Mario A. Landera

Changing trends of speech outcomes after total laryngectomy in the 21st century: A single‐center study

To describe the speech rehabilitation outcomes of patients undergoing total laryngectomy (TL) in the 21st century.

Longitudinal tracheoesophageal puncture size stability.

Objective The purpose of this study is to investigate prosthesis size stability over time and determine which factors influence need for change in size. Study Design Retrospective chart review. Setting Teaching hospital. Subjects and Methods Retrospective chart review was performed on all individuals who had previously undergone total laryngectomy and tracheoesophageal puncture and had a minimum of 3 years of consistent and consecutive follow-up data after their prosthesis was initially placed. Data reviewed included demographic variables of age at time of tracheoesophageal puncture, ethnicity, and sex. Results Fifty patients were identified who met criteria for study inclusion with a mean age of 64.7 years (range, 43-86 years) with 41 (82%) men and 9 (18%) women. Surgical management was equally divided between those who underwent total laryngectomy (n = 25) as primary treatment vs those who had salvage laryngectomy (n = 25) for persistent or recurrent disease. Prosthesis size was stable, with no change in diameter or length, in only 5 (10%) patients and unstable in 45 (90%), as they were changed at least once. The only factor that demonstrated statistical significance was sex (Fisher exact test = 0.035), with women being more likely to have a stable prosthesis size over time. Conclusions The results of this study demonstrate that 90% of patients who underwent total laryngectomy and tracheoesophageal puncture required a change in their prosthesis size beyond the first 3 months of expected healing. These results support the need for continual reassessment of the fistula tract when changing the prosthesis to ensure appropriate fit.

Changing Trends of Speech Outcomes after Total Laryngectomy in the 21st Century

Objectives: Management of laryngeal cancer has changed significantly in the past decade. Total laryngectomy (TL) has been mainly reserved for patients with recurrence or failure after chemo-radiation or patients requiring major ablative and reconstructive surgeries. Tracheoesophageal puncture (TEP) continues to be the gold standard for speech rehabilitation, yet it is unknown what the overall speech outcomes are for individuals undergoing TL in the 21st century. Our study will describe the speech rehabilitation outcomes of patients after TL in the 21st century. Methods: This is a retrospective analysis of 391 patients who underwent TL from June 2000 to February 2012 with a minimum of one year follow-up. Demographic variables and medical/surgical factors related to laryngectomy will be reviewed. Patient speech rehabilitation outcomes will be assessed and categorized into the following groups: 1) use of esophageal speech; 2) use of electrolarynx; 3) use of TEP; 4) failure to achieve functional speech; and 5) non-compliant. To be in groups 1, 2, or 3, patients must use speech as the dominant mode of communication. Results: Patients who underwent TL in the 21st century may have overall decreased success rate in speech rehabilitation; there may be decreased success rate in the use of esophageal speech and TEP. Conclusions: The current gold standard for speech rehabilitation should be readdressed, as it may not adequately meet the need of the current patient populations. More up-to-date techniques and technologies are needed to improve the communication and speech rehabilitation of current laryngectomy patients.

S191 – Unilateral Vocal Fold Paralysis: Medialization Results:

Objectives Management of glottal insufficiency due to unilateral vocal fold paralysis (UVFP) has evolved from trans-oral injection to external thyroplasty to revisited injections (transoral or transcutaneous). Currently, preference is given to the less invasive injection medialization. Multiple injectable materials have been utilized with newer ones being introduced to manage concerns over permanency and vocal fold vibratory patterns. The purpose of this study is to evaluate the long-term results of injection medialization for UVFP in terms of stability of glottal closure and voice outcome vs. need for reinjection. Methods All patients with UVFP that underwent injection medialization and had follow-up studies more than 6 months were eligible for inclusion. Parameters studied included demographic data (age, gender), side of paralysis, etiology, degree of pre-injection glottal insufficiency, length of follow-up, degree of post-injection glottal closure, mucosal wave resolution, and Voice Handicap Index. Results 146 patients were identified with a mean age of 61.7 years (17–94); males (55%) and females (45%). Etiology was idiopathic (56%); iatrogenic (48%); tumor-related (9%); trauma (3%); and neurologic (2%). Degree of glottal insufficiency was mild (21%); moderate (29%); and severe (50%). Material injected was Cymetra in 80 patients and Radiesse in 66 patients. 45 (33%) patients underwent more than 1 injection. Details of patients requiring repeat injections with regards to the material injected and the other parameters will be presented. Conclusions Injection medialization via a transcutaneous approach has long-lasting results making it an appropriate minimally-invasive option for long-term medialization for UVFP.