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[Pharyngeal constrictor muscles closure after total laryngectomy is that really beneficial?].

AbstractUNLABELLED:
High pressure of pharyngo-esophageal segment is the most important factor of impaired development of alaryngeal speech (esophageal speech, tracheoesophageal speech) after total laryngectomy. To prevent pharyngo-esophageal spasm in Department of Otolaryngology in Szczecin are used: pharyngoesophageal plastic surgery with interposition of vascular thyroid flap, two-layer (only mucosa) non-muscular pharyngeal closure and tree-layer closure (mucosa and muscle layer leaving inferior pharyngeal constrictor unsutured).
AIM OF STUDY:
The aim of this study was to compare the pharyngo-esophageal pressure between patients after pharyngo-esophageal plastic surgery and following the non-muscular pharyngeal closure.
MATERIAL AND METHODS:
One hundred eighty two subjects after total laryngectomy were enrolled in this study, and included 108 patients subjected to the pharyngo-esophageal plastic surgery, 44 patients who underwent the two-layer pharyngeal closure, and 30 patients with the tree-layer closure. To evaluate the pharyngo-esophageal pressures manometric tests were performed, and to asses the pharynx morphology videopharyngoscopy was used.
RESULTS:
The average pharyngo-esophageal pressure in the group after the pharyngo-esophageal plastic surgery was 32 (min.-5, max. 50) mmHg. After the two-layer non-muscular pharyngeal closure mean pressure was 35 (min.-17, max.-40) mmHg, and after the tree-layer non-muscular pharyngeal closure the average pressure was 22,42 (min. 5, max. 40) mmHg. The average pharyngo-esophageal pressure was significantly lower (p < 0.01) among patients after the tree-layer non-muscular closure.
CONCLUSION:
The study suggests that the tree-layer non-muscular pharyngeal closure with inferior pharyngeal constrictor unsutured is the preferable method to prevent pharyngo-esophageal spasm after total laryngectomy. However, the efficacy and safety of this surgical procedure should be explored in further multicenter studies.
AuthorsCzesława Tarnowska, Ewa Grochowska-Bohatyrewicz, Stanislaw Bień, Jarosław Sieczka, Ewa Jaworowska, Jakub Lubiński
JournalOtolaryngologia polska = The Polish otolaryngology (Otolaryngol Pol) 2010 Jan-Feb Vol. 64 Issue 1 Pg. 37-42 ISSN: 0030-6657 [Print] Poland
Vernacular TitleCzy zszywanie zwieracza gardła dolnego po laryngektomii całkowitej jest korzystne?
PMID20476591 (Publication Type: Comparative Study, English Abstract, Journal Article)
Topics
  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Squamous Cell (surgery)
  • Esophageal Spasm, Diffuse (prevention & control, surgery)
  • Female
  • Humans
  • Laryngeal Neoplasms (surgery)
  • Laryngectomy (methods)
  • Male
  • Middle Aged
  • Pharyngeal Muscles (surgery)
  • Postoperative Care (methods)
  • Pressure
  • Speech, Esophageal (methods)
  • Surgical Flaps
  • Voice Disorders (etiology)
  • Voice Quality
  • Voice Training

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