Madeleine Ménard

Supracricoid laryngectomy with cricohyoidopexy: A partial laryngeal procedure for selected supraglottic and transglottic carcinomas

The partial horizontal supracricoid laryngectomy with cricohyoidopexy consists of resection of the whole thyroid cartilage and paraglottic space, as well as the epiglottis and the whole preepiglottic space. The cricoid cartilage, the hyoid bone, and at least one arytenoid cartilage are spared. Sixty‐eight patients with squamous cell carcinoma of the supraglottis who underwent this procedure during the period from 1974 through 1986 are presented. Conventional horizontal supraglottic laryngectomy was contraindicated in all cases. All but three patients (95.4%) recovered physiologic deglutition, and none required a permanent tra‐cheostomy. The 3‐year actuarial survival rate was 71.4%. No local recurrences were encountered. The indications for the procedure are carcinomas of the supraglottis that 1. involve the glottis and anterior commissure, 2. invade the ventricle, 3. present with a marked limitation of true vocal cord mobility (transglottic lesions), and 4. invade the thyroid cartilage. The procedure is presented as a useful alternative to radiation therapy, horizontal supraglottic laryngectomy, and total laryngectomy in select cases of supraglottic carcinoma.

Supracricoid laryngectomy with cricohyoidoepiglottopexy : a partial laryngeal procedure for glottic carcinoma

The partial horizontal supracricoid laryngectomy with cricohyoidoepiglottopexy consists of resection of the whole thyroid cartilage and paraglottic space. The cricoid cartilage, the hyoid bone, most of the epiglottis, and at least one arytenoid cartilage are conserved. Thirty-six patients with squamous cell carcinoma of the glottis who underwent this procedure from 1974 through 1986 are presented. All 36 recovered physiologic deglutition and phonation. None required a permanent tracheotomy. The 3-year actuarial survival rate was 86.5%. The local recurrence rate was 5.5%. The indications for the procedure are carcinomas of the glottis that 1) spread beyond the confines of the membranous portion of the true vocal cord or 2) present with limitation of true vocal cord mobility. The procedure is presented as a useful alternative to radiotherapy, partial vertical laryngectomy, and total laryngectomy in select cases of glottic carcinoma.

Total conservative parotidectomy for primary benign pleomorphic adenoma of the parotid gland: A 25-year experience with 229 patients

A 25‐year experience with total conservative parotidectomy for primary benign pleomorphic adenoma (PBPA) of the parotid gland in a consecutive series of 229 patients has been reviewed. This study focuses on survival, morbidity, PBPA recurrence, postoperative facial nerve dysfunction, and Freys syndrome. Surgical death was never encountered in this study. The overall incidence for postoperative hemorrhage, hematoma, seroma, skin necrosis, great auricular nerve schwannoma, and keloid scar was 1.7%, 6.1%, 4.8%, 0.9%, 15.7%, and 8.3%, respectively. Five‐, 10‐, 15‐, and 20‐year PBPA control actuarial rate was 99.6%. The overall incidence for temporary facial paresis and paralysis was 64.6% and 5.6%, respectively. Kaplan‐Meier actuarial analysis demonstrated that paresis recovery was noted until the eighteenth postoperative month. The overall incidence for permanent facial paresis and paralysis was 3.9% and 0%, respectively. None of the following variables—sex, age, PBPA size, PBPA location, PBPA contact with the facial nerve, inadvertent PBPA spillage, or surgeons experience— was statistically related to PBPA recurrence and facial nerve dysfunction. The overall incidence for Freys syndrome was 65.9%. Kaplan‐Meier actuarial analysis demonstrated the need for a minimal 5‐year follow‐up to assess Freys syndrome incidence. The mean age was statistically lower in patients presenting with Freys syndrome.

In situ lifetime, causes for replacement, and complications of the Provox voice prosthesis.

One hundred ProvoxTM voice prostheses consecutively inserted in 37 patients and replaced only when phonation was impaired or complications noted were analyzed for in situ lifetime, causes for replacement, and complications. The mean in situ lifetime was 311 days. Actuarial analysis(Kaplan‐Meier method) of the in situ lifetime revealed that 65.9%, 23.7%, and 16.4% of the voice prosthesis were still in situ by the 6th, 12th, and 18th postinsertion month. Cause for replacement was salivary leakage through the prosthesis valve, salivary leakage around the prosthesis, deterioration of the prosthesis, and excessive crusting resulting in increased airflow resistance in 33%, 27%, 24%, and 16% of cases, respectively. Complications included granulation tissue formation, cervical cellulitis, necrosis of the tracheoesophageal puncture, tracheostomal stenosis, and swallowing impairment in six, two, one, three, and one patient, respectively.

Chemotherapy alone with curative intent in patients with invasive squamous cell carcinoma of the pharyngolarynx classified as T1-T4N0M0 complete clinical responders.

The current studies documented the results achieved with chemotherapy alone with curative intent in a series of 67 patients with invasive squamous cell carcinoma of the pharyngolarynx classified as T1–T4N0M0 complete clinical responders after a platin‐based induction chemotherapy regimen.

Thyroplasty type I with montgomery implant among native French language speakers with unilateral laryngeal nerve paralysis

Objective: To document the long‐term results achieved with the Montgomery implant in 96 French speakers with a unilateral laryngeal nerve paralysis (ULNP).

Trade-off between Survival and Laryngeal Preservation in Advanced Laryngeal Cancer: The Otorhinolaryngology Patient's Perspective

Objectives: We performed a prospective study to evaluate, from the patients perspective, the trade-off between speech and survival that individuals face when given a diagnosis of advanced-stage laryngeal cancer amenable to either total laryngectomy or a laryngeal preservation protocol using chemotherapy and radiotherapy. Methods: Volunteers (309) consecutively seen at the otorhinolaryngology clinic of a university teaching hospital in France completed an anonymous questionnaire designed to determine their position if they faced the diagnosis of an advanced-stage laryngeal cancer. Univariate analysis was performed for potential statistical relationships with various variables. Results: We found that 12.9% of patients were unable to determine their position regarding the two treatment options offered, and this group had a significant statistical relationship with four variables (age, education, professional status, and history of cancer among relatives). We found that 24.6% of patients made survival their main consideration and would not consider any trade-off. Among the 62.5% who considered the trade-off, the percentage of cure that patients were ready to lose in order to preserve their larynx varied from 5% to 100% (mean, 33%; SD, 23%). Aside from the undecided group, none of the variables analyzed was related either to the decision as to whether to consider a trade-off or to the percentage of cure that patients agreed to trade to preserve their larynx. Conclusions: In patients with advanced-stage laryngeal cancer, treatment should be initiated only after careful evaluation of the patients attitude toward both laryngeal preservation and survival.

Local recurrence after vertical partial laryngectomy, a conservative modality of treatment for patients with Stage I–II squamous cell carcinoma of the glottis

Based on an inception cohort of 103 patients who had local recurrence (Group I) and a witness group of 311 patients who achieved local control (Group II) after vertical partial laryngectomy for Stage I–II glottic carcinoma, the current retrospective study documented the consequences and management of local recurrence.

Resection of selected invasive squamous cell carcinoma of the pyriform sinus by means of the lateral pharyngotomy approach: The partial lateral pharyngectomy

Although the lateral pharyngotomy is a well‐known surgical procedure, to our knowledge, no published reports have described the results achieved with a lateral pharyngectomy approach in patients with isolated and previously untreated selected invasive squamous cell carcinoma of the lateral wall of the pyriform sinus.

Analysis of Local Recurrence in Patients with Selected T1–3N0M0 Squamous Cell Carcinoma of the True Vocal Cord Managed with a Platinum-Based Chemotherapyalone Regimen for Cure

Based on an inception cohort of 35 patients with T1–3N0M0 squamous cell carcinoma of the true vocal cord who had a complete clinical response after a platinum-based induction chemotherapy regimen and a minimum of 3 years of follow-up, the current retrospective study documented the long-term results and consequences of local recurrence following the use of a platinum-based chemotherapy—alone regimen for cure. During the years 1985 to 1996, 231 patients with invasive squamous cell carcinoma of the true vocal cord classified as T1–3N0M0 were managed at our department with a platinum-based induction chemotherapy regimen. A complete clinical response was achieved in 77 patients. Thirty-five of the 77 patients with complete clinical response were managed at our institution with a platinum-based chemotherapy—alone regimen. The statistical analysis of data on survival, local control, nodal control, distant metastasis, and metachronous second primary tumor incidence was based on the Kaplan-Meier product limit method. Univariate analysis was performed for potential statistical relation between local recurrence and various variables. The 3- and 5-year actuarial survival estimates were 91.4% and 88.6%, respectively. Overall, the causes of death were intercurrent disease in 6 patients and metachronous second primary tumor in 4 patients. The 3- and 5-year actuarial local control estimate was 64.8%. No significant statistical relation could be demonstrated between the incidence for local recurrence and the variables under analysis. Salvage treatment in patients with local recurrence yielded a 100% local control rate and laryngeal preservation rate. The 3- and 5-year actuarial lymph node control estimate was 97.1%. The 3- and 5-year actuarial estimate for patients with distant metastasis was 0%. The 5- and 10-year actuarial estimates for patients with metachronous second primary tumor were 9.7% and 28.1%, respectively. Although local recurrence was noted in almost a third of patients with complete clinical response who were managed with a platinum-based chemotherapy-alone regimen, it did not appear to be detrimental, as none of the patients who had local recurrence ultimately died from their disease or lost their larynx.