Total laryngectomy is a crucial surgical intervention for patients with advanced malignant tumors of the larynx and nasopharynx. Despite its effectiveness, this procedure permanently severs the connection between the nasal cavity and the lower respiratory tract, leading to the cessation of nasal airflow. This disruption significantly impairs the patient's sense of smell and adversely affects their quality of life. Although olfactory loss is common in these patients, the assessment and rehabilitation of their olfactory function are often overlooked. This article reviews relevant literature on evaluating olfactory function and rehabilitation methods following total laryngectomy, with the aim of providing a theoretical foundation to enhance olfactory rehabilitation and overall quality of life for these patients.
Humans ; Laryngectomy/rehabilitation* ; Quality of Life ; Smell ; Laryngeal Neoplasms/surgery* ; Olfaction Disorders/etiology*

Total laryngectomy remains as an important treatment option in selected patients with laryngopharyngeal cancers, which inevitably sacrifices naturally produced voice. Much effort has been devoted to voice restoration for these laryngectomized patients. Several ways of voice rehabilitation after total laryngectomy have been developed and utilized thus far, including tracheoesophageal shunt speech, esophageal speech, pneumatic speech aid, and electrolarynx. Of these, tracheoesophageal shunt speech appears to be the most effective voice restoration method, while other trials might also be useful in special situations. Nevertheless, each method has its own unique mechanisms of voice production, thus has its advantages and drawbacks in clinical setting. In this review, we discuss the currently available management options for the rehabilitation of laryngectomized voice.
Humans ; Laryngectomy* ; Methods ; Rehabilitation* ; Speech, Esophageal ; Voice*

Cricoid Cartilage ; surgery ; Humans ; Laryngectomy ; methods ; rehabilitation ; Larynx ; Recovery of Function

INTRODUCTIONIn laryngectomised patients, tracheoesophageal speech is the gold standard for voice rehabilitation. This study evaluated complications related to the tracheoesophageal puncture (TEP) and the success rate in voice prosthesis after total laryngectomy at our institution over a 10-year period.

MATERIALS AND METHODSA retrospective review of 22 TEPs was performed between January 1998 and December 2008. The timing of TEP, type of voice prosthesis, surgical and prosthesis-related complications, and TEP closure were noted.

RESULTSEighteen percent of the patients underwent primary and 82% secondary TEP. Our patients were predominantly males (95.4%) of Chinese descent with a mean age of 62.1 years. The types of voice prostheses used were ProvoxTM (n = 15), Voicemasters (n = 6), and Blom-Singer (n = 1). Prosthesis- related complications occurred in 77.3%. Notable complications were leakage (82.5%), prosthesis displacement (41.2%), intractable aspiration (29.4%), and aspiration of prosthesis (23.5%). The most common surgical-related complication was tracheostomal stenosis. An array of interventions comprising resizing or changing prosthesis type, nasogastric catheter insertion, stomaplasty, purse string suturing, and bronchoscopic removal of bronchial aspirated prosthesis were implemented to address encountered complications. In a mean follow-up of 34.8 months, 68.2% of patients achieved functional tracheoesophageal speech (75% of primary TEP and 67% of secondary TEP). There were 7 TEP closures indicated by persistent leakage, recurrent dislodgement, phonatory failure and, in 1 patient, persistent pain.

CONCLUSIONSTEP has become an integral part in the rehabilitation of a laryngectomee. However, management of the frequent complications related to TEP requires specific efforts and specialistic commitments in order to treat them.

Academic Medical Centers ; statistics & numerical data ; Adult ; Aged ; Constriction, Pathologic ; epidemiology ; etiology ; Equipment Failure Analysis ; Female ; Humans ; Incidence ; Laryngectomy ; rehabilitation ; Larynx, Artificial ; adverse effects ; Malaysia ; epidemiology ; Male ; Middle Aged ; Punctures ; adverse effects ; Retrospective Studies ; Speech, Alaryngeal ; Trachea ; surgery

OBJECTIVETo evaluate the extensive and degree of physical rehabilitation improvement of the quality of life in laryngectomees.

METHODSForty nine patients who underwent total laryngectomies were trained by esophageal voice rehabilitation successfully. The questionnaires of performance status scale for head and neck cancer patients (PSS-HN) and the functional assessment of head and neck cancer therapy (FACT-H&N) were answered by them before esophageal voice training and 3 months after successful vocal rehabilitation.

RESULTSTotal laryngectomy deteriorated the quality of life in laryngectomees. The mean scores of PSS-HN scale and FACT-H&N questionnaire were lower than the criteria scores after patients underwent total laryngectomy, the mean score were 131. 4,90.6 respectively, the difference was significant statistically (t =53. 673, P <0.001) , (t = 67.44, P <0.001). After successful esophageal speech training, the mean scores of the laryngectomees were improved both in PSS-HN scale and FACT-H&N which were 240.4 and 103.7 respectively, the difference was significant statistically (t = 18.209, P < 0.001) , (t = 21.389, P<0.001).

CONCLUSIONSThe quality of life in laryngectomees can be improved by physical rehabilitation and the esophageal voice training.

Adult ; Aged ; Female ; Humans ; Laryngectomy ; rehabilitation ; Larynx, Artificial ; Male ; Middle Aged ; Quality of Life ; Speech, Esophageal ; Surveys and Questionnaires ; Voice Training

OBJECTIVETo study the aerodynamic characteristics of low-resistance Groningen voice prosthesis for total laryngectomees and the related clinical significance.

METHODSThree aerodynamic parameters were measured in 24 laryngectomees implanted with low-resistance Groningen voice prosthesis: the sound pressure level (SPL), intratracheal pressure (pressure) and airflow rate (flowrate). Among them, 6 cases were initially implanted with other prosthesis which was replaced by the Groningen buttons later. The parameters were measured for both old and new prosthesis. The relationship between the variables were computed with means of Pearson' s product-moment correlations.

RESULTSThe parameters were measured repeatedly among all cases, 180 group data were collected. Screening test showed that the median of sound pressure level, intratracheal pressure and airflow rate are respectively 88.0 dB, 73.6 cm H2O (1 cm H2O = 0.098 kPa) and 123.2 ml/s. Thirty times measurement of patients phonation showed that the correlation between SPL and pressure was not significant (r = -0.058, P > 0.05). The relationship between flow rate and SPL was not significant(r = -0.119, P > 0.05). The correlation between pressure and flow rate was significant(r = 0.699, P < 0.05). CONCLUSIONS When pseudoglottis vibration is produced by sub pseudoglottis air flow, pseudoglottis vibration and voice loudness can not be increased by continuous air flow.

Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Kinetics ; Laryngeal Neoplasms ; rehabilitation ; surgery ; Laryngectomy ; rehabilitation ; Larynx, Artificial ; Male ; Middle Aged ; Prosthesis Design ; Speech Articulation Tests ; Speech, Alaryngeal

OBJECTIVETo investigate causes and treatment of complications of tracheoesophageal puncture for Blom-Singer voice restoration after total laryngectomy.

METHODSFrom 1986 to 2004, one hundred and fifty one cases with Blom-Singer technique after total laryngectomy for voice restoration were retrospectively analyzed.

RESULTSAll cases were followed up from 6 months to 15 years. Among 151 cases, 138 cases got successful phonation and the total success rate of voice restoration was 91.4%. Of the 151 cases, 15 cases occurred complications. The rate of complications was 9.9%. The common complications included fistula granulations, infection, and leakage. Twelve cases got successful treatment accordingly, and the other 3 cases failed in phonation.

CONCLUSIONSThe procedure of tracheoesophageal puncture for voice restoration is relatively simple and has low complications. this method had high phonation success and good phonation quality, which is one of the best way to make laryngectomee to speak.

Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Laryngeal Neoplasms ; surgery ; Laryngectomy ; adverse effects ; rehabilitation ; Larynx, Artificial ; Male ; Middle Aged ; Postoperative Complications ; epidemiology ; Retrospective Studies

BACKGROUND AND OBJECTIVES: The voice rehabilitation following total laryngectomy is very important for the quality of life of patients who are cured by cancer treatment. The purpose of this study is to investigate the success rate and complications of various procedures used in our clinics and to evaluate various factors that can affect the success rate of the voice rehabilitation. SUBJECTS AND METHOD: From March 1993 to November 2002, 77 medical charts of the patients who underwent total laryngectomy were reviewed retrospectively to determine the immediate and long-term success rates of voice rehabilitation. The statistic correlation between the variables (age, tumor stage, tumor site, radiotherapy) and the success rate was analysed. RESULTS: Good vocalization was achieved in 90.5% of patients after Provox insertion, 81% after Amatsu procedure, while esophageal voice was acquired by 11.1%. The long-term success rate in 39 patients was 75% in Provox group, 81.8% in Amatsu group and 30.5% in esophageal voice group. There were no statistically significant correlation between the variables and the success rate of vocie rehabilitation. CONCLUSION: The result of this study suggested that tracheoesophageal puncture with Provox prosthesis and Amatsu operation are very effective procedures for the long term voice rehabilitation following total laryngectomy.
Humans ; Laryngectomy* ; Prostheses and Implants ; Punctures ; Quality of Life ; Rehabilitation* ; Retrospective Studies ; Voice*

Pharyngocutaneous fistula formation is a serious complication after total laryngectomy and its incidence varies from 7.6% to 50%. It leads to a prolonged hospitalization and complicated rehabilitation. Although many reconstruction methods have been introduced, each has its own merit and demerit and there is no single perfect answer. In our study, the fistula was reconstructed with inner lining using hinge method and radial forearm free flap. The operation was performed in 5 patients who underwent pharyngocuatneous fistula after total laryngectormy. We obtained a satisfactory reconstruction of the fistula and natural neck contouring using this method in all cases. Only 1 patient had complication of wound infection. However, the patient was healed with conservative antibiotics therapy. We believe the radial forearm free flap with hinge flap is the optimal method for circumferential reconstruction of pharyngocutaneous fistula. In comparison with other reconstructive techniques, the radial forearm free flap offers the best combination of flap reliability and low donor site morbidity. This method also allows patients to shorten the hospitalization and meet their cosmetic needs.
Anti-Bacterial Agents ; Fistula* ; Forearm* ; Free Tissue Flaps* ; Hospitalization ; Humans ; Incidence ; Laryngectomy ; Neck ; Rehabilitation ; Tissue Donors ; Wound Infection

BACKGROUND AND OBJECTIVES: Head and neck cancer strikes at some of the most basic human functions, including verbal communication, social interaction, eating and breathing. Traditionally, the success of cancer treatment has been assessed by objective measures such as disease-free intervals, cure rates, and complication rates. Recently, however, there has been an increased awareness of the need to evaluate treatment effects on the individual's quality of life (QOL). The purpose of this study is to assess quality of life following various types of treatment for laryngeal carcinoma. MATERIAL AND METHODS: We assessed a quality-of-life after treatment of laryngeal carcinoma patients using WHOQOL-BREF questionnaires which was employed by the WHOQOL-group. Fifty-seven patients with laryngeal carcinoma were contacted with the completion of the survey: Radiotherapy only (n=24), conservative laryngectomy (n=16) and total layngectomy (n=17). RESULTS: This study demonstrates that there was no significant difference in QOL in physical health, social relationship and environment between the radiotherapy-only-group and the operation-group (conservative & total laryngectomy). However, the radiotherapy-only group had significantly better (p<.05) QOL on the psychological health domain, especially regarding body image and negative feelings than those of the operation group. CONCLUSION: The negative feeling, the body image change and the poor ability of communication have a negative impact on QOL in the operation group, especially in the total laryngectomee. Providing positive psychosocial adjustment training and voice rehabilitation programs for those who underwent total laryngectomy would be a great help in enhancing their quality of life.
Body Image ; Eating ; Head and Neck Neoplasms ; Humans ; Interpersonal Relations ; Laryngectomy ; Larynx ; Quality of Life* ; Surveys and Questionnaires ; Radiotherapy ; Rehabilitation ; Respiration ; Strikes, Employee ; Voice