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Purpose: Radiotherapy (RT) is widely used for early glottic cancer. Patients failing this treatment are referred to surgical management of their disease. Salvage partial laryngectomy (SPL) has the advantage of preserving laryngeal function with total laryngectomy (TL) remaining as a last resort. The purpose of this study was to determine the efficacy of SPL in preventing total laryngectomy, following failed RT, for early glottic cancer. Methods: A meta-analysis of all published English literature was performed. All publications that included patients undergoing SPL were reviewed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) reporting guidelines. The search strategy identified 154 relevant articles. A total of 15 retrospective studies that included 323 suitable patients were subsequently analyzed in this meta-analysis. The main outcome measure was the rate of laryngectomy-free survival (LFS) following SPL. The indications for salvage TL (i.e., disease recurrence and poorly functional larynxes) as well as subgroup analyses for open and trans-oral SPLs were also calculated. Results: The overall rate of LFS following SPL was 81.2% (fixed effects model range: 75.7–86.8%). Salvage TL following SPL were performed in 96.8% due to disease recurrence and in 3.2% to poorly functional larynxes. A subgroup analysis showed a 90.4% LFS after open SPL and 78.6% following trans-oral SPL. Conclusion: A high rate of successful salvage partial laryngectomies, regardless of surgical technique, is to be anticipated in well-selected patients after RT failure. [ABSTRACT FROM AUTHOR]

Purpose: The objective of the current systematic review with meta-analysis was to report the pooled survival outcomes of supracricoid partial laryngectomy in the setting of radiorecurrent laryngeal cancer to investigate if and when an organ-sparing surgical treatment is adequate.Methods: The search included all original papers from 1990 to December 2017. The search terms included the following: cricohyoepiglottopexy; cricohyoidopexy; cricohyopexy; horizontal laryngectomy; and partial, subtotal, supracricoid, and supraglottic laryngectomy. Inclusion criteria were as follows: (1) data clearly distinguish results of partial laryngeal procedures; (2) clear description of tumor stage and selection criteria; (3) clear description or derivability of local control and survival rates.Results: Eleven out of 270 papers were analyzed, and a total of 251 cases were included. Two-year LC, 3-year DFS, and 5-year OS were 92, 80, and 79%, respectively. Heterogenicity evaluated with the I2 parameter was 14, 0, 0%, respectively. The larynx preservation rate was 85.2%, the decannulation rate was 92.1%, and swallowing recovery was 96.5% (PEG dependence and the aspiration pneumonia rate were 3.5 and 6.4%, respectively).Conclusions: SCPL is oncologically sound, guaranteeing a high percentage of success. The homogeneity of data should encourage the use of SCPL as salvage treatment for recurrent LSCC. [ABSTRACT FROM AUTHOR]

Introduction: The retrograde approach (RP) to nerve identification is a method seldom used in parotid surgery. A systematic review comparing this method to the standard anterograde approach (AP) with respect to facial nerve palsy (FNP) does not currently exist.Methods: In a meta-analysis according to the PRISMA statement, eight publications, including one randomized controlled trial, were selected. The primary aim was to compare the temporary and permanent FNP resulting from the two dissection methods. Facial nerve function was graded according to the House-Brackmann Scale. The secondary goal was a comparison of the cut-suture times (CST), the volume of healthy tissue (VHT) dissected, the rates of postoperative hematoma (PH), and postoperative infection (PI).Results: Temporary FNP was noted in 18.2% in the RP group as well as in 34.4% in the AP group. Permanent FNP occurred in 0.9% RPs and 2.4% APs. According to the mixed-effect logistic regression model, there was no significant difference between the two groups in the pooled odds ratio (OR) for either temporary [OR 2.64, 95% confidence interval (CI) 0.97-7.21] or permanent FNP (OR 4.31, 95% CI 0.44-42.28). The CST was significantly shorter in the RP group (p = 0.005), with a significantly smaller VHT dissected (p < 0.0001). There were no differences regarding PH and PI.Conclusion: The RP is a safe procedure with no significant difference in FNP rates when compared to the AP and, considering the shorter CST and the lesser VHT resected in the RP, it is superior to the AP. Surgeons engaged in parotidectomy should be familiar with both methods of dissection. [ABSTRACT FROM AUTHOR]

Different surgical options are currently available for treating benign tumors of the parotid gland, and the discussion on optimal treatment continues despite several meta-analyses. These options include more limited resections (extracapsular dissection, partial lateral parotidectomy) versus more extensive and traditional options (lateral parotid lobectomy, total parotidectomy). Different schools favor one option or another based on their experience, skills and tradition. This review provides a critical analysis of the literature regarding these options. The main limitation of all the studies is the bias of selection for different surgical approaches. For this reason, we propose a staging system that could facilitate clinical decision making and the comparison of results. We propose four categories based on the size of the tumor and its location within the parotid gland. Category I includes tumors up to 3 cm, which are mobile, close to the outer surface and close to the parotid borders. Category II includes deeper tumors up to 3 cm. Category III comprises tumors greater than 3 cm involving two levels of the parotid gland, and category IV tumors are greater than 3 cm and involve more than 2 levels. For each category and for the various pathologic types, a guideline of surgical extent is proposed. The objective of this classification is to facilitate prospective multicentric studies on surgical techniques in the treatment of benign parotid tumors and to enable the comparison of results of different clinical studies. [ABSTRACT FROM AUTHOR]

Supracricoid laryngectomies (SCLs) are conservative organ-sparing surgical techniques for the treatment of selected T2-T4 laryngeal carcinomas. Although these procedures allow preserving the larynx and its functions, in several countries SCLs are not adopted in oncological protocols. One of the possible reasons to account for this choice is the complexity of post-surgical in-hospital management and the variability in functional results. The aim of this review is to analyse the literature on functional results after SCLs as knowledge on functional results will help in focusing on what is needed in the future to reach more standardized post-surgical procedures and homogeneous outcomes. The analysis of the length of hospital stay, feeding-tube removal time and time to eventual tracheotomy decannulation showed a marked variability across authors and centres. Several factors may come into play, including health-system organizations in different countries. In most studies in-depth description of the criteria applied for discharge, tracheotomy tube removal and commencement of oral feeding were not reported. Moreover, the review on swallowing functional outcomes showed marked variability, as well as a lack of consensus on how to assess swallowing after SCLs. The analysis of voice functional outcomes also revealed a marked variability; surprisingly, the tools applied in the assessments were very often not adequate for substitution voice. Literature review showed that voice- and swallowing-related quality of life are often satisfactory but the variability among centres is still too large. Therefore, there is a need for clearer clinical recommendations on early post-surgical management, tracheal-cannula and feeding-tube removal criteria, voice- and swallowing-assessment protocol, rehabilitation need and timing. [ABSTRACT FROM AUTHOR]

The objective of this study is to provide a comprehensive classification system for parotidectomy operations. Data sources include Medline publications, author's experience, and consensus round table at the Third European Salivary Gland Society (ESGS) Meeting. The Medline database was searched with the term 'parotidectomy' and 'definition'. The various definitions of parotidectomy procedures and parotid gland subdivisions extracted. Previous classification systems re-examined and a new classification proposed by a consensus. The ESGS proposes to subdivide the parotid parenchyma in five levels: I (lateral superior), II (lateral inferior), III (deep inferior), IV (deep superior), V (accessory). A new classification is proposed where the type of resection is divided into formal parotidectomy with facial nerve dissection and extracapsular dissection. Parotidectomies are further classified according to the levels removed, as well as the extra-parotid structures ablated. A new classification of parotidectomy procedures is proposed. [ABSTRACT FROM AUTHOR]

This study was designed to compare rates of failure, revision and morbidity from endoscopic and open approaches as treatment for pharyngeal pouch. Systematic review was conducted using MEDLINE and PubMed databases. Search terms treatment, Zenker's, hypopharyngeal, pharyngeal, diverticulum, and pouch. There were no randomised clinical trials. Therefore, cohort and comparative studies with at least 10 patients in each arm, a follow-up of a least 12 months and reporting on all patients were included. Seventy-one studies met inclusion criteria. Diverticulectomy with or without cricopharyngeal myotomy comprised 33 studies (1,990 patients), and endoscopic stapler diverticulotomy was in 22 studies (1,089 patients). Failure of open and endoscopic approaches was 4.2 and 18.4 %, respectively, and corresponding complication rates were 11 and 7 %. Within endoscopic techniques, failure rates were 18.9 % for stapler diverticulotomy and 21.7 % for laser diverticulotomy. Corresponding complication rates were 4.3 and 7.9 %. Flexible endoscopy techniques have a higher failure (29 %) and overall complication rate (14.3 %). Most reported complications for transcervical techniques relate to the recurrent nerve (3.4 %) and salivary fistula (3.7 %) and for endoscopic group emphysema (3.0 %) and mediastinitis (1.2 %). Operation-related deaths were infrequent in both groups, but more frequent with open approach (0.9 vs. 0.4 %). Open approaches have more success but more complications than endoscopic techniques. Taking in account overall complications and failure rates, open approaches and stapler diverticulotomy yield different patterns, but are arguably comparable. In younger patients open approach is preferred, as well in patients with unfavourable anatomic conditions for endoscopic exposure. Flexible endoscopic techniques provide a suitable option for patients who do not tolerate general anaesthesia. [ABSTRACT FROM AUTHOR]

Dysfunction of the facial nerve is a common complication of parotidectomy. The functional deficit may be total or partial, and may include all or a single branch of the nerve. Despite a wide variety of the facial nerve grading systems, most of them have a limited utility in patients after parotidectomy. Therefore, existing scales assessing facial nerve function are compared to describe facial nerve outcomes after parotidectomy. The regional House-Brackmann, Sydney, and Yanagihara classification systems were utilized. The post-parotidectomy facial nerve grading system (PPFNGS) was created based on these three grading systems and also used for this study. The facial nerve function was assessed and recorded on the first postoperative day following conservative parotidectomy in 200 patients using all 4 scales by 3 otolaryngologists. The validity of the PPFNGS and existing facial nerve grading systems was examined by assessment of interrater agreement, intraclass correlation coefficient, internal consistency and construct validity. A deficit in the facial nerve function was found in 54 patients (27 %). Although results were consistent in all tested scales, the PPFNGS had a higher interrater agreement than the other three scales. PPFNGS is a new grading system designed for assessing the facial nerve function after parotidectomy in a quantitative and qualitative way and has a higher interrater agreement than other scales used to examine function of the 7th nerve. [ABSTRACT FROM AUTHOR]

The aim of this study was to analyze prognostic factors of successful tracheal and cricotracheal segmental resection (TR/CTR), the type of revisions performed in cases of failure, and the outcome of revisions. The study is designed as case series with chart review. Between 1995 and 2011, 122 adult patients underwent TR/CTR. Forty-six patients (38 %) had concomitant airway pathologies and 59 patients (48 %) failed previous interventions. Forty-six patients (38 %) were aphonic with a complete obstruction. Cricotracheal, tracheotracheal, and thyrotracheal anastomosis was performed in 78 (64 %), 24 (20 %) and 20 (16 %) patients, respectively. Subglottic involvement, higher grade of obstruction, preoperative tracheostomy, presence of any concomitant airway pathology and impaired vocal cord movement were all associated with poorer outcome. Initially, 85 patients (68 %) achieved primary goal with no need for further intervention. Thirty-six patients underwent one or more revision surgeries (laser, dilatation, tracheostomy, stent or T-tube, laryngoplasty, segmental resection, posterior cordotomy) with a success rate of 69 %. Overall success rate, after revisions, was 88.5 %. Segmental tracheal resection for tracheal stenosis is highly successful in non-tracheotomized, cricoid sparing incomplete tracheal stenosis patients, without secondary airway pathologies. Initial failures of TR/CTR can be managed with revision surgery. [ABSTRACT FROM AUTHOR]

After failure of curative radiotherapy (RT), surgery is the main therapeutic option to control recurrent laryngeal cancer. Recurrences after RT for T1-T2 tumours of the glottic larynx are often diagnosed at a more severe stage than the original disease and, thus, usually treated by radical approaches. Our aim is to investigate the feasibility of more conservative strategies for proper treatment of post-RT recurred glottic cancer. We collected and reviewed our files from 1990 to 2006, selecting 75 patients which matched the following inclusion criteria: (1) patient was originally diagnosed with early stage squamous cell carcinoma of the glottic larynx (stage I-II according to 2010 TNM), (2) patient was treated by RT with curative intent, (3) patient presented a recurrence of disease after RT which was surgically treated at our Institution. T stage at first diagnosis was T1a in 41 cases (55 %), T1b in 12 (16 %) and T2 in 22 (29 %). At clinical examination of RT-recurred lesions, we documented advanced lesions (rT3-rT4) in 29 out of 75 patients (39 %). Overall, an upstage was reported for 56 % RT-recurred cancers, while 37.3 % remained at the same stage than the original tumour and 6.7 % were downstaged. Twelve patients (16 %) underwent salvage partial laryngectomy (SPL), while 63 (84 %) received a salvage total laryngectomy (STL). Multivariate analysis showed that rTNM according to the AJCC-UICC of 2010 was the only prognostic factor for both disease-free survival ( p = 0.042) and overall survival ( p = 0.004). Considering the prognostic impact of rT and rN we documented a statistical significance only in terms of overall survival for both factors ( p = 0.004 and p = 0.04, respectively). Although STL remains the most frequent treatment choice for failures after RT in laryngeal carcinomas, SPL represents a valid option for selected patients with limited recurrence and can deliver good oncologic and functional results if performed according to careful indications. [ABSTRACT FROM AUTHOR]

The objective of this study is to evaluate the results of circumferential tracheal and cricotracheal resection with primary anastomosis for the treatment of post-intubation tracheal and cricotracheal stenosis. This is a retrospective analytical study. A total number of 24 patients were included in this study. The relevant preoperative, operative and postoperative records were collected and analyzed. Twenty patients were finally symptom-free reflecting an anastomosis success rate of 83.3 %. Variable grades of anastomotic restenosis occurred in 11 (45.8 %) patients, three patients were symptom-free and eight had airway obstructive symptoms. Four out of the eight patients with symptomatic restenosis were symptom-free with endoscopic dilatation while the remaining four patients required a permanent airway appliance (T-tube, tracheostomy) for the relief of airway obstruction and this group was considered as anastomotic failure. Cricoid involvement, associated cricoid resection and the type of anastomosis were the variables that had statistical impact on the occurrence of restenosis ( P = 0.017, 0.017, 0.05; respectively). Tracheal resection with primary anastomosis is a safe effective treatment method for post-intubation tracheal stenosis in carefully selected patients. Restenosis does not always mean failure of the procedure since it may be successfully managed with endoscopic dilatation. [ABSTRACT FROM AUTHOR]

Past radiation therapy is known as a major risk factor promoting post-supracricoid partial laryngectomy (SCPL) complications. Risk of post-SCPL complications may further increase following failure of high dose radiation; in these patients, wound infection may become evident more than 1 month after an uneventful post-surgical course. By defining this complication as 'Delayed Wound Infection' and reviewing the clinical features, we intended to elucidate the mechanism, risk factors, and management of this post-SCPL complication. Between 1997 and 2009, 60 patients received SCPL. The incidence of post-SCPL wound infection was analyzed in reflect to radiation status, radiation dose, and medical histories. Of 60 patients, delayed wound infection was identified in 4 (7%); radiation doses were 65, 68, 70, and 76.8 Gy (avg. 70 Gy). Blood data including white blood cell and C-reactive protein showed slight elevation before the delayed infection became evident. Patients with high dose radiation (≥65 Gy) accompanied by histories of diabetes and renal insufficiency are considered a high risk group. Delayed re-epithelialization of the inner surface of the cricohyoido gap was presumed to be the main pathogenesis. Early initiation of antibiotics and hyperbaric oxygen therapy are effective for rapid recovery. 'Delayed Wound Infection' was treatable and patients undergoing surgery after failure of high dose radiation should be managed with extra precaution, but should not be excluded from the indications for SCPL. [ABSTRACT FROM AUTHOR]

The aim of the study is to investigate the functional and histopathologic changes in facial nerve due to the application of various violent and numerous electrical stimuli to the facial nerve. The study was carried out with Wistar rats weighing between 200 and 300 g. The facial nerves of the subjects were located and stimulated with electrical stimulator. Then five groups were created with 18 subjects in each group: Group 1, 1 milliampere (mA) electrical stimulus applied; Group 2, 2 mA electrical stimulus applied; Group 3, 3 mA electrical stimulus applied; Group 4, 4 mA electrical stimulus applied; Group 5, 5 mA electrical stimulus applied. All groups were divided into three sub-groups, each consisting of six subjects. The facial nerves of the subjects in first sub-group were stimulated 10 times, in second sub-group were stimulated 20 times and those in third sub-group were stimulated 30 times. The functions of the facial nerves were evaluated on first day, first week and first month, respectively. The facial nerves with branches were dissected from the surrounding tissues carefully. These specimens were investigated by light microscope about axonal degeneration, macrovacuolization and vascular congestion. Loss of facial functions was not observed in the subjects during follow-up process. There was no significant difference between groups regarding axonal degeneration, macrovacuolization and vascular congestion ( P > 0.05). While less axonal degeneration was observed in group which was stimulated 10 times, more axonal degeneration was observed in groups which were stimulated 20 and 30 times ( P < 0.05). The axonal degeneration, macrovacuolization and vascular congestion were observed more in 1-day groups ( P < 0.05). Consequently, lesser violence and lesser number of electrical stimulus application to the facial nerve appears to be an important criterion for not damaging the facial nerve in patients in whom stimulators have been used. [ABSTRACT FROM AUTHOR]

We sought to define risk factors for facial nerve involvement in parotid gland carcinoma and assess the outcome of facial nerve reanimation. Medical records were reviewed of 66 patients who underwent surgery for parotid carcinoma in 2000–2007 at a tertiary hospital. Patient and tumor characteristics were compared between patients with and without facial nerve involvement and were analyzed on their influence on functional outcome following reanimation. Facial nerve involvement was verified intraoperatively in 24 patients, of whom 16 underwent reanimation during ablative surgery. Deep lobe invasion was significantly associated with intraoperative finding of facial nerve involvement. Tumors larger than 4 cm and salivary duct carcinoma had an obvious trend for facial nerve involvement. House-Brackmann score at 12 months was 3–4 in most patients. Deep lobe involvement and large tumor size may identify patients at risk of facial nerve involvement. Reanimation is associated with good functional outcome regardless of patient’s age. [ABSTRACT FROM AUTHOR]

Supracricoid laryngectomy can be an alternative in selected patients with a local recurrence after radiotherapy when endoscopic treatment or more conservative external approaches are not indicated. In this study, we reviewed our experience in patients who underwent salvage supracricoid laryngectomies for local recurrence following radiotherapy. Between 1997 and 2005, salvage supracricoid laryngectomy was performed in nine consecutive patients. The primary tumour was located in the glottis in eight cases and in the supraglottis in one case. The reconstruction method consisted of a cricohyoidoepiglottopexy in six cases and a cricohyoidopexy in three. One patient died of a complication associated to salvage treatment and another died as a consequence of a new recurrence of the laryngeal tumour. All patients were decannulated and recovered the ability to swallow. The mean cannulation and nasogastric feeding tube times were 11 and 27 days, respectively. The mean hospitalisation time was 34 days. Six patients had wound healing complications, all of which were solved without further surgery. Laryngeal function was preserved in 78% of the patients treated. In conclusion, supracricoid laryngectomy is an effective technique as salvage treatment in selected cases of local recurrence after radiotherapy and it can be an alternative to total laryngectomy when other methods of salvage conservation laryngeal surgery are not indicated. [ABSTRACT FROM AUTHOR]

Persistence or recurrent cancer in the anterior commissure (AC) after primary radiotherapy may remain localized to its pretreatment anatomical site. If so, endoscopic CO2 laser excision, in experienced hands, may achieve complete tumor excision and result in cure for many patients. Occasionally, second and third recurrences may be similarly salvaged by further endoscopic surgery. The use of the vertical hemilaryngectomy is an alternative treatment for similar localized lesions, with a higher first time surgical tumor eradication rate, but with a more protracted hospitalization and a less satisfactory voice and swallowing outcome. In both types of such surgical salvage, CT scanning must demonstrate no evidence of cartilage invasion or destruction. When there is evidence of minimal thyroid cartilage invasion, then the supracricoid partial laryngectomy is an alternative conservation option, and is likely to result in a cure, with the retention of a voicing larynx without a stoma. When the tumor has increased in size from the original pretreatment dimension and/or site, then imaging must be used to identify possible cartilage invasion, in which case the likelihood of tumor eradication by endoscopic or external vertical partial laryngectomy is highly unlikely. The indications for the routine use of total laryngectomy for the treatment of recurrent or persistent cancer involving the AC must be reviewed; there is current evidence that cure can be achieved by a less radical procedure. However, total laryngectomy may remain the only treatment option for advanced or aggressive first time recurrence, or in patients who develop subsequent recurrence following previous less aggressive surgery (endoscopic or external). [ABSTRACT FROM AUTHOR]

Optimal surgical management of parotid pleomorphic adenoma is important because of a considerable risk of tumour recurrence and complications. Our series of primary surgery cases with standardised parotidectomy technique in a university hospital were evaluated. Medical records of 295 patients treated from 1987 to 1999 were reviewed, and 171 patients answered a questionnaire about long-term sequelae. Sixty-two patients reporting major complications were re-examined in the hospital. At a mean follow-up of 8 years, one patient (0.6%) re-appeared with a recurrence. Twenty-four percent left the hospital with a partial and 3% with a complete paresis. Only 5% developed a permanent partial paresis, whereas a permanent total paresis was not seen. Half of the patients indicated gustatory sweating, but treatment was required in only 6%. Other major permanent complications were not seen. Treatment of pleomorphic adenoma by standardised parotidectomy in a university hospital demonstrates favourable results with low perioperative and long-term morbidity, as well as minimal risk of tumour relapse. [ABSTRACT FROM AUTHOR]

In hypopharyngeal carcinoma, open partial resection is rarely feasible because of the high rate of chronic aspiration. Transoral laser surgery, however, is not associated with major swallowing problems. Between 1991 and 1995, a total of 29 patients with cancer of the hypopharynx were treated using laser surgical resection. In 25 patients, a neck dissection was performed, and 26 patients were radiated postoperatively. The 5-year overall survival was 48% and tumor-related survival 58%. The outcome was significantly (P<0.048) dependent on the preoperative lymph node status (N0=74%, N+=34% overall survival). Accordingly, the 5-year survival in stage I and stage II tumors was 71% and in stage III and IV tumors 47%. The highest local control rate was achieved in patients with carcinoma of the hypopharyngeal walls. A major advantage of laser surgery is that resurfacing of the wounds takes place per secundam. No reconstructions with free vascularized grafts have to be performed. There were no functional deficits regarding speech and swallowing in 94%, 100% and 100% of the surviving patients without local recurrence after 3, 4 and 5 years, respectively. No patient had to have a tracheostomy intraoperatively. Laser surgical treatment in combination with neck dissection and postoperative radiotherapy of selected patients with early cancer of the hypopharynx shows comparable results with open surgical procedures and is superior to radiotherapy alone. Given the low postoperative morbidity, transoral laser surgery with the goal of preserving the larynx should gain more importance in the future. [ABSTRACT FROM AUTHOR]

Surgical management of subglottic laryngeal and upper tracheal stenosis remains a formidable challenge. The significant number of proposed techniques only highlights the difficulties associated with effectively managing this problem. Between 1996 and 1999, seven patients with stenosis of the upper trachea were treated. The stenosis resulted from long-term intubation during intensive-care hospitalization in five patients and from tracheotomy complications in the other two. Six patients were male and one female, their ages ranging between 13 and 60 years. The mean postoperative observation period was 3 years (1.5–4.5 years). In all patients, the stenosis exclusively involved the upper tracheal segment, measuring from 2 to 5 cm in length. The stenotic area of the trachea is exposed, and the local application of a solution of mitomicin C for a duration of 4 min is performed. A graft consisting of cartilage and mucosa is harvested from the nasal septum and is fixed with sutures to a titanium semi-ring. After the fixation of the graft on the ring, the entire construct is placed on the stenosed segment of the exposed trachea. The graft must cover the anterior exposed face of the trachea with the lateral members of the semicircular titanium ring adjacent to the lateral walls of the trachea, externally. The lateral tracheal walls are attracted laterally with sutures and are attached on the edges of the semicircular titanium ring. Four of the patients in whom no tracheotomy had been performed preoperatively needed none at all intraoperatively, and they were decannulated normally at the end of the procedure. Tracheotomy was deemed necessary for one patient's safety and was maintained for 7 days. In one patient with a preoperative tracheotomy, the point of the tracheotomy was displaced lower on the trachea and was maintained there for 7 days. The course of management described here and employed on seven patients involves a safe surgical procedure with excellent results. The placement of the titanium ring offers very good support for the graft and maintains the patency of the tracheal lumen. The main reasons for the failure of techniques using only cartilage grafts are therefore avoided. The number of cases presented here is certainly too small to establish definite conclusions; however, the initial results are extremely satisfying and urge us to suggest the use of this method in indicated cases. [ABSTRACT FROM AUTHOR]

From April 1998 to May 2000, 14 patients with supraglottic cancer underwent transoral laser surgery (T-stage T1–2: 11 patients, T3: 3 patients). In three patients, an epiglottectomy or hemi-epiglottectomy was performed. In 11 patients, further structures (false cords, the valleculae and the base of the tongue and/or parts of the arytenoid cartilage) had to be resected. Thirteen patients had to undergo neck dissection and post-operative irradiation. Tracheostomy was carried out prophylactically in two cases. Every patient received a nasogastric tube peri-operatively. One week after surgery, an evaluation of dysphagia was performed by video endoscopy (VEED). Aspiration was the main problem; in no case did dysphagia occur. The aspiration was graded according to videolaryngoscopical classification. Four patients had an occasional and ten patients a permanent aspiration after surgery. According to this assessment, an individual deglutition therapy management was established. Ten patients with permanent aspiration received a temporary percutaneous endoscopic gastrostomy (PEG) and were integrated in a rehabilitation programme (stimulation of the swallowing reflex, training of compensatory swallowing manoeuvres, dietary regime). Due to this training programme, the PEG could be removed in eight patients after 2–9 months. No patient needed a laryngectomy or a tracheostomy due to aspiration. There were no cases of aspiration-associated pneumonia. To obtain satisfying functional results after transoral laser surgery of supraglottic cancers with resection of the epiglottis, post-operative deglutition management, consisting of video endoscopy, a training programme and often a PEG, is necessary. [ABSTRACT FROM AUTHOR]

Patients and methods: Between 1974 and 1997, 297 patients underwent a subtotal laryngectomy at the Institut Gustave-Roussy; 146 of these patients underwent cricohyoidopexy (CHP) for a supraglottic primary as their first treatment. The majority of patients were men (137) aged from 33 to 78 years (median 54 years). The tumour stage at presentation was T1 in 2, T2 in 87, T3 in 53 (pre-epiglottic space involvement), and T4 (minimal thyroid cartilage invasion) in 4 patients. One hundred and twenty-five patients were N0 (86%) and 21 patients were Np (palpable); 98% had homolateral and 55% had bilateral neck dissections. Results: One patient died postoperatively of a myocardial infarction and 68% patients had an uneventful course. Aspiration was the commonest complication (23 patients, 19%). The median time to removal of the tracheotomy cannula was 10 days and for the nasogastric tube 21 days during the past 10 years. Completion of subtotal laryngectomy into total laryngectomy was done in 21 cases (15%): eight times because of oncological events [five local failures, two second primary (hypopharynx), one positive margin] and 13 times because of aspiration (9%). There were six local failures (4%) and eight nodal failures (5%). The rates of distant metastases and second primaries were 6% and 16% respectively. Half of the local and nodal failures were subsequently sterilized. Findings at death were two local recurrences, four nodal recurrences, eight distant metastases, and 11 second primaries. The 3- and 5-year overall survival rates were 92% and 88% respectively, with an overall laryngeal preservation rate of 86%. Conclusion: When supraglottic laryngectomy is not feasible for supraglottic cancer, subtotal laryngectomy with CHP is a safe and effective oncological procedure, with preservation of satisfactory laryngeal function. [ABSTRACT FROM AUTHOR]

Partial horizontal supracricoid laryngectomy with cricohyoidopexy at the Department of Otolaryngology, Medical University of Białystok, involves resection of the entire thyroid cartilage with the pre-epiglottic and paraglottic spaces. Experience has shown that this technique will permit adequate phonation, respiration and deglutition in selected advanced cases of supraglottic and glottic carcinoma. The purpose of this study was to verify histologically the indications for this surgery by examining sections of whole-organ laryngeal specimens. Post-laryngectomy specimens from 90 patients with otherwise previously untreated supraglottic (48), transglottic (22) and glottic (20) carcinomas were reviewed retrospectively. The majority (66) of the specimens were staged as pT4. Findings showed that 22 of the specimens analyzed (mostly supraglottic tumors) could have been eradicated by supracricoid laryngectomy alone. The present study confirmed the principles of supracricoid laryngectomy for selected large tumors. [ABSTRACT FROM AUTHOR]

Previous experience has shown that conservation of the healthy hemilarynx is possible for the treatment of extended lateralized laryngeal and hypopharyngeal cancers. One major indication for supracricoid hemilaryngectomy is glottic cancer involving either the arytenoid or Morgagni’s ventricle. Hemilaryngopharyngectomy is also indicated when tumor of the pyriform sinus involves its anterior part, lateral wall, medial wall and ary- and pharyngoepiglottic folds. Supracricoid hemilaryngopharyngectomy was performed in seven cases. The resection consisted of removal of the surpacricoid hemilarynx and ipsilateral pyriform sinus. The reconstruction was performed by elevating the posterior pharyngeal wall and suturing the mucosa to the midline. This surgical technique provided good functional results. Patients had no airway impairments, but the recovery of satisfactory deglutition may require 14–32 days. Phonatory rehabilitation was successful, and each patient had a satisfactory vocal quality. Postoperative irradiation did not affect the functional results. [ABSTRACT FROM AUTHOR]

It is widely accepted that tumoral invasion of the pre-epiglottic space (PES) has a significant prognostic importance in supraglottic laryngeal carcinomas. The lymphatics of the supraglottic larynx drain to cervical lymph nodes via the PES. Since the supraglottic larynx is an embryological unit that contains the PES, malignant lesions of this region must be resected with en bloc surgery, including the PES. Tumors with PES invasion are already considered to be T3 in TNM staging. The purpose of this study was to review the clinical experience we have had with these tumors at Ankara University. The study comprised 150 patients with squamous cell carcinomas of the supraglottic larynx treated with either partial or total laryngectomies. Findings suggested that PES invasion occurred at early stages of supraglottic tumor progression. Suprahyoid epiglottic lesions behaved less aggressively than tumors originating from other supraglottic subsites and did not invade the PES until advanced stages. PES invasion was not considered to be a significant prognostic factor because the majority of the supraglottic lesions studied demonstrated PES invasion regardless of cervical lymph node metastases. Analysis of oncological and functional results revealed that en bloc resection of the supraglottis with the PES was facilitated by preservation of the hyoid bone. [ABSTRACT FROM AUTHOR]