Philippe Naudo

Supracricoid Partial Laryngectomy After Failed Laryngeal Radiation Therapy

Twelve patients managed with supracricoid partial laryngectomies(SCPLs) after failed laryngeal radiation therapy (RT) were evaluated. None of the recurrent tumors were amenable to vertical or horizontal partial laryngectomy. Results were analyzed for tracheostomy decannulation, oral alimentation, morbidity, local control, and survival. Major complications included perichondritis (2 patients), laryngeal stenosis (2 patients), and pneumonia from aspiration (1 patient). Mucocutaneous fistula and cricoarytenoid joint ankylosis were not encountered. Margins of resection were uninvolved in all cases. The Kaplan‐Meier 3‐year actuarial survival and local control estimate was 83.3%. Salvage total laryngectomy allowed for an overall 100% local control rate and a 75% laryngeal preservation rate.

Complications and Functional Outcome after Supracricoid Partial Laryngectomy with Cricohyoidoepiglottopexy

We present a review of the postoperative course, complications, and functional outcome of 190 patients consecutively treated with supracricoid partial laryngectomy with cricohyoidoepiglottopexy. The average times until removal of the tracheostomy and nasogastric feeding tubes were 9 and 16 days, respectively. The postoperative mortality rate was 1%. Major complications included pneumonia from aspiration, cervical wound infection, symptomatic laryngocele, ruptured pexis, laryngeal chondroradionecrosis, and laryngeal stenosis in 8.5%, 4.2%, 3.1%, 1%, 0.5%, and 0.5% of the patients, respectively. Completion total laryngectomy, permanent gastrostomy, and permanent tracheostomy were requested in 0.5% of the patients. Normal swallowing without gastrostomy and respiration without tracheostomy was achieved by the first postoperative year in 98.4% (187/190) of the patients. This article presents a univariate analysis of the potential correlation between various variables and the duration of tracheostomy and the length of time the nasogastric feeding tubes were inserted, the mortality incidence and causes, the incidence and type of the various complications, and the duration of hospitalization. Comparison of our data with the reported functional results after vertical partial laryngectomy suggested that supracricoid partial laryngectomy with cricohyoidoepiglottopexy does not result in an increased rate of postoperative complications.

Functional outcome and prognosis factors after supracricoid partial laryngectomy with cricohyoidopexy.

A retrospective analysis of the medical records and operative files of 124 patients who consecutively underwent supracricoid partial laryngectomy with cricohyoidopexy (SCPL-CHP) was undertaken. The objective of this study was to analyze the postoperative course and functional results of SCPL-CHP. The mean duration of follow-up was 7 years (range 1 to 20 years). The postoperative mortality was 1.6%. The average times until tracheostomy and nasogastric feeding tube removal were 8 and 22 days, respectively. All patients but 1 were decannulated. The rate of pneumonia from aspiration was 11.5%. Completion total laryngectomy and permanent gastrostomy were required in 2.5% and 2.5% of patients, respectively. Overall normal swallowing without permanent gastrostomy and respiration without tracheostomy were achieved by the first postoperative year in 91% and 99.1% of patients, respectively. Univariate analysis of the potential correlation between various variables and the duration of the tracheostomy and nasogastric feeding tube, the incidence and causes of mortality, the incidence and type of the various complications, the recovery of swallowing, and the length of hospitalization is presented. The report also discusses the management and follow-up care.

Tracheal resection with end-to-end anastomosis for isolated postintubation cervical trachea stenosis: long-term results.

A 20-year experience with end-to-end tracheal resection and anastomosis for isolated postintubation stenosis of the cervical trachea, in a consecutive series of 32 adult patients, has been reviewed. Surgical death was never encountered. The overall incidences for superficial wound infection, pneumonia, and inferior left laryngeal nerve paralysis were 6.2%, 3.1%, and 3.1%, respectively. One-, 3-and 5-year actuarial anastomosis success rates were 96.7%, 93.3%, and 93.3%, respectively. Successful revision tracheal end-to-end anastomosis was performed once, resulting in an overall 96.9% success rate in our series. None of the following variables — sex, age, cause for intubation, intubation type (laryngotracheal and/or tracheotomy) and duration, delay from initial injury, presence of an open stoma, number of tracheal rings resected, and type of sutures used — were statistically related to the anastomosis success rate or the incidence of complications.

Supracricoid partial laryngectomy with cricohyoidoepiglottopexy: Functional results and outcomes in 190 patients

The external nasal pyramid and the septum are both anatomically and functionally interrelated and are best considered as a single unit. Harmony between the nasal skeleton and the overlying S-STE is mandatory for the desired aesthetic and functional results. Trauma and certain other clinical problems affect both parts of the nose. This can only be addressed by one stage septorhinoplasty procedure. A novel technique of septorhinoplasty with intact columella is described herewith. Methods: Two rim incisions are made on either side of the nostril. This is joined with another incision 2 to 3 mm behind the columella on either side. The flaps are raised on both sides and the dissection is carried forward into the membranous septum. The mucoperichendrium and periosteum flaps are raised on one side. The dorsal skin of the nasal vault is elevated through the rim incision. Septoplasty is performed by dual control and the cartilage graft is harvested for reconstruction of the nasal tip. Nasal vault deformities together with nasal tip deformities are corrected with intact mucosal lining under direct vision and the cartilage graft is stitched to the modified nasal tip. Results: Of 128 patients who underwent septorhinoplasty in the past 5 years, 52 (40.6%) had intact columellar septorhinoplasty, four (7.7%) complained of rigid tip, three (5.7%) had persistent edema and required steroid injection, and four (7.7%) needed revision surgery.