed and presented. Results: Complications occurred in 23 (22%) patients. Fifteen of them were previously irradiated. There were no surgery-related complications. In the group of prosthesis-related complications, one patient had increased negative pressure during swallowing with extremely short prosthesis life time. There were 17 complications in the group of fistula related ones; 3 patients had excessive granulation tissue around the fistula and 14 patients experienced prosthesis displacement (7 had closed esophageal end of the fistula, 5 had the prosthesis turned sideways in an open fistula, one patient inhaled and one ingested the prosthesis). Tracheoesophageal voice was not established in 5 patients. Previous irradiation had no statistically significant influence on the complication rate (P = 0,251). Conclusions: The majority of complications following secondary voice prosthesis insertion are fistula-related ones, among which, displacement of the voice prosthesis is the most common. Previous irradiation does not significantly increase the risk of developing complications.


Assuntos
Fístula , Laringe Artificial , Fístula/epidemiologia , Fístula/etiologia , Humanos , Laringectomia/efeitos adversos , Laringe Artificial/efeitos adversos , Desenho de Prótese , Implantação de Prótese/efeitos adversos
5.
J Wound Care ; 30(3): 234-237, 2021 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-33729841

RESUMO

Closure of a tracheoesophageal puncture site performed during voice prosthesis implantation may sometimes be required. Besides local techniques, more elaborate procedures, such as closure by means of free microvascular flaps, have been advocated. In this report, we describe a case of local treatment of a hard-to-heal fistula with local application of autologous platelet-rich fibrin matrix in a 77-year-old male patient. At one-week follow-up, the size of the fistula had decreased dramatically but some leakage remained when drinking. After one month, the patient was able to drink and eat normally without any leakage. There was no recurrence of the leakage at two years' follow-up. In summary, local application of platelet-rich fibrin seems to be a simple, safe and effective procedure for tracheoesophageal fistula closure.


Assuntos
Adesivo Tecidual de Fibrina/uso terapêutico , Laringe Artificial/efeitos adversos , Fibrina Rica em Plaquetas , Fístula Traqueoesofágica/terapia , Idoso , Terapia Combinada , Humanos , Injeções Intralesionais , Laringectomia , Masculino , Punções , Fístula Traqueoesofágica/etiologia , Transplante Autólogo , Resultado do Tratamento
6.
Eur Arch Otorhinolaryngol ; 278(11): 4459-4467, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33582848

RESUMO

PROPOSE: The aim of the present article is to propose an alternative technique to the traditional secondary tracheoesophageal puncture (TEP) for voice rehabilitation after total laryngectomy, describing the procedure step-by-step, analyzing the complications and long-term results. METHODS: A retrospective study was conducted on patients who underwent secondary TEP with the blind technique using a rigid hysterometer. The main steps in this technique are described and illustrated. Patient demographics and surgical outcomes were assessed. RESULTS: Thirty-two patients were enrolled in this study. In all but one case, risk factors that could hinder rigid esophagoscopy were identified (37.5% neopharyngeal/esophageal post-surgical issues, 81.3% prior radiotherapy, 21.9% cervical arthrosis, and 12.5% prior coloplasty or gastric transposition). No intra- or postoperative surgical complications were noted. CONCLUSION: The blind technique offers an alternative method to perform a secondary TEP safely and efficiently in patients with unfavorable anatomical or clinical conditions, lowering the risk of procedure-related complications.


Assuntos
Neoplasias Laríngeas , Laringe Artificial , Humanos , Neoplasias Laríngeas/cirurgia , Laringectomia , Punções , Estudos Retrospectivos , Traqueia/cirurgia , Resultado do Tratamento
7.
Head Neck ; 43(6): 1705-1710, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33544436

RESUMO

BACKGROUND: To present an effective and easily applicable method for tracheoesophageal puncture (TEP) closure by using a localized annular flap instead of bulky and distant flaps. METHODS: The medical records of patients who underwent TEP closure surgery with the annular mucosal flap technique between July 2012 and August 2018 were retrospectively reviewed. Fistula size, indication for closure, duration of surgery, radiotherapy status, and surgery results were analyzed. RESULTS: We have used our technique in nine patients. No postoperative bleeding, wound infection, esophageal stenosis, and tracheostoma stenosis occurred. In all these patients except one, successful closure was achieved. None of the patients had a recurrence of the TEP. CONCLUSION: The annular mucosal flap technique for TEP closure is easy and quick to apply. The patient's oral feeding at the sixth hour after procedure without using a nasogastric tube makes the technique preferable as a priority.


Assuntos
Neoplasias Laríngeas , Laringe Artificial , Esôfago/cirurgia , Humanos , Neoplasias Laríngeas/cirurgia , Laringectomia , Punções , Estudos Retrospectivos , Traqueia , Resultado do Tratamento
9.
Otolaryngol Head Neck Surg ; 164(2): 277-284, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-32746738

RESUMO

OBJECTIVE: To describe a remote approach used with patients with voice prosthesis after laryngectomy during the COVID-19 pandemic and the resulting clinical outcomes in terms of voice prosthesis complications management, oncological monitoring, and psychophysical well-being. STUDY DESIGN: Prospective cohort study. SETTING: Otolaryngology Clinic of the University Polyclinic A. Gemelli, IRCCS Foundation. SUBJECTS AND METHODS: All patients with voice prosthesis who underwent laryngectomy followed by our institute were offered enrollment. Patients who agreed to participate were interviewed to inquire about the nature of the need and to plan a video call with the appropriate clinician. Before and 1 week after the clinician's call, patients were tested with the Hospital Anxiety and Depression Scale. Degrees of satisfaction were investigated with a visual analog scale. A comparison between those who accepted and refused telematic support was carried out to identify factors that influence patient interest in teleservice. RESULTS: Video call service allowed us to reach 37 (50.68%) of 73 patients. In 23 (62.16%) of 37 cases, the video call was sufficient to manage the problem. In the remaining 14 cases (37.83%), an outpatient visit was necessary. Participants who refused telematic support had a significantly shorter time interval from the last ear, nose, and throat visit than patients who accepted (57.95 vs 96.14 days, P = .03). Video-called patients showed significantly decreased levels of anxiety and depression (mean Hospital Anxiety and Depression Scale total score pre- vs post-video call: 13.97 vs. 10.23, P < .0001) and reported high levels of satisfaction about the service. CONCLUSION: Remote approach may be a viable support in the management of patients with voice prosthesis rehabilitation.


Assuntos
COVID-19/epidemiologia , Neoplasias Laríngeas/cirurgia , Laringectomia/reabilitação , Laringe Artificial/efeitos adversos , Telemedicina , Triagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/diagnóstico , Ansiedade/etiologia , Ansiedade/prevenção & controle , Depressão/diagnóstico , Depressão/etiologia , Depressão/prevenção & controle , Feminino , Humanos , Neoplasias Laríngeas/psicologia , Laringectomia/efeitos adversos , Laringectomia/psicologia , Laringe Artificial/psicologia , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Prospectivos , Resultado do Tratamento , Treinamento da Voz
10.
Am J Emerg Med ; 41: 266.e1-266.e2, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-32919807

RESUMO

Foreign body aspiration (FBA) is a rare, but potentially fatal condition frequently seen in the emergency department. Bronchoscopy plays a major role in its diagnosis and treatment. In patients with laryngectomy, the strategies for airway maintenance and foreign body retrieval are limited. We describe management of a patient with laryngectomy presenting with aspiration of a tracheoesophageal voice prosthesis (TEP). The TEP was not initially seen in chest radiography; however, computed tomography showed it within the right lower bronchus. Successful extraction of the TEP was achieved through bronchoscopy with forceps and retrieval basket. Otolaryngology placed a larger TEP and secured it with sutures. TEP migration is rare, but represents a risk for FBA. Initial imaging in the emergency department can be misleading, requiring a high degree of suspicion, as the TEP device may not be seen in standard chest radiography. Flexible bronchoscopy under moderate sedation in conjunction with forceps and retrieval basket may be appropriate for treatment of FBA in patients with laryngectomy and can be performed in the emergency department, preventing hospital admission.


Assuntos
Brônquios , Broncoscopia , Corpos Estranhos/etiologia , Corpos Estranhos/cirurgia , Laringectomia , Laringe Artificial/efeitos adversos , Falha de Prótese , Implantação de Prótese/efeitos adversos , Idoso , Esôfago , Humanos , Masculino , Traqueia
11.
Laryngoscope ; 131(5): E1616-E1623, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33264438

RESUMO

OBJECTIVES/HYPOTHESIS: To evaluate the voice and speech outcomes after tubed supraglottic laryngeal closure (TSLC) surgery to treat chronic aspiration after radiotherapy for head and neck cancer. STUDY DESIGN: A retrospective case-control study. METHODS: The data of patients who underwent radiotherapy for head and neck cancer and who later required total laryngectomy or TSLC for chronic aspiration between 2004 and 2017 were retrieved from a dysphagia clinic. Preoperative and postoperative voice and speech were assessed by the GRBAS and INFVo rating scales. Control subjects who underwent radiotherapy alone or total laryngectomy with a tracheoesophageal prosthesis for other indications were recruited for comparison. RESULTS: Of 15 patients who underwent a TSLC with a mean age of 57.3 years (45-75 years), 13 were male and 2 female. All patients had a history of nasopharyngeal carcinoma. The success rate of speech production using their own larynx following an intact TSLC was 64%. There was no statistically significant difference in voice and speech ratings between preoperative and TSLC subjects on the GRBAS (P = .32) and INFVo scales (P = .57), although the quality of voice appeared to deteriorate after TSLC. However, the INFVo scale for impression, intelligibility and unsteadiness of the voice after TSLC was statistically significantly better than for laryngectomy with tracheoesophageal speech. CONCLUSIONS: A tubed supraglottic laryngeal closure controls chronic aspiration while preserving the larynx for phonation, and results in a better voice and speech quality than a laryngectomy with a voice prosthesis. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E1616-E1623, 2021.


Assuntos
Laringoplastia/métodos , Carcinoma Nasofaríngeo/terapia , Neoplasias Nasofaríngeas/terapia , Lesões por Radiação/cirurgia , Aspiração Respiratória/cirurgia , Idoso , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Laringectomia/efeitos adversos , Laringoplastia/efeitos adversos , Laringe/fisiopatologia , Laringe/efeitos da radiação , Laringe/cirurgia , Laringe Artificial/efeitos adversos , Masculino , Pessoa de Meia-Idade , Fonação/fisiologia , Período Pós-Operatório , Lesões por Radiação/etiologia , Aspiração Respiratória/etiologia , Estudos Retrospectivos , Inteligibilidade da Fala/fisiologia , Resultado do Tratamento , Qualidade da Voz/fisiologia , Reconhecimento de Voz
12.
Laryngoscope ; 131(6): 1349-1357, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33280117

RESUMO

OBJECTIVE: Traditionally, after total laryngopharyngectomy (TLP), patients cannot speak without a prosthesis or an artificial larynx. In Taiwan, most patients use a commercialized pneumatic laryngeal device (PLD). Phonatory tube reconstruction with the anterolateral thigh (ALT) flap is a novel, modified version of synchronous digestive and phonatory reconstruction involving a free muscular cutaneous flap. This study reviewed and compared speech performance between patients who underwent novel flap reconstruction and conventional PLD users. METHOD: We retrospectively reviewed patients with laryngeal or hypopharyngeal cancer who underwent TLP from August 2017 to September 2019. The voice handicap index (VHI), speech intelligibility, acoustic and aerodynamic analysis results, and speech range profile (SRP) were compared between patients who underwent ALT phonatory tube reconstruction (ALT group) and those using PLDs (PLD group). RESULTS: Twenty patients were included; 13 patients were included in the ALT group, and 7 patients were included in the PLD group. Compared to the PLD group, the ALT group had a better fundamental frequency range (P < .001) and semitone range (P < .001) during speech but showed worse jitter, shimmer, and harmonic-to-noise ratios. The two groups showed comparable VHI and speech intelligibility performance. CONCLUSIONS: The ALT phonatory tube, a novel flap for reconstruction, can restore digestive and voice functions simultaneously. Compared with PLD use, ALT phonatory tube reconstruction yields an improved speech range and comparable levels of voice handicap and speech intelligibility, suggesting that the technique is a good alternative for patients after TLP. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:1349-1357, 2021.


Assuntos
Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Voz Alaríngea/métodos , Fala/fisiologia , Distúrbios da Voz/cirurgia , Retalhos de Tecido Biológico , Humanos , Laringectomia/efeitos adversos , Laringe Artificial , Masculino , Pessoa de Meia-Idade , Faringectomia/efeitos adversos , Fonação/fisiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Inteligibilidade da Fala , Medida da Produção da Fala , Taiwan , Coxa da Perna/cirurgia , Resultado do Tratamento , Distúrbios da Voz/etiologia , Qualidade da Voz
13.
Head Neck ; 43(4): 1321-1330, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33372408

RESUMO

BACKGROUND: Although many patients achieve serviceable speech after total laryngectomy (TL), others are limited by un-naturally low pitch. We describe a cadaveric study to provide proof of concept for a novel voice prosthesis after TL with free tissue laryngoplasty. METHODS: Devices were implanted into fresh frozen cadavers after TL and free tissue laryngoplasty. Phonation pressures were measured using a custom Blom-Singer Manometer (InHealth Technologies, Carpinteria, CA) and acoustic files were analyzed using Praat, a speech analysis software. RESULTS: Two fresh frozen cadavers were implanted with the voice prosthesis. Both prostheses demonstrated appropriate stenting of the laryngoplasty. Successful sound production was achieved after airflow generation at the proximal trachea. An average phonation pressure of 3.5 cmH2 O (SD 1.7 cmH2 O) was necessary to generate a sound intensity of 80.6 dB (SD 0.2 dB) at an average fundamental frequency of 299.5 Hz (SD 112.6 Hz). CONCLUSIONS: The novel voice prosthesis described herein offers a feasible voice generation mechanism.


Assuntos
Laringoplastia , Laringe Artificial , Humanos , Laringectomia , Fonação , Desenho de Prótese , Fala
14.
Laryngorhinootologie ; 99(11): 788-794, 2020 11.
Artigo em Alemão | MEDLINE | ID: mdl-32854119

RESUMO

After total laryngectomy, regaining ability to speech is a keystone in regards of life quality. Voice prostheses have been shown to be a sufficient tool for satisfying communication, although frequent replacements of prostheses are burdening certain patients. Therefore, a more accurate understanding of mechanisms of prosthetic leakage is urgently needed. METHODS: We performed a retrospective analysis of 58 Patients after laryngectomy. Additionally, we analyzed pre- and post-therapeutic CT-scans of 22 Patients regarding pharyngeal stenosis. RESULTS: In 40 Patients, at least one replacement of voice prosthesis was documented during observation period, median device life was 235 days. Patients treated with adjuvant radiotherapy (RT) showed a significantly longer device life than patients with adjuvant radio-chemotherapy (RCT, p = 0.002). Furthermore, patients suffering of gastroesophageal reflux disease (GERD) showed a significantly shortened device life (p = 0.04).17 patients (42.5 %) suffered of clinically relevant stenosis of the neopharynx, which was treated with dilatation in 14 patients (82 %) and did not affect prosthesis device life. CONCLUSION: GERD is a risk factor for shortened voice prosthesis' device life and therefore should be treated effectively after laryngectomy. Also, adjuvant RCT predisposes a shortened device life.Stenosis is observed frequently after laryngectomy but does not affect device life when effectively treated.


Assuntos
Refluxo Gastroesofágico , Neoplasias Laríngeas , Laringe Artificial , Humanos , Neoplasias Laríngeas/cirurgia , Laringectomia , Desenho de Prótese , Falha de Prótese , Estudos Retrospectivos , Fala
15.
J Otolaryngol Head Neck Surg ; 49(1): 59, 2020 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-32778168

RESUMO

With the COVID-19 pandemic, there has been significant changes and challenges in the management of oncology patients. One of the major strategies to reduce transmission of the virus between patients and healthcare workers is deferral of follow-up visits. However, deferral may not be possible in total laryngectomy patients. Urgent procedures may be necessary to prevent complications related to ill-fitting tracheoesophageal puncture (TEP) voice prostheses, such as aspiration or loss of voicing. In this paper, we describe the Princess Margaret Cancer Center's approach to managing this unique patient population.


Assuntos
Infecções por Coronavirus/prevenção & controle , Controle de Infecções/organização & administração , Neoplasias Laríngeas/cirurgia , Laringectomia/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , COVID-19 , Infecções por Coronavirus/epidemiologia , Infecção Hospitalar/prevenção & controle , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Humanos , Neoplasias Laríngeas/diagnóstico , Laringectomia/métodos , Laringe Artificial , Masculino , Ontário , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Implantação de Prótese/métodos , Implantação de Prótese/estatística & dados numéricos , Medição de Risco
16.
Am J Otolaryngol ; 41(6): 102652, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32711236

RESUMO

PURPOSE: Tracheoesophageal puncture with voice prosthesis placement remains the gold standard for voice restoration following total laryngectomy, but may cause various complications. This study aims to summarize patient-related and device-related adverse events associated with tracheoesophageal puncture and voice prosthesis placement. MATERIALS AND METHODS: The U.S. Food and Drug Administration's Manufacturer and User Facility Device Experience database was queried for reports of adverse events related to tracheoesophageal puncture with voice prosthesis placement from January 1, 2010, to April 30, 2020. Data were extracted from reports pertaining to tracheoesophageal prostheses. RESULTS: Seventy-seven reports involving tracheoesophageal voice prostheses were identified, from which 111 adverse events were extracted. Of these, 58 (52.3%) were patient-related, while 53 (47.7%) were device-related. The most frequently reported patient-related adverse events were aspirated prosthesis (24 [41.4%]), foreign body during placement (11 [19.0%]), aspiration pneumonia (9 [15.5%]), and aspirated brush tip (8 [13.8%]). The most common device-related adverse events were detached brush tip (15 [28.3%]), leak (14 [26.4%]), and torn esophageal flange (11 [20.8%]). CONCLUSIONS: While tracheoesophageal puncture with voice prosthesis placement has revolutionized voice rehabilitation following total laryngectomy, the procedure may be associated with adverse events both at the time of placement and later. Interventions aimed at improving both physician and patient education may help reduce adverse events attributed to improper use. Further research is needed to clarify optimal approaches to education.


Assuntos
Laringe Artificial/efeitos adversos , Distúrbios da Voz/reabilitação , Análise de Dados , Bases de Dados Factuais , Esôfago/cirurgia , Corpos Estranhos/epidemiologia , Corpos Estranhos/etiologia , Corpos Estranhos/prevenção & controle , Humanos , Laringectomia/efeitos adversos , Educação de Pacientes como Assunto , Pneumonia Aspirativa/epidemiologia , Pneumonia Aspirativa/etiologia , Pneumonia Aspirativa/prevenção & controle , Falha de Prótese/etiologia , Punções/métodos , Traqueia/cirurgia , Distúrbios da Voz/etiologia
17.
Artigo em Inglês | MEDLINE | ID: mdl-32604875

RESUMO

(1) Introduction: Laryngeal cancer is one of the most common types of cancer affecting the upper aerodigestive tract. Despite ensuring good oncological outcome in many locoregionally advanced cases, total laryngectomy is associated with relevant physical and psychological sequelae. Treatment through tracheo-esophageal speech, if promising, can lead to very variable outcomes. Not all laryngectomee patients with vocal prosthesis benefit from the same level of rehabilitation mainly due to the development of prosthetic or fistula related problems. The relating sequelae in some cases are even more decisive in the patient quality of life, having a higher impact than communicational or verbal skills. (2) Material and Methods: A retrospective study was conducted on 63 patients initially enrolled with a history of total laryngectomy and voice rehabilitation, treated at the University Hospital of Catania from 1 January 2010 to 31 December 2018. Quality of life (QoL) evaluation through validated self-administrated questionnaires was performed. (3) Results: The Voice-Related Quality of Life questionnaire revealed significantly better outcomes in both socio-emotional and functional domains of the tracheoesophageal patient group compared to the esophageal group (p = 0.01; p = 0.01, respectively), whereas in the Voice Handicap Index assessment, statistically significant scores were not achieved (p = 0.33). (4) Discussion: The significant differences reported through the V-RQOL and Voice Handicap Index scales in the presence of fistula related problems and device lifetime reduction when compared to the oesophageal speech group have demonstrated, as supported by the literature, a crucial role in the rehabilitative prognosis. (5) Conclusions: The criteria of low resistance to airflow, optimal tracheoesophageal retention, prolonged device life, simple patient maintenance, and comfortable outpatient surgery are the reference standard for obtaining good QoL results, especially over time. Furthermore, the correct phenotyping of the patient based on the main outcomes achieved at clinical follow-up guarantees the primary objective of the identification of a better quality of life.


Assuntos
Laringe Artificial , Fístula Traqueoesofágica , Idoso , Feminino , Humanos , Neoplasias Laríngeas/cirurgia , Laringectomia , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Estudos Retrospectivos , Fístula Traqueoesofágica/cirurgia , Qualidade da Voz
18.
J Oral Maxillofac Surg ; 78(10): 1754-1758, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32531266

RESUMO

Decompression of the odontogenic keratocyst has been a long-standing treatment modality in the armamentarium of oral-maxillofacial surgeons. Many different types of effective decompression tubes have been described in the literature. They reduce the size of the cystic lesion by decreasing the intraluminal pressure, induce histologic structural changes in the epithelial lining of the cyst, and allow for bone deposition to occur from the periphery of the cystic cavity. However, many of these have pitfalls including tube dislodgement, traumatization of the oral mucosa, and mucosal overgrowth. We describe a novel technique using an indwelling voice prosthesis (Inhealth Technologies, Carpinteria, CA) to decompress odontogenic keratocysts. We found that our method provides effective decompression using appropriate-length prostheses fit to the cyst dimensions. It provides improved comfort in patients, with less mucosal irritation or overgrowth, improved ease of irrigation, and improved retention that often does not require sutures.


Assuntos
Laringe Artificial , Cistos Odontogênicos , Tumores Odontogênicos , Humanos , Cistos Odontogênicos/cirurgia , Cirurgiões Bucomaxilofaciais
20.
Otolaryngol Head Neck Surg ; 163(3): 618-620, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32513063

RESUMO

Tracheoesophageal puncture for voice prosthesis placement is often used in vocal rehabilitation of patients undergoing total laryngectomy. Although its closure can occur spontaneously, some patients require a surgical procedure. We propose a surgical technique, without flap interposition, that begins with careful separation of the esophagus and trachea and identification of the site of tracheoesophageal fistula. After continuous suture closure of the esophagus, the anterior segment of the first tracheal rings is vertically incised to facilitate tracheal closure in a suture without tension. Finally, a small pectoral skin flap is made and mobilized to suture to the free edges of the sectioned tracheal rings, thus reducing the risk of tracheal stenosis. Four patients underwent this procedure with uneventful postoperative evolution and permanent closure of the fistula.


Assuntos
Esôfago/cirurgia , Laringectomia , Laringe Artificial , Implantação de Prótese , Traqueia/cirurgia , Técnicas de Fechamento de Ferimentos , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/cirurgia , Humanos , Neoplasias Laríngeas/cirurgia , Masculino , Punções
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