Cricohyoepiglottopexy: long-term results in 55 patients

Near total laryngectomy with cricohyoepiglottopexy (CHEP) allows cure of glottic carcinomas with voice preservation. The subject of this study was to evaluate CHEP in terms of tumour control and functional result in T1 and T2 glottic carcinomas. This study reviewed retrospectively 55 consecutive cases of CHEP performed between January 1, 1981 and September 1, 1992 with the exclusion of post-radiotherapy salvage surgery. CHEP was indicated for a T1a limit to the anterior commissure and/or with dysplasia of the other vocal fold (10 cases), T1b (11 cases) and T2 (34 cases) glottic carcinomas. All our patients have a follow-up of more than five years. The post-operative course after this surgery was generally uneventful. The median time to decannulation was 18 days, to removal of the nasogastric tube was 15 days and to discharge from hospital was 23 days. No significant difference was observed according to the preservation of one or both arytenoid cartilages. The long-term functional result can be considered to be good in three-quarters of cases, with normal oral swallowing and an easily understood voice. The remaining one quarter had a whispery voice and sometimes episodes of aspiration when swallowing liquids. In terms of oncological results, the five-year recurrence-free survival rate was 94 per cent for T1 and 84 per cent for T2. The ultimate tumour control (taking into account four cases of total laryngectomy) was 94 per cent for T1 and 93 per cent for T2. Primary surgery by CHEP therefore appears to be a good option for early glottic carcinomas. The main problem remains that voice recovery is mediocre in one quarter of patients.     

Reconstruction of the mouth floor with nasolabial flap after cancer resection. Report of 81 cases]

The authors report functional results in a series of 81 patients with carcinoma of the floor of the mouth treated by surgical resection and reconstruction by nasolabial flap. The study confirms the literature concerning advantages and limits of such a flap. With regards to others techniques of reconstruction, nasolabial flap is still perfectly usefull in reconstruction of T2 T3 carcinomas of the floor of the mouth.     

Supraglottic surgery in vestibular cancer

This paper deals with the experience acquired in the E.N.T. Clinic of the University of Ferrara regarding horizontal supraglottic laryngectomy in vestibular cancer. The anatomical background of this functional surgery and the most important principles of the technique are specified. The results regard 121 cases (13 T1 cases, 93 T2 cases and 15 T4 cases) divided into three groups: 1. patients who had only surgery (68 cases); 2. patients who for various reasons also had complementary postoperative radiotherapy (39 cases); 3. patients with extralaryngeal expansion who had preoperative radiotherapy (14 cases). The high overall survival rate for the 121 cases is particularly significant, as is the shortening of the high-risk period to less than the usual 5 years. The 4-year cure rate is 78% and remains unchanged right through the 7-year follow-up. The authors feel that these data demonstrate further the validity of supraglottic laryngectomy when its precise indications are rigorously observed.     

Experience with vertical partial laryngectomy with special reference to laryngeal reconstruction with cervical fascia

In this paper we report our experience of vertical partial laryngectomy using the superficial cervical fascia; we describe the technique and present the functional and oncological results of this method of treatment. A total of 42 patients with squamous cell carcinoma of the true vocal folds, in stage T(1) (n = 28) or T(2) (n = 14), were treated in our department using vertical partial laryngectomy during the decade 1987-1997. Nine patients had post-operative radiotherapy. The shortest follow-up time was three years. There were six recurrences in all, four in the larynx and two in the neck. All four of the laryngeal recurrences were treated with total laryngectomy and are doing well. Both the patients with neck metastases, who were treated with neck dissection, died. Permanent tracheotomy was necessary in one patient. There were no problems with aspiration. The recurrence rate was 14 per cent, the three-year survival index was 95.2 per cent and the three-year larynx preservation index was 90 per cent. According to our experience, vertical partial laryngectomy, using the method we describe, has a good functional and oncological result for stage T(1) and T(2) tumours.     

Frontolateral vertical partial laryngectomy without tracheotomy for invasive squamous cell carcinoma of the true vocal cord: a 25-year experience

On the basis of an inception cohort of 270 patients with a previously untreated invasive squamous cell carcinoma of the true vocal cord (232 T N0M0, 35 T2N0M0, and 3 T3N0M0) and a minimum of 3 years of follow-up, the authors analyze the oncological and functional outcomes following frontolateral vertical partial laryngectomy without tracheotomy. The 5-year Kaplan-Meier actuarial survival estimate ranged from 83.1% for T1 tumors to 67.2% for T2 tumors (p = .005). On univariate analysis, a significant statistical relationship was noted between reduced survival and the following variables: increased age, increased Charlson comorbidity index score over grade 0, increased tobacco intake, increased alcohol intake, increased T stage, local failure, nodal failure, and development of a metachronous second primary cancer. The hospital mortality rate was 0.4%. A significant postoperative surgical complication was noted in 49 patients (18.1%). The predominant significant surgical complication was wound infection (19 patients; 7%), followed by seroma and major subcutaneous emphysema. No significant statistical relationship was noted in a comparison of each, significant postoperative complication (including postoperative death) with the variables under analysis. The incidence of secondary tracheotomy was 0.4%. The incidence of completion laryngectomy due to functional problems was 0%. The 5-year Kaplan-Meier actuarial local control estimate was 91% for T1 tumors and 68.7% for T2 tumors (p <.0001). Within the T1 tumors, the 5-year Kaplan-Meier actuarial local control estimate ranged from 96.2% for tumors without anterior commissure involvement to 74.7% for tumors with anterior commissure involvement (p = .0002). On univariate analysis, a significant statistical relationship was noted between an increase in local recurrence and the following variables: increased T stage, anterior commissure involvement, and pathological margin involvement. The overall disease control rate and laryngeal preservation rate were 92.9% and 93.3%, respectively.     

Diagnostic and treatment of lesions of the facial nerve after fractures of the temporal bone

The authors review functional late results of 47 cases of facial palsies due to otobasal fracture by considering the clinical and electrophysiological test results, seen between 1983 and 1988. There were 36 longitudinal, 5 transversal and 6 combined temporal bone fractures. 5 patients suffered from a bilateral facial paralysis. In all cases, an electrodiagnostic examination was carried out in order to determine the pronosis and to indicate a surgical exploration. The electrodiagnostic consisted in electromyographie (EMG) and electroneuromyographie (ENoG). 36 patients got a medical treatment and 6 patients were treated by surgery. All facial nerve paralyses (n = 28), that were incomplete according to the clinical examination as well as the electrophysiological tests, received a medical treatment which lead to good functional late results without exception. 19 facial nerve paralyses seemed to be complete in clinical examination, but in 11 cases electrodiagnostic tests revealed a residual volontary electrical activity. This indicated a conservative therapy with 7 good (66%) and 4 (33%) fair results. So, no poor result had been found in this group. In the other 8 cases, 4 of which had a delayed onset of the paralysis, no electrocal activity could be proved. 4 patients were treated by surgery, and in 2 cases a complete facial nerve transection was found. The reconstruction of the facial nerve led to 1 good and to 1 satisfactory result. In the other 2 cases, the decompression lead to 1 good and to 1 poor late result. In these 4 cases the facial nerve had been completely decompressed, in a combined transmastoidal and enlarged transtemporal middle fossa approach.(ABSTRACT TRUNCATED AT 250 WORDS)     

Critical study of dacryorrhinostomy (author's transl)]

Dacryorrhinostomy is a last-chance operation for severe palpebral and canalicular damage which can lead to loss of tissue. The reconstruction of a delicate tube remains a gamble because of the absence of normal structures. The multiplicity of the procedures proposed clearly demonstrates the difficulty in obtaining a functional result. The excellent results obtained with this procedure incited the authors to prolong their study and increase the number of cases in order to confirm the validity of their findings in a large series.     

Rehabilitation of facial paralysis by temporal muscle flap and implantation of gold weights

Facial paralysis is a severe disability that often produces major ocular disorders, cosmetic deformities, and, in many cases, functional incapacity for something as characteristic of human beings as facial expression. For these reasons, it is necessary to correct this defect as completely as possible to produce the best physiological result. Of the many methods available for the repair of the lesion, most authors agree that direct repair of the nerve is the most reliable technique. When this is not feasible, the use of gold weights for the eyelid and a temporalis muscle flap for the mouth are two easily realized methods that are reversible and produce good esthetic and functional results. As a result, this is the technique of choice for this disorder and it has the added advantage of being compatible with other procedures.     

Reconstruction after tumour's excision in lip's cancer: report of 100 cases

OBJECTIVE: Cancer of the lips is a frequent pathology, it represents 1/5 of cancers of the upper aerodigestive tract. Its objectives are to present the experience of the plastic and reconstructive surgery unit of the universitary hospital of Casablanca. MATERIAL AND METHOD: The authors present a retrospective study about 100 cases of lips cancer treated between January 1999 and December 2002. RESULTS: The average age is 59 years. The sex-ratio is 7.3. Eighty-five percent of our patients were smokers and 22% were alcoholics, the association alcoholic and smoker was found in 20%. In our study 71% were classified T1-T2 and 29% as T3-T4. The tumoral location was the lower lip in 82% and the upper lip in 10%. The histological study showed a squamous cell carcinoma type in 85% and a basal-cell carcinoma type in 14% of cases. After the tumour's excision, the reparation was done by cross-lip flap in 25%, the naso-lateral flap in 16% and the Gillies flap in 8%. The functional result was good in 92% of cases and the aesthetic result was excellent in 60% of cases and good in 30% of cases. The survival rate at 2 year was 90%. CONCLUSION: Actually, lip's cancer treatment is essentially surgical. The reconstructive techniques are various, depending on the size and location of the loss of substance.     

Reconstruction of the lower lip for sequelae of noma (author's transl)]

The authors present a case of reconstruction of the height of the lower lip for sequelae of probable noma in a 35-year-old Algerian. They used a bipediculated Dufourmentel flap. The morphological and functional result was satisfactory.     

The supracricoid laryngectomy with cricohyoidopexy. Carcinological and functional results. 23 cases report of the Centre A. Lacassagne (Nice)

OBJECTIVE: This study is to estimate the survival results, the morbidity and the functional consequences of the supracricoid laryngectomy with cricohyo?dopexy (SL-CHP). PATIENTS AND METHODS: Between 1990 and 2001, 23 patients had a SL-CHP in Centre Antoine Lacassagne of Nice. The average age was of 59 years. Patients were classified as follow: 1 T1, 11 T2, 10 T3 and 1 T4 (invasion of the thyroid cartilage without involving of anterior soft tissues). 17 patients were NO (73.9%). A bilateral radical neck dissection was performed in 10 cases, a radical neck dissection was associated to a functional neck dissection (1 case) and a homolateral functional neck dissection (10 cases). RESULTS: The limits were insufficient for a patient. Six patients were N+ (28.5%) of which 4 N+R+. The average delay was 21 days and 32.7 days to remove respectively the tracheotomy and the nasogastric tube. A functional total laryngectomy was done in two cases. We noted two cases of local recurrence. Survivals according to the method of Kaplan-Meier are 81% in 3 years and 75% in 5 years. CONCLUSION: The SL-CHP represents an alternative to the total laryngectomy for the supraglottic and transglottic carcinomas.     

Modifications in the vertical position of the stomion in facial osteotomies and osseous genioplasties

A retrospective statistical analysis is made on 45 patients who have undergone a facial osteotomy. The authors study the vertical changes of the stomion on pre- and post-operative lateral cephalograms. Considering the bad initial results, it has been necessary to create subdivisions on the surgical procedure and to work on homogeneous groups. The results of this study led to the following conclusions: the stomion follows the vertical displacement of the maxilla on an approximative ratio of 1/3, with rather great variations between the subjects; the functional osseous genioplasties, specially with vertical displacement, are not accompanied by significant vertical changes in the position of the stomion. Furthermore, it is obvious that it is necessary to use a "multivariable" method for a better prevision of the cutaneous changes after facial osteotomies, specially for the lips. Indeed, vertical soft tissue changes are the result of the interactions of many vertical and horizontal surgical squelettal displacements.     

Vertical extended hemi crico-laryngectomy and reconstruction with a prefabricated tracheal free flap--initial results

We describe our experiences of treating three patients with recurrent T3 squamous cell carcinoma of the larynx, following initial treatment with radiotherapy; using the technique of partial crico-laryngectomy and autologous pre-fabricated tracheal flap reconstruction as described in 1998 by Delaere (1). We have found the technique to be technically challenging. The patients require extensive speech and swallowing rehabilitation following surgery, but the functional result offers significant advantages over the other surgical salvage procedures of total or near-total laryngectomy. We describe our early results of three patients that we have treated using this technique.     

Cochlear implant and traumatic lesions secondary to electrode insertion

On the basis of data reported in the literature, the authors have attempted to define the relationship between the functional results of cochlear implants and possible traumatic damage caused by the insertion of electrodes and their support into the cochlear bony walls. These findings show that traumatic conditions result in functional damage only when they involve the body of Corti's ganglion cells or the central part of their axon, whereas functional results are not influenced by traumatic damage to the peripheral part of the axon. Traumatic damage sustained by other non-nervous structures and the inevitable fibrosis and subsequent bone metaplasia processes which occur when a foreign body penetrates a living organism also appear to be unimportant.     

Laser resection of T1a glottic carcinomas: results and postoperative voice quality

OBJECTIVES: To calculate recurrence, mortality and complication rates and evaluate postoperative voice quality after laser resection of T(1a) glottic carcinoma. MATERIAL AND METHODS: Since 1995 we have treated 118 patients with a T(1a) glottic carcinoma with laser surgery. In order to evaluate postoperative voice quality, patients who were alive and free of recurrence were sent the Voice Handicap Index (VHI) questionnaire containing 30 questions concerning how their voice affects their daily life physically, emotionally and socially. RESULTS: Twelve patients (10%) had a local recurrence and received further treatment, either a second laser treatment, radiotherapy or a total laryngectomy. One patient (0.84%) died due to the laryngeal cancer. Ninety-nine patients were sent the VHI questionnaire and 94 of the completed questionnaires were included in the study and analyzed. The mean total score was 13.2, with mean subscores of 6.5 (physical), 4.1 (functional) and 2.5 (emotional). CONCLUSIONS: The results indicate that these patients as a group do not consider that their voice has a negative impact on their daily life. Good surgical technique is essential to obtain a good functional result. The laser strength should be kept low and the surgical margins small in order to minimize scarring and vocal cord stiffness.     

人B7-1 cDNA的克隆及鉴定

［摘要］目的：克隆人B7 1全长cDNA以构建相应腺病毒表达载体。方法:根据B7 1基因序列设计并合成可扩增B7 1 cDNA的特异性引物，用RT PCR法从骨髓细胞总RNA中扩增B7 1 cDNA，并克隆至pGEM T载体中，经酶切鉴定后再行序列分析。结果: 逆转录多聚酶链反应扩增产物长度与预期的889 bp一致; 用M13正、反向引物行序列测定，证实克隆出的序列与GenBank的B7 1 cDNA序列完全一致; 人B7 1全长cDNA被成功地插入到质粒pGEM T中。结论: 克隆人B7 1全长cDNA为构建相应腺病毒表达载体及应用B7 1行肿瘤免疫基因治疗提供了可能性。     

Supracricoid laryngectomies: long-term oncological and functional results

CONCLUSIONS: Our results confirm that supracricoid laryngectomies (SL) are reliable techniques for glottosupraglottic tumors, even for selected T3 and T4 cases, if the indications are correct. These surgical techniques allow a good quality of life with the preservation of the larynx. OBJECTIVE: SL with cricohyoidoepiglottopexy (CHEP) and cricohyoidopexy (CHP) have been popular over the last 20 years for the treatment of the glottic and/or supraglottic squamous cell carcinoma due to demonstrated good oncological and functional results. We report our experience with these techniques, with special focus on long-term oncological and functional results. PATIENTS AND METHODS: We retrospectively reviewed 206 patients who had undergone SL with CHEP or CHP technique between 1987 and 1998 for glottosupraglottic squamous cell carcinoma in our department. The long-term results for 206 patients with T1-T4 laryngeal carcinomas treated with SL are reported: 90.8% CHEP and 9.2% CHP. The mean follow-up was 62 months. RESULTS: Oncological results: the 5-year actuarial disease-free survival was 85%; the 5-year determinate actuarial survival was 88.3%. Functional results: organ preservation rate was 97%. Phonation was assessed according to the GRBAS scale.     

Supraglottic laryngectomy. Still on-going

IntroductionHorizontal supraglottic laryngectomy (HSL) allows the preservation of a functioning larynx and avoids a permanent tracheostoma. Its use and training have been conditioned by the employment of organ preservation programs and endoscopic laser surgery.ObjectiveTo show functional and oncological long-term results of HSL.Material and method110 patients treated with HSL with a minimum of 5 years follow-up.ResultsLocal control, 89% for T1, 91% for T2, 80% for T3 and 91% for T4. Regional control 80.9%. Cause specific survival, 77.6%, 72.6% and 67% at 3, 5 and 10 years, significantly influenced by N-stage. Functional larynx preservation, 87%, with a 8.5% of non-decanulated patients.ConclusionHSL is a safe surgical procedure, with similar functional and oncological results to other therapeutic options. Its indications should be considered according to own experience and results.     

Supracricoid laryngectomies: Long-term oncological and functional results

Conclusions. Our results confirm that supracricoid laryngectomies (SL) are reliable techniques for glottosupraglottic tumors, even for selected T3 and T4 cases, if the indications are correct. These surgical techniques allow a good quality of life with the preservation of the larynx. Objective. SL with cricohyoidoepiglottopexy (CHEP) and cricohyoidopexy (CHP) have been popular over the last 20 years for the treatment of the glottic and/or supraglottic squamous cell carcinoma due to demonstrated good oncological and functional results. We report our experience with these techniques, with special focus on long-term oncological and functional results. Patients and methods. We retrospectively reviewed 206 patients who had undergone SL with CHEP or CHP technique between 1987 and 1998 for glottosupraglottic squamous cell carcinoma in our department. The long-term results for 206 patients with T1–T4 laryngeal carcinomas treated with SL are reported: 90.8% CHEP and 9.2% CHP. The mean follow-up was 62 months. Results. Oncological results: the 5-year actuarial disease-free survival was 85%; the 5-year determinate actuarial survival was 88.3%. Functional results: organ preservation rate was 97%. Phonation was assessed according to the GRBAS scale.     

Unusual case of a para- and retropharyngeal space tumor (cavernous haemangioma) obturating the laryngeal entry

The authors presents un unusual case of the para- and retropharyngeal space cavernous haemangioma displacing posterolateral wall of the pharynx to the laryngeal aditus. In the beginning tumor didn't cause any symptoms, but later life threatening dyspnea appeared. The surgical treatment with good anatomical and functional result is presented.