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Functional results after partial vertical laryngectomy
Horváth, Emília ; Élö, János
There is an increasing popularity of the organ sparing (OS) approaches to tumour treatment also in the head-neck (HN) surgery, as these methods at the same time aim to fulfill the requirements of ...radical approach in oncology, yetwith less aggressive surgery. Partial vertical laryngectomy (PVL) is a prefered OS method in the treatment of certain glottic malignancies. Patients soon get accustomed to their usual surroundings, but a significant deterioration of voice quality is unavoidable. In this work, we studied the act of swallowing and the effectiveness of voice therapy after PVL of various extents. Methods: Between 1986 and 1996, the authors performed 51 PVL-s, 16 chordectomies (3 with conventional surgery and 13 with laser) and 35 hemilaryngectomies of various extents for the treatment of T1-T2 glottic tumours. The act of swallowing was tested by videofluorography on the 7th postoperative day and 8 weeks after surgery. Phoniatric therapy started immediately after the wound was healed: exercises were identical to the accepted exercises for recurrent laryngeal nerve paresis. The patients were called for indirect and direct (flexible Faryngo-Naso-Laryngoscope r, PENTAX) laryngoscopic control every week. Voice quality parameters (phonatory duration, vocal range, fundamental speech frequency) were examined before starting and 8 weeks after phoniatric therapy. Voice recordings were spectrographically analyzed, too. Results: A marked aspiration was observed byvideofluorography in 61% (31/51) of the patients on the 7th postoperative day. The aspiration showed no correlation with the type of surgery. Eight weeks after surgery all patients could swallow satisfactorily without any functional disturbance. An improvement in voice quality was deteced 2-3 monthslater; the phonatory duration and vocal range were extended. In normal social conversations the voice was audible, yet more or less hoarse in spite of the voice therapy. (Abstract truncated at 2000 ch
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