Flavio M. Gripp

Primary versus secondary tracheoesophageal puncture for speech rehabilitation in total laryngectomy : Long-term results with indwelling voice prosthesis

OBJECTIVE: To evaluate the long-term use of indwelling Blom-Singer voice prosthesis (VP) for vocal rehabilitation of patients submitted to total laryngectomy (TL). The influence of the timing (primary or secondary) of tracheoesophageal puncture (TEP), use of radiotherapy (xRT), patient age, and length of follow-up were studied to evaluate the success rate of VP use. STUDY DESIGN AND SETTING: Prospective clinical study in a tertiary referral center. Seventy-one patients were submitted to TL and rehabilitated with indwelling VP. All patients were evaluated for vocal functional issues by an otolaryngologist and a speech pathologist at 1 month, then at every 3 months up to 1 year, and then at every 6 months after 1 year of follow-up. The relative data on time of placement of VP, time of VP use, xRT, age, length of follow-up, and life span of each VP were recorded during the follow-up. RESULTS: Eighty-seven percent of the patients underwent primary and 13%, secondary TEP. The follow-up varied from 12 to 87 months, with an average of 38 months for primary and 51 months for secondary TEP. Fifty-nine percent of the patients were submitted to xRT. The general rate of success was 94%, with 97% for primary and 78% (P = 0.07) for secondary TEP; after 2 years, the success rate was 96% for primary and 75% for secondary (P = 0.07) TEP. The use of xRT and patient age had no influence on the success of VP use for primary and secondary TEP, independently of the length of follow-up. CONCLUSIONS: The success rate of voice rehabilitation with VP was 94%. In primary TEP, the success rate was 97%, whereas in secondary TEP it was 78%; 2 years later, it was 96% and 75%, respectively. A tendency for a higher success rate in voice rehabilitation after TL was observed in primary TEP. The use of xRT and age of patient had no influence on the success rate.

Role of margin status in recurrence after CO2 laser endoscopic resection of early glottic cancer

Conclusion. In patients with early glottic squamous cell carcinoma (SCC) submitted to CO2 laser endoscopic resection, local disease recurrence was significantly correlated with the presence of positive additional surgical margins on permanent sections. Objectives. To evaluate the rate of cancer recurrence in patients with early glottic SCC submitted to CO2 laser endoscopic resection according to margin status after resection, stage of disease and postoperative radiotherapy. The rate of larynx preservation and the length of hospital stay were also evaluated. Material and methods. Forty consecutive patients with early glottic cancer were subjected to laser endoscopic resection surgery of glottic cancer followed by frozen-section control of margins, with intraoperative enlargement of margins when positive. Adjuvant radiation therapy or enlargement of previous margins was indicated in the case of positive additional surgical margins on permanent section. Results. Local recurrence occurred in three patients (7.5%), all with positive additional surgical margins on permanent section. Positive additional surgical margins on permanent section were related to 37.5% of recurrences and negative additional surgical margins with 0% of recurrences (p=0.006). All patients spent at most 1 day at the hospital.

Nova válvula fonatória para traqueotomia: uma proposta brasileira

Introducao: A traqueotomia esta indicada em condicoes com obstrucao respiratoria alta ou doenca pulmonar obstrutiva cronica. As valvulas fonatorias (VF) de traqueotomia ja foram anteriormente descritas, porem apresentam alto custo para o paciente, pois sao todas importadas. Objetivo: Demonstrar a VF, desenvolvida na Universidade Estadual de Campinas, confeccionada em aco inox, para cânula de traqueotomia e a possibilidade de sua utilizacao na reabilitacao fonatoria desses pacientes. Forma de estudo: Clinico prospectivo. Material e Metodo: A VF, desenvolvida na Universidade Estadual de Campinas, foi utilizada em dez pacientes consecutivos. A valvula tem diafragma dentro de um corpo em aco inox com encaixes de plastico. Ela permite o direcionamento do ar para a laringe durante a fonacao com oclusao do traqueotoma e abertura do mesmo na inspiracao, sob baixa pressao. Resultados: Atualmente dez pacientes estao utilizando estas VF com fonacao sem necessidade de oclusao do orificio externo da cânula e confortavelmente, inclusive durante o sono. Discussao: As VF para cânulas de traqueotomia melhoram a comunicacao, inteligibilidade, higienizacao e umidificacao das vias aereas dos pacientes traqueotomizados. Ha tambem melhora no aspecto emocional e diminuicao das secrecoes orais e traqueais. O custo de producao dessa VF nacional e baixo e milhares de pacientes poderao ser beneficiados no Brasil. As criancas com traqueotomia podem apresentar retardo no desenvolvimento da linguagem. O uso da VF facilitara a comunicacao e a interacao social dessas criancas. Conclusao: A valvula fonatoria metalica, desenvolvida na Universidade Estadual de Campinas, acoplada a uma cânula de traqueotomia metalica permite fonacao, sem a oclusao digital da cânula, e respiracao sob conforto.

Use of computerized manometry for the detection of pharyngoesophageal spasm in tracheoesophageal speech

Objective To evaluate the utility of computerized manometry (CM) to identify pharyngoesophageal segment (PES) spasm during tracheoesophageal speech. Study Design Prospective clinical, controlled study. Subjects and Methods Intraluminal pressures of the PES were collected in 12 tracheoesophageal speakers without spasm and 8 tracheoesophageal speakers with PES spasm before and after localized injection of botulinum toxin to the PES. All subjects underwent voice analysis and videofluoroscopy in addition to CM before and after treatment. Results All tracheoesphageal speakers with PES spasm presented with mean intraluminal pressures greater than 16 mmHg (mean, 25.36 mmHg). In contrast, mean intraluminal pressures of subjects without spasm was 11.76 mmHg (P < 0.05). The negative predictive value associated with the use of 16 mmHg as a threshold value for spasm was 100%. Conclusion CM is a clinically useful tool to aid in speech rehabilitation for tracheoesophageal speakers. Intraluminal pressures of greater than 16 mmHg was highly predictive for PES spasm.

Botulinum toxin in speech rehabilitation with voice prosthesis after total laryngectomy

UNLABELLED In tracheo esophageal puncture (TEP), we carry out a myotomy of the pharynx constrictor muscle; however, about 9 to 79% of patients need such procedure. The consequence of such procedure is an increase in salivary fistula rates in the postoperative. Botulin toxin is used in an outpatient basis. AIM analyzing the efficacy of botulin toxin (BT) use in the rehabilitation of totally laryngectomized patients with tracheo-esophageal voice (TEV) with spasms (S) of the pharyngo-esophageal segment (PES) without myotomy. MATERIALS AND METHODS We analyzed eight patients submitted to total laryngectomy (TL), rehabilitated with TEV, with speech prosthesis (SP) and struggle to utter voice because of PES spasms. They were all submitted to treatment of such motor alteration with the injection of 100 units of BT in the PES. The evaluation was based on perceptive voice analysis, video fluoroscopy (VF) of the PES, acoustic voice analysis and computerized manometry (CM) of the PES, all before and after BT injection. STUDY DESIGN prospective. RESULTS There was a reduction in PES CM pressure after BT injection. Acoustic analysis showed an improvement in harmonics quality after treatment. There was smoother voice utterance and spasm improvement after BT. CONCLUSION all patients with PES spasms presented vocal improvement after BT injection in the PES.