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Resumen Objetivos Determinar la aplicabilidad de la tecnica del ganglio centinela (GC) en tumores N0 de laringe. Material y metodos Realizamos un estudio prospectivo en 19 pacientes con tumores N0 de laringe. Infiltramos peritumoralmente 1mCi de nanocoloides de albumina marcados con 99mTc con endoscopio rigido bajo anestesia general. Detectamos el GC intraoperatoriamente con una sondagamma durante el vaciamiento cervical. Los resultados histologicos del GC se comparan con los del vaciamiento cervical. Resultados Identificamos el GC en 17 pacientes (89,47%). Once pacientes presentaron GC libres de tumor, reflejando correctamente el estatus del cuello (pN0). Tres pacientes presentaron metastasis en el GC l. Encontramos 3 falsos negativos. La sensibilidad de la tecnica fue 50,0% (3/6) y el VPN de un 78,6%. Conclusiones Pensamos que para que la tecnica del GC sea aplicable en tumores de laringe se precisan de un mayor numero de estudios, siendo fundamental la realizacion de un correcta seleccion de los pacientes.

Resumen Introduccion La videofibrosomnoscopia es una tecnica que permite la visualizacion de la faringe de un paciente al que se le ha inducido el sueno farmacologicamente. De este modo se puede diagnosticar la o las zonas causantes de la vibracion y colapso de los pacientes con roncopatia cronica Material y metodos La prueba se realizo a un total de 51 pacientes. A todos se les realizo una anamnesis estandar y una exploracion otorrinolaringologica como parte del diagnostico habitual Resultados La zona de obstruccion mas frecuentemente encontrada fue el velo del paladar en el 90,4%, seguido de la base de la lengua en el 38,5%. El colapso multinivel se dio en el 60,7%. No se han hallado correlaciones entre la obstruccion hallada en la consulta y la vista durante la VFS Conclusiones La VFS es una tecnica util en el diagnostico del paciente con roncopatia y es aconsejable su utilizacion para saber con certeza el tipo de obstruccion del paciente

Resumen Objetivos Este estudio muestra los resultados obtenidos mediante la aplicacion del ganglio centinela en tumores de labio y cavidad oral; elaboramos un mapa linfografico de dichos tumores. Material y metodo Estudiamos prospectivamente 14 pacientes con tumores de labio y cavidad oral N0 clinicos. Inyectamos de forma peritumoral, 1 mCi de nanocoloides de albumina marcada con Tc99 preoperatoriamente, para posteriormente localizar el ganglio centinela. Una vez localizado este, se envia separadamente del resto de cadenas ganglionares para su estudio anatomopatologico. Resultados En todos los pacientes se identifico el ganglio centinela. En 11 casos el ganglio centinela fue negativo para metastasis prediciendo correctamente el estadio cervical. En 3 casos el ganglio centinela fue el unico ganglio que contenia metastasis. No hubo ningun caso de falso negativo. La sensibilidad de la tecnica fue del 100%. Conclusiones: Los resultados muestran esta tecnica como un metodo fiable en esta localizacion que podria evitar los vaciamientos cervicales en pacientes N0 clinicos.

ntroduction: Lymphoid tissue from waldeyer’s ring produces all types of mmunoglobulins, mainly G and A, and between 4 to 10 years, of age. In other words, the age in which the adenoid and tonsillar surgery is canied out. Our study tries to analyze the impact of the tonsillar surgery on the serum levels of immunoglobulins. Material and methods: We present a prospective study with 89 healthy children aged between 4 to 10 years. Immunoglobulin G, A and M levels were measured preoperatively, at a month and at four months after adenoidectomy and/or tonsillectomy. Results: Serum IgG levels dropped after surgery, but partially recovered four months later. IgA dropped less significantly and IgM did not change its levels. No one of the studied inmunoglobulins dropped below the normal serum levels. Discussion/Conclusions: Adenoid and tonsil ar surgery cause a fall of postoperative immunoglobulin G and A serum levels, partiallyne recovering after four months. Serum levels never dropped below normal levels, and of the studied children suffered a postoperative disease due to immunodeficiency.

Resumen Objetivo El cancer de hipofaringe es un cancer muy agresivo que generalmente se diagnostica en estadios muy avanzados, siendo su pronostico desalentador y la tasa de supervivencia muy baja. El objetivo de este estudio es presentar la evolucion y los resultados postoperatorios de pacientes tratados en nuestro servicio por cancer de hipofaringe Material y Metodo Realizamos un estudio retrospectivo sobre 60 pacientes intervenidos quirurgicamente entre los anos 1980-1999. En su mayoria se trataba de estadios avanzados (III-IV) y el 75% presentaban adenopatias palpables en el momento del diagnostico Resultados La supervivencia a los 5 anos fue de 38,4%. Encontramos una incidencia de metastasis a distancia y segundos tumores de un 12,5% y un 10,4% respectivamente Conclusiones El carcinoma de hipofaringe continua siendo el cancer de cabeza y cuello de peor pronostico. La tasa de supervivencia parece estar relacionada primeramente con el estadio tumoral de presentacion y particularmente con el estatus de los ganglios linfaticos cervicales

treatment in pN0 patients showed a neck recurrence of 6,1%. We performed a unilateral neck dissection in those patients with clear-lateral tumours. In these cases the clinical control of the contralateral neck gave a 5,5% recurrencies on that side. Patients treated with elective primary radiotherapy suffered a 5,5% of regional recurrence. Discussion/Conclusions: Neck treatment of the N0 supraglottic cancer is recommended. We treat neck in the same way of primary tumour (surgery or radiotherapy) with good control of regional recurrencies, less than 10%. In case of a negative pathological study of the neck careful, watching is the elective attitude. In the positive pathological study of the neck (pN+), radiotherapy is the elective treatment in those with three or more affected nodes or capsular breakdown in any of them.

Resumen Introduccion El exito de la cirugia del hiperparatiroidismo se ha basado tradicionalmente en la exploracion bilateral del cuello. La monitorizacion intraoperatoria de hormona paratiroidea intacta (PTHi), permite la confirmacion bioquimica de que todo el tejido paratiroideo hiperfuncionante ha sido resecado, consiguiendose cirugias menos extensas. Material y metodos Se obtuvieron muestras de sangre de 32 pacientes antes y 10 minutos despues de la exeresis del tejido paratiroideo patologico. La monitorizacion de PTHi se llevo a cabo mediante inmunoquimioluminiscencia, con un tiempo de incubacion corto y resultados disponibles en 15 minutos. Resultados Los niveles de PTHi descendieron > 60% en 30 de los 32 pacientes estudiados, 26 casos de adenoma y 4 casos de hiperplasia. Dos casos en los que la PTHi descendio 60% tras la exeresis de las glandulas hiperplasicas remanentes. Conclusion El analisis rapido de PTHi es una tecnica facil de realizar y es capaz de predecir el exito de la cirugia del hiperparatiroidismo.

Resumen Objetivos: El objetivo del presente estudio es comprobar el valor del ganglio centinela (GC) en tumores de cabeza y cuello y elaborar un mapa linfografico de dichos tumores. Material y me todos : Estudiamos prospectivamente 13 pacientes con carcinomas de cabeza y cuello N0, divididos en dos grupos segun la localizacion tumoral. Inyectamos peritumoralmente Tc-99 marcado con albumina coloidal e identificamos el GC intraoperatoriamente. Este es enviado para estudio anatomopatologico separadamente del vaciamiento cervical. Resultados: En el grupo de cavidad oral y orofaringe, con 5 pacientes, el GC predijo correctamente el estadio cervical en todos ellos. En el grupo de laringe e hipofaringe, con 8 pacientes, en 6 casos el GC predijo correctamente el estadio cervical. En 2 casos el GC resulto negativo para tumor, encontrandose metastasis en el resto del vaciamiento. Conclusiones: Esta tecnica representa una ventaja sobre los vaciamientos cervicales como metodo de estadiaje cervical, pero su valor en este campo todavia permanece incierto.

Resumen Objetivo Determinar la rentabilidad diagnostica de las diferentes tecnicas de localizacion de las glandulas paratiroides. Material y Metodos Se realiza un estudio prospectivo sobre 71 pacientes diagnosticados de hiperparatiroidismo primario e intervenidos quirurgicamente. Evaluamos la validez diagnostica de la ecografia de alta resolucion, gammagrafia de sustraccion Ta l i o / Tecnecio y gammagrafia sestamibi en doble fase. Resultados La sensibilidad (S) y especificidad (E) de la utilizacion conjunta de la gammagrafia de sustraccion Ta l i o / Tecnecio y la ecografia en los adenomas fue de 72,27% y 89,22%, respectivamente. La combinacion de la gammagrafia sestamibi seguida de la ecografia mejoro discretamente los parametros evaluados, en particular la especificidad (93,67%) y el valor predictivo positivo (80,39%). En nuestra serie la rentabilidad diagnostica ha sido inferior en las hiperplasias. Conclusion La utilizacion conjunta de la gammagrafia seguida de la ecografia de alta resolucion, realizadas por un operador experimentado, son la mejor estrategia diagnostica a seguir para la localizacion preoperatoria de las glandulas paratiroides patologicas.

Resumen El objetivo principal de la cirugia de la otitis media cronica es eliminar la enfermedad y mejorar la audicion siempre que sea posible. La supuracion persistente de una cavidad de mastoidectomia supone un fracaso de la cirugia e impide que estos objetivos se alcancen. En el siguiente trabajo, presentamos la actitud de nuestro servicio ante las cavidades de mastoidectomia supurante y asi mismo exponemos cuales son las causas que impiden el adecuado control de la misma.

are emphazised: the spontaneous bilateral presentation in one of the cases, and the CSF leak as an initial symptom. We present a review of the literature, describing epidemiology results and the main accepted etiology theories. We discuss the diagnosis and treatment methods: magnetic resonance imaging and surgery.

Along the history of medicine, diphtheria has been the cause of many deadly epidemics. Up to the incorporation of microbiology in medicine and the definition of diphtheria provided by Bretonneau in 1826, this disease was studied with all types of sore throut into the galenic system. Spanish physicians in Renaissance started the way to its systematisation, taking it off the rest of sore throat types, with other laryngeal diseases, as it was known later as "croup", giving it the name of "garrotillo". They were the first to describe some important questions about this disease, as the specificity of the diphtheric pseudomembranes, the ineffective potential of salivary drops and the palsy of the soft palate.

Resumen objetivo El del trabajo es estudiar a aquellos pacientes que presentan una ocupacion unilateral de fosa nasal, en apariencia polipoidea, y la fosa contralateral normal. Valorando, por un lado, la incidencia real de poliposis inespecificas y de otros diagnosticos. Y, por otro lado, comparamos los datos que nos ofrece la radiologia preoperatoria con los hallazgos quirurgicos encontrados. Material y metodos Hacemos un estudio prospectivo de 23 pacientes recogidos en un periodo de 30 meses en el servicio de ORL del Hospital Dr. Peset de Valencia. Se realiza en todos los pacientes TAC y biopsia preoperatoria, comparandolos posteriormente con los hallazgos quirurgicos y el diagnostico anatomopatologico definitivo. Resultados y conclusiones Hubo discordancia entre la biopsia preoperatoria y el diagnostico definitivo en el 26% de los pacientes, siendo la incidencia de poliposis del 52%, papilomas invertidos del 26%, tumores malignos el 13% y otros diagnosticos 8,6%. Hay una buena correlacion entre La TAC preoperatoria y los hallazgos quirurgicos en las poliposis y los papilomas invertidos, pero no en los tumores malignos donde la TAC suele infravalorar las lesiones.

Resumen El hiperparatiroidismo primario (HPP) ha pasado de ser una enfermedad rara caracterizada por presentar una sintomatologia florida renal y esqueletica, a ser una enfermedad mas comun con minima sintomatologia. El empleo difundido de los autoanalizadores ha conducido a un aumento en su incidencia y a que el diagnostico se realice precozmente. El objetivo de este estudio es analizar la forma de presentacion y alteraciones bioquimicas, asi como los hallazgos quirurgicos y resultados postoperatorios de un grupo de pacientes diagnosticados de HPP e intervenidos quirurgicamente. De los 71 pacientes estudiados, la mayoria presentaban sintomatologia en el momento del diagnostico, 6 eran asintomaticos y 11 normocalcemicos. En 5 pacientes fue necesaria una reintervencion por HPP persistente. El 95,77% de los pacientes normalizaron los niveles de hormona paratiroidea tras la cirugia. La paratiroidectomia es una tecnica segura y efectiva que debe ser indicada precozmente, incluso en los casos asintomaticos.

We present our results in a timpanoplasty technique using autologous cartilage, in a retrospective study of 71 cases within 3 years. We used this technique in revision surgery, large perforations, severe retractions, and atrophic membranes. 32% of cases needed ossicular chain reconstruction. A complete closing of the membrane was obtained in 86% of cases, while 14% remained re-perforated or discontinued between cartilage pieces. These results are comparable to other studies using cartilage graft with several techniques. These results encourage us to continue using this technique in order to acquire more experience and a better knowledge about the efficacy of this technique.

Large tracheoesophageal fistulas (TEF) following a total laryngectomy are rare. Most often are associated with the creation of a surgical speech fistula or puncture. We describe the surgical technique used in 3 patients with large TEF after a total laryngectomy and the creation of a speech fistula with a voice prosthesis, followed by radiation therapy. Pertinent literature is reviewed.

Video-fiberoscopy is the exploration of upper respiratory airways used in our diagnostic protocol in patients with chronic snoring and obstructive sleep apnea syndrome (OSAS). We perform a fibroscopy during propofol induced sleep without tracheal intubation; video recording and monitoring of level of sleep, pulse oximetry, blood pressure, ECG, etc. is used. This exploration allows us to asses upper respiratory airways when the patient is asleep as well as the areas of collepse and vibration both from a functional and anatomical points of view.

Sleep disordered breathing patients usually undergo an ENT clinical examination before any therapeutic decision is taker. This clinical examination should be predictive about the occurrence of OSAS, reproductible and should determine the sites of obstruction in the upper airways. We have evaluated the clinical ENT examination and compared it with the bibliography in order to standardize it.We have done the same clinical ENT examination to 181 patients. 127 had a standar polysomnography.The patient's mean age was 49.6 years, the mean BMI was 29.3 kg/m2. 92.7% had an abnormal palate, 4.5% a tonsilar hipertrophy, 66.5% high Modified Mallampati scores, 60.8% were clasiffied as Fujita IIb type and 39.2% had nasal obstruction.Upper airway examination is important for the assessment of chronic snoring patients. Most of them have anatomical alterations that can be represented in visual scales to make it more reproductible. The obstruction area does not predict the severity of OSAS.

This study shows the results obtained by the application of the sentinel node (SN) in oral and lip cancer and performs a lymphatic map of these tumours.We prospectively studied 14 patients with lip and oral tumours, all of them N0. We injected colloidal particles of serum albumin labeled with Tc-99 peritumoraly and we located the SN intraoperatively. The SN was then sent for anatomopathological study.Sentinel node was identified in all of the patients. In 11 of them the sentinel node was negative for metastases and correctly predicted the status of the neck. In 3 patients the sentinel node was the only node that contained metastases. There were no false negatives. The sensibility of the technique was 100%.The results showed that this technique is a feasible method for tumours in these locations and can avoid neck dissections in N0 patients.

Sleep endoscopy is a technique that allows a direct visualization of the pharynx during drug-induced sleep. It allows an assessment of the anatomical site of obstruction or vibration in habitual snorers.A total of 51 patients underwent sleep endoscopy. All answered a standard questionnaire and underwent an otolaryngological exam as a part of the diagnostic procedure.The most frequent site of obstruction was the palate in 90.4%, followed by the base of the tongue in 38.5%. Obstruction at multiple levels was found in 60.7% of patients. No correlations were found between the level of the obstruction found in the ENT examination and the one found during the sleep endoscopy.Sleep endoscopy is useful for the assessment of the usual snorer and we recomend it to label the patient's obstruction.

Lymphoid tissue from Waldeyer's ring produces all types of immunoglobulins, mainly G and A, and between 4 to 10 years, of age. In other words, the age in which the adenoid and tonsillar surgery is carried out. Our study tries to analyze the impact of the tonsillar surgery on the serum levels of immunoglobulins.We present a prospective study with 89 healthy children aged between 4 to 10 years. Immunoglobulin G, A and M levels were measured preoperatively, at a month and at four months after adenoidectomy and/or tonsillectomy.Serum IgG levels dropped after surgery, but partially recovered four months later. IgA dropped less significantly and IgM did not change its levels. No one of the studied inmunoglobulins dropped below the normal serum levels.Adenoid and tonsilar surgery cause a fall of postoperative immunoglobulin G and A serum levels, partially recovering after four months. Serum levels never dropped below normal levels, and of the studied children suffered a postoperative disease due to immunodeficiency.

Large tracheoesophageal fistulas (TEF) following a total laryngectomy are rare. Most often are associated with the creation of a surgical speech fistula or puncture. We describe the surgical technique used in 3 patients with large TEF after a total laryngectomy and the creation of a speech fistula with a voice prosthesis, followed by radiation therapy. Pertinent literature is reviewed.

Hypopharyngeal carcinoma is an aggressive malignancy that usually presents at a late stage, thereby resulting in an overall poor prognosis for these patients. The aim of this study is to determine the evolution and postoperative results of patients treated in our department for hypopharyngeal cancer.We retrospectively reviewed 60 patients who had undergone surgery followed by radiation therapy between 1980-1999. Most of them were advanced stage (III-IV) and 75% patients showed regional metastases at presentation.The 5-year survival rate was 38.4%. The overall incidence of distant metastases and second neoplasms was 12.5% and 10.4%.Hypopharyngeal cancer remains one of the most lethal ones in head and neck cancer. The poor survival rate is related primary to advanced stage disease and particularly to lymph node metastases.

Occult regional metastases in supraglottic cancer NO are the object of classical controversies. The aim of our study is to provide our experience in order to determine how neck treatment affects on regional recurrence of NO supraglottic cancer.A retrospective study of 246 patients with NO supraglottic cancer treated in our service between 1977 to 1999 is presented.11.4% of patients did not have any cervical treatment, with a 23% of neck recurrence amongst the evolution. 66.7% of patients were treated with a modified radical neck dissection, 24% of these presented occult metastases in the histopathological study. Global regional recurrence was 2.9% in early stages (T1/T2) and 13.1% in advanced stages (T3/T4). In pN+ patients, 85% underwent postoperative radiotherapy, with a regional recurrence of 8.8%. Postoperative clinical control without any other treatment in pN0 patients showed a neck recurrence of 6.1%. We performed a unilateral neck dissection in those patients with clear-lateral tumours. In these cases the clinical control of the contralateral neck gave a 5.5% recurrencies on that side. Patients treated with elective primary radiotherapy suffered a 5.5% of regional recurrence.Neck treatment of the NO supraglottic cancer is recommended. We treat neck in the same way of primary tumour (surgery or radiotherapy) with good control of regional recurrencies, less than 10%. In case of a negative pathological study of the neck careful, watching is the elective attitude. In the positive pathological study of the neck (pN+), radiotherapy is the elective treatment in those with three or more affected nodes or capsular breakdown in any of them.

The success in the surgical management of hyperparathyroidism has conventionally required a bilateral neck exploration. The intraoperative monitoring of intact parathyroid hormone (PTHi), allows a less extensive procedure by confirming the complete removal of hypersecreting tissue.Plasma samples were obtained from 32 consecutive patients before and 10 minutes after removal of abnormal parathyroid tissue. PTH was measured with a modifie immunochemiluminometric assay with a short incubation time and the results made available in 15 minutes.PTHi decreased by at least 60% in 30 of 32 cases. A single adenoma was removed in 26 cases, and multiple hyperplastic glands in 4 cases. The two cases in which PTHi fell60% were diagnosed as hyperplasia. PTHi decreased60% after the removal of the remnant hyperplastic glands.The rapid PTHi assay had excellent analytical performance and predicted the success of parathyroid surgery.

The objective of this study is to assess the value of the sentinel node (SN) in head and neck tumours and to create a lymphatic mapping of these tumors.We prospectively studied 13 patients with head and neck tumours N0. We divided these patients in two groups depending on the location of the primary tumour. We injected colloidal particles of serum albumin labeled with Tc-99 peritumoraly and we located the SN intraoperatively. The SN was then sent for anatomopathological study.In the oropharynx and oral cavity group, with 5 patients, the SN correctly predicted the pathological status of the neck in all of them. In the group of larynx and hypopharynx, with 8 patients, in 6, the SN correctly predicted the pathological status of the neck. In 2 patients, the SN was negative for metastases but there were metastases in the neck dissection.This technique represents an advance over selective dissection as an accurate method of neck staging, but its value in this field remains unclear.

To determine the accuracy of imaging techniques for localization of nodular lesions of parathyroid glands.Seventy one patients were prospectively enrolled and underwent surgical examination for primary hyperparathyroidism. Ultrasonography (US), 201Tl/99mTc parathyroid subtraction scintigraphy and 99mTc MIBI scintigraphy were evaluated.The sensitivity and specificity for combined 201Tl/99mTc parathyroid subtraction scintigraphy and US for parathyroid adenomas were 72.27% and 89.22% respectively. The combination of 99mTc MIBI scintigraphy and US resulted in improved specificity (93.67%) and positive predictive value (80.39%). The accuracy of the localizing studies was lower for patients with hyperplasia.The combination of scintigraphy and US is the best approach for localization of nodules. In most cases, the two techniques are complementary.

Primary hyperparathyroidism (PHPT) was a rare but serious disease with massive biochemical, renal and skeletal signs at the time of diagnosis. In the last decades it has become a more common disorder often diagnosed by chance. The disease usually shows minimal symptoms. These clinical changes are due to advances in biochemical screening procedures, which have led to a remarkable increase in the incidence of PHPT. The aim of this study is to describe the clinical profiles, biochemical data, operative findings and postoperative results. Seventy one consecutive patients were prospectively enrolled and underwent surgical examination. Most of them showed symptoms: 6 patients were asymptomatic and 11 had a normocalcemic hyperparathyroidism. After surgery 5 patients showed persistent primary hyperparathyroidism. Parathyroid hormone concentration returned to normal levels in 95.77% of the patients studied. Parathyroidectomy is a safe and effective approach to the treatment of primary hyperparathyroidism.

We present our results in a timpanoplasty technique using autologous cartilage, in a retrospective study of 71 cases within 3 years. We used this technique in revision surgery, large perforations, severe retractions, and atrophic membranes. 32% of cases needed ossicular chain reconstruction. A complete closing of the membrane was obtained in 86% of cases, while 14% remained re-perforated or discontinued between cartilage pieces. These results are comparable to other studies using cartilage graft with several techniques. These results encourage us to continue using this technique in order to acquire more experience and a better knowledge about the efficacy of this technique.

Two cases of idiopathic brain herniation into the middle ear without previous surgery are reported. Brain herniation is an unusual pathology, usually related to middle ear surgery. The idiopathic appearance of this disease is the secondly most frequent cause. Its origin is believed to be related to a congenital defect of tegmen timpani. Two elements, both rare, are emphazised: the spontaneous bilateral presentation in one of the cases, and the CSF leak as an initial symptom. We present a review of the literature, describing epidemiology results and the main accepted etiology theories. We discuss the diagnosis and treatment methods: magnetic resonance imaging and surgery.

Video-fiberoscopy is the exploration of upper respiratory airways used in our diagnostic protocol in patients with chronic snoring and obstructive sleep apnea syndrome (OSAS). We perform a fibroscopy during propofol induced sleep without tracheal intubation; video recording and monitoring of level of sleep, pulse oximetry, blood pressure, ECG, etc. is used. This exploration allows us to asses upper respiratory airways when the patient is asleep as well as the areas of collepse and vibration both from a functional and anatomical points of view.

The aim of this paper is to study a group of patients with occupancy of a nasal fossal, apparently by polyps, and being the other side of the nose normal. Evaluating on the one hand the true incidence of unspecific polyposis and, of other diagnosis, and on the other hand to compare the preoperative radiological findings with those seen during surgery.A prospective study of 23 consecutive patients was carried out over a period of 30 months at the ENT Department of the Dr. Peset Hospital, in Valencia. A CT scan and preoperative biopsy was performed in all cases, the results of these being later compared with the surgical findings and the final histopathologic diagnosis.A discrepancy between the preoperative biopsy and final diagnosis was found in 26% of the patients. The incidence of polyposis was 52%, inverted papilloma 26%, malignant tumours 13% and other diagnosis 8.6%. There is a good correlation between preoperative CT scans and surgical findings in those cases of polyposis and inverted papilloma, but not in those of malignant tumours as CT scans often underestimated these lesions.

The main goal for performing surgery for chronic otitis media is to eliminate the disease and improve hearing whenever possible. Persistent drainage of a mastoid cavity means failure of surgery and of achieving the goal. In this study, we present our department's attitude for suppurative mastoid cavities as well as the reasons that do not allow adequate control of them.

In an overall group of 270 patients who underwent total phonatory laryngectomy (TPL) with surgical restoration of alaryngeal voice by tracheoesophageal puncture (TEP) and prosthesis insertion, a subgroup of 152 consecutive patients who had undergone surgery at least 24 months earlier was selected (10 years follow-up). The frequency and type of effects of postoperative radiotherapy on TPL were studied. We analyzed postoperative complications, TEP closure and its causes, the tracheoesophageal voice achieved, and manometric results in the pharyngoesophageal segment. We conclude that postoperative radiotherapy at east a maximum dose of 65 Gy did not preclude phonatory surgery.