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Multidisciplinary guidelines for the management of tracheostomy and laryngectomy airway emergencies.Anaesthesia Sep 2012Adult tracheostomy and laryngectomy airway emergencies are uncommon, but do lead to significant morbidity and mortality. The National Tracheostomy Safety Project... (Meta-Analysis)
Meta-Analysis
Adult tracheostomy and laryngectomy airway emergencies are uncommon, but do lead to significant morbidity and mortality. The National Tracheostomy Safety Project incorporates key stakeholder groups with multi-disciplinary expertise in airway management. , the Intensive Care Society, the Royal College of Anaesthetists, ENT UK, the British Association of Oral and Maxillofacial Surgeons, the College of Emergency Medicine, the Resuscitation Council (UK) the Royal College of Nursing, the Royal College of Speech and Language Therapists, the Association of Chartered Physiotherapists in Respiratory Care and the National Patient Safety Agency. Resources and emergency algorithms were developed by consensus, taking into account existing guidelines, evidence and experiences. The stakeholder groups reviewed draft emergency algorithms and feedback was also received from open peer review. The final algorithms describe a universal approach to managing such emergencies and are designed to be followed by first responders. The project aims to improve the management of tracheostomy and laryngectomy critical incidents.
Topics: Adult; Airway Management; Algorithms; Child; Device Removal; Emergency Medical Services; Equipment Design; Humans; Laryngectomy; Oxygen Inhalation Therapy; Patient Safety; Respiration; Societies, Medical; Suction; Tracheostomy; United Kingdom
PubMed: 22731935
DOI: 10.1111/j.1365-2044.2012.07217.x -
The Laryngoscope Apr 2023To examine the relationship between surgeon volume and operative morbidity and mortality for laryngectomy.
OBJECTIVE
To examine the relationship between surgeon volume and operative morbidity and mortality for laryngectomy.
DATA SOURCES
The Nationwide Inpatient Sample was used to identify 45,156 patients who underwent laryngectomy procedures for laryngeal or hypopharyngeal cancer between 2001 and 2011. Hospital and surgeon laryngectomy volume were modeled as categorical variables.
METHODS
Relationships between hospital and surgeon volume and mortality, surgical complications, and acute medical complications were examined using multivariable regression.
RESULTS
Higher-volume surgeons were more likely to operate at large, teaching, nonprofit hospitals and were more likely to treat patients who were white, had private insurance, hypopharyngeal cancer, low comorbidity, admitted electively, and to perform partial laryngectomy, concurrent neck dissection, and flap reconstruction. Surgeons treating more than 5 cases per year were associated with lower odds of medical and surgical complications, with a greater reduction in the odds of complications with increasing surgical volume. Surgeons in the top volume quintile (>9 cases/year) were associated with a decreased odds of in-hospital mortality (OR = 0.09 [0.01-0.74]), postoperative surgical complications (OR = 0.58 [0.45-0.74]), and acute medical complications (OR = 0.49 [0.37-0.64]). Surgeon volume accounted for 95% of the effect of hospital volume on mortality and 16%-47% of the effect of hospital volume on postoperative morbidity.
CONCLUSION
There is a strong volume-outcome relationship for laryngectomy, with reduced mortality and morbidity associated with higher surgeon and higher hospital volumes. Observed associations between hospital volume and operative morbidity and mortality are mediated by surgeon volume, suggesting that surgeon volume is an important component of the favorable outcomes of high-volume hospital care. Laryngoscope, 133:834-840, 2023.
Topics: Humans; Laryngectomy; Hypopharyngeal Neoplasms; Treatment Outcome; Hospitals, High-Volume; Surgeons; Postoperative Complications
PubMed: 35634691
DOI: 10.1002/lary.30229 -
Respiratory Research Feb 2023Severe dysphagia can cause intractable pneumonia and lead to life-threatening conditions. Intractable aspiration can occur despite medical management for aspiration... (Review)
Review
BACKGROUND
Severe dysphagia can cause intractable pneumonia and lead to life-threatening conditions. Intractable aspiration can occur despite medical management for aspiration prevention. Surgical intervention is indicated for intractable aspiration to prevent potentially life-threatening complications. Since the 1970s, several surgical treatments to prevent aspiration have been reported, and various aspiration prevention surgeries have been introduced, but little is known about them or their benefits. This is a review of the types of aspiration prevention surgery, with the aim of increasing aspiration prevention surgery awareness and their clinical outcomes among medical professionals, which will guide the choices of aspiration prevention surgeries for patients with intractable aspiration.
MAIN BODY
Aspiration prevention surgeries can be categorized into three according to their approaches: removal of the larynx, altering the structure of the trachea, and closure of the larynx. Aspiration prevention surgeries to remove the larynx include total and central-part laryngectomy. Aspiration prevention surgeries to alter the structure of the trachea include tracheoesophageal diversion, laryngotracheal separation, and the tracheal flap method. Surgeries to close the larynx can be divided into supraglottic laryngeal closure, glottic laryngeal closure, and subglottic laryngeal closure. Aspiration prevention surgeries prevent aspiration and increase oral intake in 50-80% of patients. Most patients lose vocal function after aspiration prevention surgeries; however, some patients who have undergone total laryngectomy or laryngotracheal separation restored their speech function through tracheoesophageal puncture and use of voice prosthesis. Postoperative suture failure is frequent after epiglottic flap closure and total laryngectomy but rare after central-part laryngectomy, laryngotracheal separation, glottic closure, and subglottic closure. Furthermore, aspiration prevention surgeries improve the quality of life of patients and their caregivers by decreasing suctioning frequency.
CONCLUSIONS
In this review, we described the history and development of aspiration prevention surgeries. Medical professionals need to continually improve their knowledge and skills to facilitate appropriate aspiration prevention surgeries according to patient condition.
Topics: Humans; Quality of Life; Pneumonia, Aspiration; Trachea; Larynx; Laryngectomy; Retrospective Studies
PubMed: 36747240
DOI: 10.1186/s12931-023-02354-0 -
Journal of Voice : Official Journal of... Jan 2020The larynx is a complex organ which has a role in a variety of functions such as phonation, breathing, and swallowing. To research these functions, it is widely accepted... (Review)
Review
The larynx is a complex organ which has a role in a variety of functions such as phonation, breathing, and swallowing. To research these functions, it is widely accepted that in vivo studies provide more anatomically and physiologically relevant findings. However, invasive procedures are generally needed to measure variables such a subglottal pressure, vocal fold tension and stiffness, and cricothyroid muscle stretch. Performing studies using excised larynges is a useful technique which makes it possible to not only measure phonation parameters but control them as well. Early studies using excised larynges mainly focused on controlling specific parameters and mathematical modeling simulations. The use of these studies has helped further research in laryngeal anatomy, imaging techniques, as well as aerodynamic, acoustic, and biomechanical properties. Here, we describe the progress of this research over the past 5 years. The number of accepted animal models has increased and ideas from excised larynx studies are starting to be applied to treatment methods for laryngeal disorders. These experiments are only valid for an excised situation and must continue to be combined with animal experimentation and clinical observations.
Topics: Animals; Biomechanical Phenomena; Computer Simulation; Humans; Laryngectomy; Larynx; Models, Animal; Models, Theoretical; Phonation
PubMed: 30262190
DOI: 10.1016/j.jvoice.2018.07.023 -
La Clinica Terapeutica Jul 2021Laryngeal squamous cell carcinoma (LSCC) is the most common malignant neoplasms of the head and neck. Several treatment options exist for LSCC according to cancer... (Comparative Study)
Comparative Study Review
Laryngeal squamous cell carcinoma (LSCC) is the most common malignant neoplasms of the head and neck. Several treatment options exist for LSCC according to cancer location and stage at diagnosis; proposed treatments include surgery alone or in combination with chemotherapy and radiotherapy. In selected LSCC cases in the T2-T4 staging, supracricoid laryngectomy (SCL) is an organ-sparing surgical approach aimed at preserving the main laryngeal functions that has been proposed as an alternative to total laryngectomy. Rehabilitation for swallowing and respiratory functions plays a central role after SCL; functional outcomes after SCL may significantly vary among different centers but they are generally satisfactory when oncological radicality has been obtained and the rehabilitation protocol starts promptly. In this clinical review, we analyzed functional outcomes for swallowing and voice rehabilitation in patients after SCL, as well as the optimal SCL surgical technique, post-operative complications and comparison with total laryngectomy or radio-chemotherapy protocols.
Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Female; Humans; Laryngeal Neoplasms; Laryngectomy; Male; Middle Aged; Postoperative Complications; Rehabilitation; Treatment Outcome
PubMed: 34247220
DOI: 10.7417/CT.2021.2341 -
International Journal of Surgery... Mar 2022Although guidelines indicate that thyroidectomy should be performed routinely during total laryngectomy in patients with advanced laryngeal cancer, its clinical... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Although guidelines indicate that thyroidectomy should be performed routinely during total laryngectomy in patients with advanced laryngeal cancer, its clinical indications remain controversial. Some researchers believe that thyroid invasion is uncommon and that thyroid preservation should be considered in most cases.
OBJECTIVE
This study aimed to identify the incidence and predictors of thyroid invasion in patients with laryngeal cancer to facilitate decision-making regarding whether to perform thyroidectomy during total laryngectomy.
MATERIALS AND METHODS
The author conducted a systematic review and meta-analysis of all published articles retrieved from a search of the MEDLINE (1982-2020) and EMBASE (1971-2020) databases. The published studies of advanced laryngeal cancer with total laryngectomy and partial or total thyroidectomy for laryngeal cancer were selected. The incidence and predictors of thyroid invasion were analyzed.
RESULTS
We analyzed 25 studies (2177 cases), of which 176 people (8.08%) had thyroid invasion. Subglottic tumors (odds ratio [OR], 3.74; 95% CI, 1.75-7.99), T4 stage tumors (OR, 2.39; 95% CI, 1.20-4.75), subglottic extension (OR, 3.85; 95% CI,2.09-7.11), and thyroid cartilage invasion (OR, 3.98; 95% CI, 1.47-10.75) are risk factors for thyroid invasion, and no statistically significant difference was noted between recurrent tumor and thyroid invasion.
CONCLUSION
The risk of thyroid invasion was significantly higher when advanced laryngeal cancer involved subglottic tumors, T4 stage tumors, subglottic extension, and thyroid cartilage invasion. The overall incidence of thyroid gland invasion was low; therefore, thyroidectomy may be performed for cases deemed risky rather than as a routine measure of total laryngectomy. RESEARCH REGISTRY UIN: reviewregistry1226.
Topics: Carcinoma, Squamous Cell; Humans; Laryngeal Neoplasms; Laryngectomy; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Retrospective Studies; Thyroid Gland; Thyroid Neoplasms; Thyroidectomy
PubMed: 35172203
DOI: 10.1016/j.ijsu.2022.106262 -
Brazilian Journal of Otorhinolaryngology 2020Supratracheal laryngectomy has been described as a surgical procedure for glottic or supraglottic cancer extending to the subglottic region and/or involving the...
INTRODUCTION
Supratracheal laryngectomy has been described as a surgical procedure for glottic or supraglottic cancer extending to the subglottic region and/or involving the cricoarytenoid joint, aiming to preserve laryngeal function (breathing, phonation and swallowing), without diminishing locoregional cancer control. The choice of supracricoid laryngectomy in these cases could result in a high risk of compromised resection margins.
OBJECTIVE
To determine the safety, viability, adequacy of surgical margins and the supratracheal laryngectomy results for intermediate and advanced laryngeal cancer by reviewing the results at three different institutions in Brazil.
METHODS
This is a retrospective study that analyzed the charts of 29 patients submitted to supratracheal laryngectomy from October 1997 to June 2017. The type of laryngectomy performed was classified according to the European Laryngological Society classification for horizontal laryngectomies. Early and late results were evaluated. Survival rates (overall, specific, disease-free and total laryngectomy-free survival) were calculated. The mean follow-up time was 44 months.
RESULTS
Of the 29 patients submitted to supratracheal laryngectomy, 25 had no previous treatment. One patient (3.4%) had compromised margins. Four patients (13.8%) had recurrence. Of these, three had local recurrence and one had regional recurrence. Five patients (17.2%) required a total laryngectomy, two due to ruptured pexy and three due to local recurrence. Four of these patients (80%) achieved a successful total procedure. Four patients (13.8%) died, two due to postoperative complications and two due to recurrence. Overall, specific, disease-free and total laryngectomy-free survival at 5 years were, respectively, 82.1%; 88.2%; 83.0% and 80.2%.
CONCLUSION
Selected patients with intermediate and advanced laryngeal cancer may benefit from supratracheal laryngectomy, that resulted in total laryngectomy-free survival and specific survival of 80.2% and 88.2%, respectively.
Topics: Brazil; Humans; Laryngeal Neoplasms; Laryngectomy; Neoplasm Recurrence, Local; Retrospective Studies; Treatment Outcome
PubMed: 31175040
DOI: 10.1016/j.bjorl.2019.04.004 -
BMC Research Notes Dec 2023Total laryngectomy (TL) is a complex procedure, and patients undergoing TL are at high risk for readmission, which exposes them to hospital-acquired complications....
BACKGROUND
Total laryngectomy (TL) is a complex procedure, and patients undergoing TL are at high risk for readmission, which exposes them to hospital-acquired complications. Readmission rate is a metric for quality of care. We aimed to identify the rate, causes, and predictors of hospital readmission within 60 days after discharge following TL.
METHODS
This is a 12-year retrospective study where we included all patients undergoing TL in a single tertiary care center between 2008 and 2022. Patient charts were reviewed for demographics, comorbidities, and causes for readmission.
RESULTS
Of 83 patients who underwent TL, 12 (14.50%) were readmitted within 60 days. Common causes were surgical site infection (33.33%) and mucocutaneous fistula (25%). Significant predictors for readmission were tobacco use (P = 0.003), African ethnicity (P = 0.004), being unmarried (P < 0.001), lower preoperative serum albumin (P < 0.001), higher preoperative TSH (P = 0.03), higher preoperative neutrophil count (P = 0.035), higher American Society of Anesthesiology (ASA) score (P = 0.028), and higher Cumulative Illness Rating Scale (CIRS) score (P = 0.029).
CONCLUSION
One in every seven patients were readmitted following TL. Frequent causes include wound infection and fistulas. Predictors include preoperative hypoalbuminemia, hypothyroidism, African ethnicity, being unmarried, tobacco use, and a higher baseline burden of comorbidities. Such factors can be targeted to reduce hospital readmission rates.
Topics: Humans; United States; Laryngectomy; Patient Readmission; Retrospective Studies; Risk Factors; Surgical Wound Infection; Postoperative Complications
PubMed: 38124147
DOI: 10.1186/s13104-023-06645-z -
European Annals of Otorhinolaryngology,... Jan 2023
Topics: Humans; Anniversaries and Special Events; Laryngectomy
PubMed: 36404207
DOI: 10.1016/j.anorl.2022.10.006 -
European Annals of Otorhinolaryngology,... Nov 2020
Topics: Humans; Laryngectomy
PubMed: 31982360
DOI: 10.1016/j.anorl.2019.06.002