Comparative videostroboscopic analysis after different external partial laryngectomies

Abstract

Background/Aim. After external partial laryngectomias, videostroborscopy is very usefull in evaluation of postoperative phonatory mehanisms showing the ?slow motion? of the vibrations of the remaining laryngeal structures. The aim of this paper was to compare the videostroboscopic characteristics of the vibration and to establish the differences in the phonation mechanisms depending on the type of external partial laryngectomy performed. Methods. This prospective study was conducted during the period 2003-2009 at the Ear, Nose and Throat Clinic, Clinical Center of Vojvodina, Novi Sad, including 99 patients with laryngeal carcinoma, treated with open surgical approach using different types of vertical and horizontal partial laryngectomy. Videostroboscopy was used to analyse vibrations of the remaining laryngeal structures. Results. The dominant vibration structure after partial horizontal laryngectomy, chordectomy, frontolateral laryngectomy and three quarter laryngectomy was the remaining vocal fold, after hemilaryngectomy it was the false vocal fold and after subtotal and near total laryngectomy it was the arythenoid. In patients with supracricoid hemilaryngopharyngectomy performed, many different structures were involved in the vibration. After most of the partial laryngectomies, vibrations can be found in the reconstructed part of the defect. In both horizontal and vertical partial laryngectomies movements of the larynx during phonation were mostly medial, while in cricohyoidoglottopexies they were anterior-posterior. Most of the operated patients (72.7%) had insufficient occlusion of the neoglottis during the phonation. Conclusion. Videostroboscopy is a useful method in examining the phonation mechanisms of reconstructed laryngeal structures after partial laryngectomy as well as in planning postoperative voice therapy.Uvod/Cilj. Nakon eksternih parcijalnih laringektomija, videostroboskopija je veoma korisna za procenu postoperativnog mehanizma fonacije pokazivanjem usporenosti vibracija preostalih laringealnih struktura. Cilj rada bio je da se medjusobno uporede videostroboskopske karakteristike vibracija preostalih struktura larinksa i utvrde razlike fonacijskih mehanizama nakon razlicitih parcijalnih laringektomija otvorenim spoljasnjim pristupom. Metode. Ispitivanje je sprovedeno kao prospektivna klinicka studija u periodu od 2003. do 2009. na Klinici za bolesti uva, grla i nosa, Klinickog centra Vojvodine u Novom Sadu, a obuhvatilo je 99 bolesnika operisanih zbog karcinoma larinksa nekom od parcijalnih laringektomija, kod kojih je nacinjena videostroboskopska analiza vibracija preostalih struktura i fonacijskih mehanizama. Rezultati. Dominantno mesto vibracije bila je glasnica kod horizontalne supragloticne laringektomije, hordektomije, frontolateralne laringektomije i kod trocetvrtinskih operacija. Ventrikularni nabor dominantno je vibrirao kod hemilaringektomije, a aritenoid kod suptotalnih i kod skoro totalne laringektomije. Kod suprakrikoidne hemilaringofaringektomije zabelezeno je ucesce u vibraciji vise razlicitih struktura. Moguce su vibracije i u zoni rekonstrukcije defekta kod vecine operativnih tehnika. Kod horizontalnih i vertikalnih laringektomija pokreti larinksa u fonaciji bili su najcesce medijalni, dok su kod krikohioidoepiglotopeksije bili anterioposteriorni. Insuficijentna okluzija neolarinksa u fonaciji bila je prisutna kod vecine operisanih bolesnika. (72,7%). Zakljucak. Videostroboskopija je korisna metoda proucavanja fonacijskih mehanizama rekonstruisanog larinksa posle parcijalnih laringektomija, kao i kod planiranja vokalne terapije.