Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 9.577
Filtrar
1.
BMJ Open ; 11(4): e045308, 2021 04 30.
Artigo em Inglês | MEDLINE | ID: mdl-33931410

RESUMO

OBJECTIVES: To investigate the utilisation of different treatment modalities for patients with laryngeal cancer (LC) during last decade in Poland. SETTING: Retrospective population-based study. PARTICIPANTS: Patients with LC treated between January 2009 and December 2018. PRIMARY AND SECONDARY OUTCOME MEASURES: The contemporary utilisation of treatment modalities of LC: surgery with intent of radical resection (total or partial laryngectomy), radiotherapy (RT) and chemoradiotherapy (CRT). RESULTS: There was determined the overall number of 22 957 new diagnosis of LC from 2010 to 2018 and confirmed the steady decrease in the incidence rate of LC in the following years from 7.7 to 6.03. The mean age of patients with LC was raising by an average of 0.3832 of year per year. There was observed decrease in number of total laryngectomies (TLs) in subsequent years (from 1122 in 2009 to 776 in 2018). The number of procedures involving partial laryngeal resection was within stable ranges however the upward trend was observed separately for vocal cordectomy. There was established decreased involvement of surgery in LC treatment from 52.8% in 2009 to 24.3% in 2016 with the subsequent rise to 33.7% in 2018. The percentage of patients receiving RT increased from 23.8% in 2009 to 42.1% in 2013 with the next decrease to 25.7% in 2018. The utilisation of CRT in LC treatment was progressively increasing over analysed years from 23.4% in 2009 reaching 40.6% in 2018. CONCLUSIONS: The presented data revealed an increase in total number of organs preserving treatment modality with CRT in subsequent years with decreasing number of TLs in Polish patients with LC.


Assuntos
Neoplasias Laríngeas , Humanos , Neoplasias Laríngeas/epidemiologia , Neoplasias Laríngeas/cirurgia , Laringectomia , Estadiamento de Neoplasias , Polônia/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento
2.
Einstein (Sao Paulo) ; 19: eAO5715, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33978098

RESUMO

OBJECTIVE: To investigate the association between aging and the functional aspects of swallowing (laryngeal penetration and laryngotracheal aspiration) in individuals who underwent supracricoid laryngectomy in the late period and without complaints. METHODS: A total of 70 patients, 56 (80%) aged >60 years and 14 (20%) <60 years, under outpatient follow-up, after cancer treatment and with no complaints of swallowing, performed functional evaluation using the swallowing videofluoroscopy. Image classification was performed using the penetration-aspiration scale developed by Rosenbek. The χ2 test and logistic regression were applied to associate the age categories to the outcomes (penetration and aspiration). RESULTS: Patients aged over 60 years had a higher prevalence of penetration (24.29%) and aspiration (48.57%) than patients aged under 60 years. In this sample, aspiration was associated with age. Patients aged over 60 years were more likely to present penetration (27% more) during swallowing than patients under 60 years. Patients aged over 60 years had an approximately four-fold greater probability of laryngotracheal aspiration than patients aged under 60 years. CONCLUSION: In patients without complaints of swallowing in the late postoperative period of supracricoid laryngectomy, there is a greater probability of laryngotracheal aspiration in elderly aged over 60 years than in individuals under 60 years.


Assuntos
Transtornos de Deglutição , Neoplasias Laríngeas , Laringe , Idoso , Deglutição , Transtornos de Deglutição/epidemiologia , Transtornos de Deglutição/etiologia , Humanos , Neoplasias Laríngeas/diagnóstico por imagem , Neoplasias Laríngeas/cirurgia , Laringectomia , Período Pós-Operatório , Resultado do Tratamento
3.
J Int Med Res ; 49(5): 3000605211014784, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33983073

RESUMO

This current report describes a rare clinical case of neuroendocrine carcinoma (NEC) of the larynx with associated Lambert-Eaton myasthenic paraneoplastic syndrome (LEMS). A 68-year-old male patient presented with severe dysphonia and dysphagia. He underwent a total laryngectomy and the excised lesion was extremely large. A pathological examination demonstrated 'morphological findings of a poorly differentiated carcinoma (G3) with aspects of neuroendocrine differentiation' (i.e. a poorly differentiated neuroendocrine carcinomas [PD-NEC]). Based on the patient's medical history and the immunohistochemical findings, he was treated with three cycles of neoadjuvant chemotherapy (cisplatin-etoposide) and then radiotherapy with a total dose of 70 Gy. Of the 10 cases of paraneoplastic syndrome (PNS) related to laryngeal NEC reported in the literature, nine of these syndromes were of an endocrine type. Only one case of PNS associated with laryngeal cancer had a neurological manifestation, which was LEMS. To the best of our knowledge, this current case has only one similar precedent in the literature and it is the second report of an association between a PD-NEC and LEMS. Laryngeal NECs are rare lesions with different prognostic characteristics. The diagnosis should be made using an endocrinological, neurological, radiological and histological multidisciplinary approach. A radical surgical approach is recommended.


Assuntos
Carcinoma Neuroendócrino , Síndrome Miastênica de Lambert-Eaton , Neoplasias Laríngeas , Laringe , Neoplasias Pulmonares , Idoso , Carcinoma Neuroendócrino/complicações , Carcinoma Neuroendócrino/diagnóstico por imagem , Humanos , Recém-Nascido , Síndrome Miastênica de Lambert-Eaton/complicações , Síndrome Miastênica de Lambert-Eaton/diagnóstico , Neoplasias Laríngeas/complicações , Neoplasias Laríngeas/diagnóstico por imagem , Neoplasias Laríngeas/cirurgia , Masculino , Prognóstico
4.
Artigo em Chinês | MEDLINE | ID: mdl-33794613

RESUMO

Objective:To improve the diagnosis and treatment of laryngeal schwannoma. Methods: The clinical data of 15 patients with laryngeal schwannoma were retrospectively analyzed, including 5 male patients and 10 female patients. The tumors were located in aryepiglottic fold in 4 cases, arytenoid region in 4 cases, interarytenoid in 2 cases, false vocal cord in 2 cases, epiglottis in 1 case, vocal cord in 1 case, and subglottic region in 1 case. All patients underwent laryngeal mass resection under general anesthesia, including 4 cases of tumor resection by external approach and 11 cases of tumor resection by oral approach. Results:Following up for 13-80 months, 1 patient had low voice after operation. The hoarseness of 5 patients improved after operation, but not completely recovered. One patient died of esophageal cancer at 49 months of follow-up, and no recurrence was found during the follow-up period. The remaining 8 cases had no obvious abnormalities. Conclusion:The clinical symptoms of laryngeal schwannoma vary, and the prognosis is generally good. The choice of surgical path is closely related to the location and size of the laryngeal schwannoma. If the laryngeal schwannoma is well exposed under endoscopy, the tumor can be removed by transoral radiofrequency coblation. Schwannomas on both sides of the subglottic region can be resected by two surgeries, and the tracheotomy can be performed first if necessary.


Assuntos
Neoplasias Laríngeas , Laringe , Neurilemoma , Feminino , Humanos , Neoplasias Laríngeas/cirurgia , Masculino , Recidiva Local de Neoplasia , Neurilemoma/cirurgia , Estudos Retrospectivos
5.
Artigo em Chinês | MEDLINE | ID: mdl-33730804

RESUMO

Objective: To explore the application value of enhanced recovery after surgery (ERAS) with the multidisciplinary team (MDT) model in laryngeal cancer surgery. Methods: Eighty patients with laryngeal cancer treated in Department of Otorhinolaryngology Head and Neck Surgery of Yantai Yuhuangding Hospital from May 2016 to June 2017 were selected, including 76 males and 4 females, aged 45 to 75 years old. By random number table method, they were divided into ERAS group (40 cases) and control group (40 cases). Visual analogue scale (VAS), general comfort questionnaire (GCQ) and self-rating Anxiety Scale (SAS) were used to evaluate the symptoms and signs and psychological state of the two groups before and after operation. Mann Whitney U test was used for non-normal distribution data, and chi square test, Fisher exact probability method and covariance analysis were used for classification data. Repeated measures analysis of variance was used for the comparison of each group at different time points. Results: Two cases in the ERAS group and six cases in the control group withdrew from the study for some reason. Finally, 38 cases in the ERAS group and 34 cases in the control group were enrolled in this study. The postoperative pain scores of the two groups were the highest at 6 h after operation, and then gradually decreased. At different time points after operation, the pain scores of ERAS group were lower than those of the control group. At 24 h after operation, the pain relief degree of ERAS group was significantly higher than that of the control group, with a statistically significant difference (P<0.05). Compared to control group, ERAS group had lower preoperative thirst score [(0.15±0.36) vs. (4.29±1.17), Z=-7.695, P<0.001] and hunger score [(0.38±0.49) vs. (3.44±1.13), Z=-7.426, P<0.001]. The total number of postoperative adverse reactions (8 vs.16), oral feeding time [(4.06±4.42) d vs. (9.06±2.42) d] and postoperative hospital stay [(5.91±0.97) d vs. (11.03±2.11)d] in ERAS group were lower than those in control group (statistics 5.461, -4.558, -7.347, P<0.05), but there was no significant difference in postoperative catheter indwelling time and neck drainage tube indwelling time between the two groups (P>0.05). Before discharge, the comfort of ERAS group was significantly higher than that of control group [(60.37±8.78) vs. (50.38±8.08), Z=-4.370, P<0.001]. Before discharge, the anxiety level of ERAS group decreased, while that of the control group increased significantly, which was higher than that of ERAS Group [(59.12±6.43) vs. (52.62±6.25), Z=-4.179, P<0.001]. Conclusion: The application of multidisciplinary ERAS in laryngeal cancer surgery can improve preoperative hunger and thirst, postoperative pain and mental state, shorten the length of hospital stay and reduce postoperative adverse reactions.


Assuntos
Recuperação Pós-Cirúrgica Melhorada , Neoplasias Laríngeas , Idoso , Feminino , Humanos , Neoplasias Laríngeas/cirurgia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória , Período Pós-Operatório
6.
BMJ Case Rep ; 14(2)2021 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-33563684

RESUMO

Chondrosarcoma of the larynx is rare accounting for approximately 1% of laryngeal cancers; clear cell subtype is a rare variant. Given the low risk of occult nodal disease, they present a unique opportunity to maximise tissue preservation in order to optimise both recovery and long-term functional outcomes. We present a case of laryngeal clear cell chondrosarcoma causing critical airway obstruction. An emergency tracheostomy was performed and mapping biopsies were taken. The tumour originated from the cricoid and extended into both arytenoid superstructures precluding cricotracheal resection. A modified narrow-field laryngectomy was performed, preserving all pharyngeal mucosa and neurovascularly intact infrahyoids. Organ preservation surgery is preferred in the management of laryngeal chondrosarcoma. If laryngectomy is required, the surgeon must ensure that all uninvolved, functional tissue is preserved carefully to improve swallow and voice outcomes postoperatively. We describe a novel technique used to achieve this outcome.


Assuntos
Obstrução das Vias Respiratórias/etiologia , Obstrução das Vias Respiratórias/cirurgia , Condrossarcoma/complicações , Condrossarcoma/cirurgia , Neoplasias Laríngeas/complicações , Neoplasias Laríngeas/cirurgia , Obstrução das Vias Respiratórias/diagnóstico por imagem , Cartilagem Aritenoide/diagnóstico por imagem , Cartilagem Aritenoide/cirurgia , Biópsia , Condrossarcoma/diagnóstico por imagem , Cartilagem Cricoide/diagnóstico por imagem , Cartilagem Cricoide/cirurgia , Humanos , Neoplasias Laríngeas/diagnóstico por imagem , Laringectomia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Traqueostomia
10.
BMJ Case Rep ; 14(2)2021 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-33602770

RESUMO

Leiomyosarcomas are soft tissue tumours that rarely occur in the larynx. This case report describes the presentation and management of a 77-year-old man referred to the otolaryngology clinic with hoarseness who was found to have a large supraglottic leiomyosarcoma after panendoscopy and biopsies. He subsequently underwent laryngectomy for treatment of this tumour but, unexpectedly, the histological analysis of the laryngectomy specimen revealed a second primary tumour in the larynx-a squamous cell carcinoma (SCC). The patient had further treatment with neck radiotherapy. Three years after treatment, there are no signs of recurrence of either tumour. This case report discusses the very few similar cases of leiomyosarcoma coexisting with SCC in the larynx, collating the evidence surrounding the treatment of this rare presentation.


Assuntos
Carcinoma de Células Escamosas , Neoplasias Laríngeas , Laringe , Idoso , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/cirurgia , Humanos , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/cirurgia , Laringectomia , Masculino , Recidiva Local de Neoplasia
11.
BMJ Case Rep ; 14(1)2021 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-33504538

RESUMO

A 32-year-old man with Down's syndrome was referred to the ear, nose and throat (ENT) department in view of failed attempts at extubation, and subsequently, at decannulation of tracheotomy tube. He had previously required ventilatory support and had history of intubation for 1 week. A flexible fibre-optic laryngoscopy showed a smooth mass covering the laryngeal inlet which moved with respiration. Direct laryngoscopy under general anaesthesia revealed a smooth mucosa covered fleshy mass arising from the left aryepiglottic fold and arytenoid, obstructing the laryngeal inlet. The mass was removed using controlled plasma ablation, and histopathological examination of the same was consistent with lymphangioma. Endoscopic examinations during the regular follow-up visits revealed well-healed supraglottic area with adequate glottic chink and the patient could be successfully decannulated.


Assuntos
Obstrução das Vias Respiratórias/diagnóstico , Neoplasias Laríngeas/diagnóstico , Linfangioma/diagnóstico , Técnicas de Ablação , Adulto , Obstrução das Vias Respiratórias/complicações , Obstrução das Vias Respiratórias/cirurgia , Infecções Comunitárias Adquiridas/terapia , Síndrome de Down/complicações , Humanos , Neoplasias Laríngeas/complicações , Neoplasias Laríngeas/cirurgia , Laringoscopia , Linfangioma/complicações , Linfangioma/cirurgia , Masculino , Pneumonia/terapia , Síndrome do Desconforto Respiratório/etiologia , Síndrome do Desconforto Respiratório/terapia , Traqueostomia
13.
Eur Arch Otorhinolaryngol ; 278(5): 1515-1521, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33515084

RESUMO

PURPOSE: The margin status after CO2 laser cordectomy for glottic carcinoma may influence prognosis. There are no studies assessing the possible bias due to anatomic changes of the specimens for shrinkage. The authors evaluated the intraoperative shrinkage of specimens immediately after transoral CO2 laser microsurgery (CO2 TOLMS) to improve the understanding and the interpretation of surgical margins. METHODS: This is a prospective study involving a consecutive cohort of 23 patients (19 males, 4 females, mean age 69.9 years, range 42-83 years) with early glottic carcinoma treated by CO2 TOLMS from February 2017 to April 2019. The anteroposterior shrinkage of the specimen, of the tumor, and of the anterior and posterior margins was measured intraoperatively with a cross table reticle glass micrometer ruler, inserted into the eyepiece of the surgical microscope. RESULTS: The mean shrinkage of the mucosal specimen from intralaryngeal measurement to post-resection measurement was 3.8 ± 0.3 mm, resulting in an average loss of 29% of the anteroposterior length (p < 0.01). The anteroposterior length of both the tumor and the margins after resection significantly decreased, but the shrinkage of the anterior and posterior margins was significantly greater than the shrinkage of the tumor (49% versus 20% and 45% versus 20%, p < 0.01). CONCLUSION: The present study demonstrates significant shrinkage of specimens after CO2 TOLMS, especially in the anteroposterior length of the vocal cords, and justifies the good oncological results for specimens with close and single positive superficial margins. Follow-up versus a second surgical look policy could be safely suggested in cases of close superficial and single positive superficial margins.


Assuntos
Neoplasias Laríngeas , Terapia a Laser , Adulto , Idoso , Idoso de 80 Anos ou mais , Dióxido de Carbono , Feminino , Glote/patologia , Glote/cirurgia , Humanos , Neoplasias Laríngeas/patologia , Neoplasias Laríngeas/cirurgia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
14.
Ann Otol Rhinol Laryngol ; 130(6): 591-601, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33412910

RESUMO

OBJECTIVES: To determine the impact of lymph node yield (LNY) in patients undergoing neck dissection at the time of total laryngectomy (TL). To determine the impact of radiation therapy (RT) on LNY. METHODS: Retrospective review of LNY and clinical outcomes in 232 patients undergoing primary or salvage total laryngectomy (TL) with ND. RESULTS: Preoperative RT significantly decreased mean LNY from 31.7 to 23.9 nodes (P < .001). In primary TL patients, age (P < .001) and positive margins (P = .044) were associated with decreased OS. In salvage TL patients, only positive margins was associated with poorer OS (P = .009). No LNY cutoff provided significant OS or DFS benefit. CONCLUSIONS: Radiotherapy significantly reduces LNY in patients undergoing TL and ND. Within a single institution cohort, positive margins, but not LNY, is associated with survival in both primary and salvage TL patients.Level of Evidence: 4.


Assuntos
Neoplasias Laríngeas/mortalidade , Laringectomia , Razão entre Linfonodos , Esvaziamento Cervical , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Feminino , Humanos , Neoplasias Laríngeas/radioterapia , Neoplasias Laríngeas/cirurgia , Metástase Linfática , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Terapia Neoadjuvante , Radioterapia Adjuvante , Estudos Retrospectivos , Terapia de Salvação
15.
Laryngoscope ; 131(6): E1980-E1986, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33399237

RESUMO

OBJECTIVES/HYPOTHESIS: We investigated growth patterns and pathological features in intermediate-size laryngeal carcinoma amenable to supraglottic laryngectomy. STUDY DESIGN: Retrospective cohort study. METHODS: We reviewed patients who underwent an open partial horizontal laryngectomy (OPHL) type I. We analyzed pathological data, tumor sizes, overall survival, disease-specific survival, local control, and laryngeal preservation. Results were stratified between three groups: group I comprised patients with endolaryngeal carcinoma, group II comprised patients with anterior epilaryngeal carcinoma who underwent an OPHL type I + base of tongue (BOT), group III comprised patients with lateral epilaryngeal carcinoma who underwent an OPHL type I + pyriform sinus (PIR). RESULTS: Sixty-eight patients were analyzed. The 5-year rates of overall survival, disease-specific survival, local control, and laryngeal preservation were 68.4%, 83.7%, 91.6%, and 98.3%, respectively. The tumor sizes at pathological examination were similar between the three groups (mean 27 mm, P = .80) and were associated with pathological features, notably pre-epiglottic space (PES) invasion (24.9 mm vs. 32.2 mm, P = .01), occult invaded lymph nodes (22.6 mm vs. 29.9 mm, P = .03), and trends for margins status (26.5 mm vs. 29.3 mm, P = .45). The risks of PES invasion, occult lymph nodes, and positive margins, respectively, predominated in group I (41.7%), group II (56.3%), and group III (23.3%). CONCLUSION: In intermediate-size tumors amenable to supraglottic laryngectomy, pathological features are associated with tumor size according to group stratification based on tumor location. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E1980-E1986, 2021.


Assuntos
Neoplasias Laríngeas/cirurgia , Laringectomia/métodos , Adulto , Idoso , Feminino , Humanos , Neoplasias Laríngeas/mortalidade , Neoplasias Laríngeas/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
16.
Head Neck ; 43(1): 198-202, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33043533

RESUMO

BACKGROUND: The aim of the study was to describe a novel technique for reinforcement of salvage laryngectomy closure using a bipedicled musculofascial submental flap. METHODS: A retrospective cohort study design identified patients who underwent salvage laryngectomy reinforcement with a bipedicled submental hammock flap between January 2008 and December 2016 were compared to salvage laryngectomy patients treated with primary closure of the neopharynx during the same time period. Pharyngocutaneous fistula rates were compared between groups. RESULTS: Pharyngocutaneous fistula rate in the submental hammock group (2/31, 6.5%) was significantly lower compared to the primary closure group (14/45, 31%, P < .05). CONCLUSION: The bipedicled musculofascial submental hammock flap is a viable method for reinforcement of salvage laryngectomy defects. It has a favorable pharyngocutaneous fistula rate compared to primary closure alone and has unique advantages over conventional methods of reinforcement.


Assuntos
Fístula Cutânea , Neoplasias Laríngeas , Doenças Faríngeas , Fístula Cutânea/etiologia , Fístula Cutânea/cirurgia , Humanos , Neoplasias Laríngeas/cirurgia , Laringectomia , Doenças Faríngeas/cirurgia , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Terapia de Salvação , Retalhos Cirúrgicos
18.
Am J Otolaryngol ; 42(1): 102757, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33128995

RESUMO

BACKGROUND: The association between pathological tumor size and predictive value in patients with supraglottic carcinoma who receive surgery is poorly understood. To gain further insight into this association, the influence of postoperative tumor size assessed via pathological evaluation on survival outcomes in patients with supraglottic carcinoma was fully analyzed. MATERIALS AND METHODS: This study collected data from 375 consecutive supraglottic carcinoma patients who underwent primary surgical treatment between 2005 and 2010. The parameters of tumor size, including tumor diameter, tumor area, and tumor volume, were used to analyze the prognostic abilities of overall survival (OS) and disease-free survival (DFS) in supraglottic carcinoma. RESULTS: Twelve women and 363 men were included, with a mean age of 61.2 years. The 5-year OS and DFS rates were 65.4% and 56.2%, respectively. The mean tumor diameter, tumor area, and tumor volume of all patients was 3.1 cm, 8.6 cm2, and 9.1 cm3, respectively. Tumors with higher pT stages had a larger tumor diameter, tumor area, and tumor volume. These three factors were significantly correlated with pT stage, and tumor volume was the strongest factor contributing to pT stage. Patients with a larger tumor diameter, tumor area, and tumor volume had worse OS and DFS. Tumor area and tumor volume were independent prognostic factors of OS and DFS in supraglottic carcinoma patients. CONCLUSIONS: Patients with a larger tumor size have inferior survival outcomes, and tumor area and tumor volume are independent predictive parameters of survival in supraglottic carcinoma patients who are treated with primary surgery.


Assuntos
Carcinoma/patologia , Carcinoma/cirurgia , Glote/patologia , Glote/cirurgia , Neoplasias Laríngeas/patologia , Neoplasias Laríngeas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma/mortalidade , Quimiorradioterapia Adjuvante , Feminino , Previsões , Humanos , Neoplasias Laríngeas/mortalidade , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Fatores de Tempo
19.
J Plast Reconstr Aesthet Surg ; 74(6): 1355-1401, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33358461

RESUMO

AIM: Previous reports have demonstrated good outcomes with the use of the Anterolateral Thigh Flap (ALT) in pharyngeal reconstruction. We report a new modification of free ALT flap pharyngeal reconstruction utilizing vascularised fascial wings or extensions placed in the parastomal gutters to cover the major neck vessels. PATIENTS AND METHODS: This was a single-center retrospective case review. Between November 2017 and January 2019, 8 patients (6 male, 2 female mean age 61, range 35 to 74) underwent near circumferential pharyngeal reconstruction by the modified technique. 3 patients had laryngopharyngectomy for radiorecurrent larynx SCC, 2 for primary, advanced laryngeal SCC, and 3 for primary hypopharyngeal SCC. RESULTS: All eight patients regained adequate swallow to maintain nutrition without tube-feeding. Two of the patients have been assessed as appropriate for tracheo-esophageal puncture and are awaiting placement. One patient uses an electrolarynx for speech and 5 patients aphonic only. One patient died 2 months after the procedure from chest infection. There were no flap failures, no fistulas and no strictures at one year. One patient who underwent a salvage laryngopharyngectomy experienced parastomal wound dehiscence, but critically there was no return to theater for exposed major vessels and the wound healed within 6 weeks requiring dressings only. CONCLUSION: Here we report outcomes of pharyngeal reconstruction with a modified single perforator free ALT flap using fascial extensions to line the parastomal gutters. In the event of parastomal dehiscence, the placement of vascularized tissue parastomally may facilitate spontaneous healing and prevent major vessel exposure.


Assuntos
Carcinoma de Células Escamosas , Retalhos de Tecido Biológico , Neoplasias Laríngeas , Laringectomia/efeitos adversos , Neoplasias Faríngeas , Faringectomia/efeitos adversos , Complicações Pós-Operatórias/terapia , Procedimentos Cirúrgicos Reconstrutivos , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Feminino , Humanos , Neoplasias Laríngeas/patologia , Neoplasias Laríngeas/cirurgia , Laringectomia/métodos , Masculino , Pessoa de Meia-Idade , Retalho Perfurante , Neoplasias Faríngeas/patologia , Neoplasias Faríngeas/cirurgia , Faringectomia/métodos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Recuperação de Função Fisiológica , Estudos Retrospectivos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...