Improving the functional outcome of Tucker's reconstructive laryngectomy.
BACKGROUND
The goal of reconstructive laryngectomy addressing glottic carcinoma, as described by Tucker, is twofold: achieve local control and preserve as much as possible the physiological laryngeal function.


METHODS
The study consisted of long-term assessment of oncological, deglutitory, and vocal outcome in 34 patients following Tucker's reconstructive laryngectomy. Postoperative follow-up included fiberscopic examination, videoradiography, and voice assessment after speech rehabilitation.


RESULTS
The 5-year overall survival rate was 92% +/- 5%. Fiberscopic examination and videoradiography contributed to observing and understanding the rehabilitation process and impairment to its progress. Two main compensatory movements were identified: the anticipatory backward movement of the tongue base (50%) and the anticipatory upward laryngeal motion (15%). Both movements occurred simultaneously at the beginning of the pharyngeal stage of the swallow (35%). The median duration prior to tracheostomy tube removal was 14 days. Swallowing of solids resumed on day 9 (median), and liquid intake (water and soup) resumed on day 12 (median). The median duration of hospitalization was 16 days. Following speech rehabilitation, the latest follow-up visit measured as follows: the mean conversational voice intensity at 64 dB (range, 57-79 dB); the mean maximum intensity at 87 dB (range, 78-96 dB); the minimum intensity at 54 dB (range, 45-65 dB); the mean maximum phonation time at 16 seconds (range, 10-29 seconds); and the mean phonation quotient at 284 mL/second (range, 205-341 mL/second). According to our classification, voice spectral analysis revealed 19 class-III patients, 12 class-II patients, and three class-I patients.


CONCLUSIONS
Tucker's reconstructive laryngectomy is reliable in terms of both the oncological and functional outcome. Fiberscopic examination and videoradiography are two complementary methods for assessing postoperative deglutition.
Lawson
G
G
Department of ENT - Head and Neck Surgery, Louvain University Hospital at Mont-Godinne, B-5530 Yvoir, Belgium.
Jamart
J
J
Remacle
M
M
D000328:Adult; D000368:Aged; D003679:Deglutition; D005931:Glottis; D006801:Humans; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000601:surgery*; D007825:Laryngectomy; D007902:Length of Stay; D008875:Middle Aged; D019647:Oral Surgical Procedures; D019651:Plastic Surgery Procedures; D016896:Treatment Outcome; D014833:Voice Quality