[Voice rehabilitation after laryngectomy with the Provox voice prosthesis. Surgical and technical aspects. II].
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Aged↗
Biomedical subjects
F J Hilgers
Publications and source records attributed to F J Hilgers.
Scintigraphic assessment of salivary function and excretion response in radiation-induced injury of the major salivary glands.
BACKGROUND: Both loss of the secretory function and impairment of the excretion may play a role in radiation-induced injury of the major salivary glands after radiotherapy for head and neck malignancies. Therefore, quantitative 99mTc-pertechnetate (99mTc) salivary scintigraphy to assess trapping, secretion, and excretion, was used to analyze irradiation-induced changes in relation to the radiation dose and the time interval after radiotherapy. PATIENTS AND METHODS: Salivary scintigraphy was performed on 25 patients who had been irradiated to the neck and head for various malignancies with irradiation of the major salivary glands and in 6 nonirradiated patients. Excretion was induced by stimulation with carbachol (Carbacholum, Pharmachemie BV, Haarlem, The Netherlands). As a parameter for salivary glandular trapping and secretion, the cumulative 99mTc-pertechnetate glandular uptake in the first 12 minutes was used. Scintigraphic data were analyzed for each patient and for each individual gland at three radiation dose levels (range, 5-70 Gy), and at short (range, 2-7 months) and long (range, 10-50 months) intervals after radiotherapy. RESULTS: The excretion response to the stimulant carbachol was totally or partially disturbed in 84% of the irradiated patients. For individual glands, excretion was maintained in all glands irradiated with 25 Gy or less, in nearly half of the glands at doses of 25-45 Gy, and was almost invariably impaired at doses higher than 45 Gy, regardless of the time interval after radiotherapy. Although cumulative 99mTc glandular uptake tended to decrease at higher radiation dose levels (z = -3.059, P < 0.0022), at 45 Gy or more, cumulative 99mTc uptake was considerably higher in glands examined at a short postirradiation interval compared with glands examined after a long time interval (P = 0.0001). This tendency, seen for both parotid and submandibular glands, was not observed at doses lower than 45 Gy. CONCLUSION: These data suggest that in the first period after high dose irradiation, xerostomia is based predominantly on the failure of the gland to excrete saliva, whereas in the later period, a decreased trapping ability together with loss of secretory function play an additional role. Salivary scintigraphy using 99mTc-pertechnetate is a suitable method to assess radiation-induced salivary gland injury. The test is able to detect salivary glandular dysfunction in an early phase and may be useful to predict which patients will respond symptomatically to salivary stimulants.
Adolescent↗
Intracystic administration of Tc-99m colloid particles to study retention and drainage in lymphangioma of the neck.
The particular use of lymphoscintigraphy to document retention and drainage in cystic lymphangioma of the neck is reported. Radionuclide examination using Tc-99m colliod particles, performed before sclerosing treatment with tetracycline in a patient with a large lymphangioma located in the neck, demonstrated a satisfactory tumor retention and slow outflow, enabling the administration of tetracycline without (risk of) organ toxicity. The treatment was successfully performed.
Adult↗
Carcinoma of the soft palate and the posterior oropharyngeal wall.
Between 1966 and 1984, 14 patients with carcinoma of the soft palate and eight patients with a posterior oropharyngeal wall carcinoma were treated at the Netherlands Cancer Institute. In the soft palate group, the majority of patients (10) had small tumours T1-T2; the median patient delay was 1 month (range 0-5). Eleven patients were treated with radiotherapy and three with surgery, as single treatment modalities. Tumour control was achieved in 10 patients following initial treatment. Five-year results for tumour control and overall survival were 67% and 41%, respectively. In the posterior wall group all patients had advanced tumours (T3-T4), after a median patient delay of 4 months (range 0-6). Six patients were treated with radiotherapy, one with surgery only and one with a combination of these. Following the initial treatment, tumour control was achieved in half of the patients. Five-year tumour control was 50%, and overall survival at 5 years was 38%. In conclusion, the tumours in these two sub-sites of the oropharynx differ significantly in the extent of the primary tumour (P < 0.01), posterior wall tumours being more advanced on admission, after a significantly longer history (P < 0.01).
Adult↗
Lymph node metastases in the neck and parotid gland from an unknown primary melanoma.
A lymph node metastasis in the neck or parotid region from an unknown primary melanoma is an uncommon occurrence. Out of a total of 300 patients with head and neck melanoma treated at the Netherlands Cancer Institute between 1976 and 1992, 17 (5.7%) presented in this way. The most common site for metastatic lymph nodes (18 nodes in 17 patients) was level V (n = 7), followed by the parotid region (n = 4), level II (n = 4), level III (n = 2), and level IV (n = 7). Two patients had local excision of the neck node metastasis only, while the remaining 15 patients underwent more extensive surgical treatment. The 5-year disease-specific survival rate in this group was 48%, with a median survival of 36 months, which is more or less similar to the prognosis of stage II melanoma of the head and neck with a known, surgically treated primary tumour. No relation was found between disease-free interval and sex, the number of positive lymph nodes or the duration of symptoms.
Adult↗
Surgeon's workshop: changing the indwelling Provox tracheoesophageal voice prosthesis as an out-patient procedure. Clin. Otolaryngol. 18, 145-149.
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Ambulatory Surgical Procedures↗
Merkel cell carcinoma of the head and neck.
Merkel cell carcinoma is a rare cutaneous tumour that typically arises in the head and neck area of elderly patients. The tumour often follows an aggressive course with frequent local recurrences and (regional) metastases, especially when localized above the clavicles. Five patients with a Merkel cell carcinoma of the head and neck, treated in our institute since 1984, are presented, illustrating the need for radical initial treatment consisting of surgery and radiotherapy, and showing how rapidly progressive the disease can be. Four of the five patients were cured of disease by a combination of surgery and radiotherapy.
Aged↗
Communication, functional disorders and lifestyle changes after total laryngectomy.
Functional changes after total laryngectomy, including voice quality, hyposmia and dysgeusia, nasal discharge, swallowing and smoking habits were studied by means of a structured interview with 63 laryngectomized patients. Eighty per cent of the patients reported that they were satisfied with the quality of their voice including speaking on the telephone. Significant correlations were found between the quality of the voice and fatigue, frequency of making telephone calls and anxiety about speaking (P < 0.01). Vocal rehabilitation was achieved in the majority of patients (78%) with the indwelling Provox voice prosthesis. Forty-five per cent of the patients complained about annoying eructation. Hyposmia was reported by 52% of the patients, while 15% experienced dysgeusia. A significant correlation was found between hyposmia and dysgeusia (R = 0.43, P < 0.001). All patients with a taste problem also reported a poor sense of smell. Daily nasal discharge was reported by 38% of the patients. Due to difficulties in swallowing solid food, about one quarter of the patients changed their diet. All but one patient had been heavy smokers pre-operatively. Only 9% continued to smoke post-operatively. These results, along with the previously reported respiratory problems resulting from total laryngectomy, should be taken into account in counselling patients who are candidates for this surgical procedure.
Aged↗
Carcinoma arising in thyroglossal remnants.
Three patients with a papillary carcinoma arising in a thyroglossal duct cyst are presented and the literature is reviewed. This rare malignancy is seen mostly in women between the ages of 20 and 50 years. The distribution of carcinoma subtypes differs from that of thyroid carcinomas and thyroglossal duct carcinoma is recognized as a primary tumour. The diagnosis is seldom made pre-operatively though especially in older patients with midline swellings in the neck the diagnosis should be considered. Sistrunk's operation is the treatment of choice. In this operation the cyst, the middle part of the hyoid bone and the thyroglossal duct are removed in continuity.
Adult↗
Saccular mucocele in association with laryngeal cancer.
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Carcinoma, Squamous Cell↗
[Reconstructive surgery of the head and neck region using free muscle flaps].
Twenty-seven patients who underwent microvasculosurgical free tissue transfers for head and neck reconstruction with a M. rectus abdominis or M. latissimus dorsi flap are reviewed. In this series the flap reconstruction was completed in 15 patients with extraoral defects, in six patients with an intraoral defect and in six patients with a combined intra and extraoral defect. Split thickness skin graft coverage was used in all cases. All free muscle grafts survived and good take of the split skin was obtained. In extraoral defects coverage of free muscle transfer with split thickness skin grafts results in a better color match than with musculocutaneous flaps and complements the appearance and pliability of the free muscle flap. Reshaping and three-dimensional positioning made reconstruction of every intraoral defect and combined intra and extraoral defects possible. In skilled hands, free tissue transfer provides a reliable method for reconstruction of almost every defect in the head and neck.
Abdominal Muscles↗
Aerodynamic characteristics of the Provox low-resistance indwelling voice prosthesis.
The use of various prostheses for voice rehabilitation after total laryngectomy has become widely accepted in recent years. Two different types of prostheses can be distinguished: non-indwelling devices, which can be removed and replaced by the patient, and indwelling voice prostheses, which have to be removed and replaced by a physician. In this report we describe the in vitro measurement of the airflow dynamics of the recently developed Provox low-resistance, indwelling voice prosthesis. Airflows used in these experiments varied from 0.05 to 0.4 ls-1. With increasing flows, the trans-device air pressure against airflow rates increased from 0.28 kPa to 1.36 kPa, while the mean airflow resistance decreased from 5.6 to 3.4 kPa l-1 s-1. From these data and by comparison with data for other prostheses, the Provox voice prosthesis shows favorable airflow characteristics.
Humans↗
Radiotherapy of tonsillar and base of the tongue carcinoma. Prediction of local control.
119 patients with squamous cell carcinoma of the tonsillar region (68) and the base of the tongue (51), who received external radiotherapy with curative intent between 1966 and 1984, are analysed with respect to overall treatment results, local tumour control and prognostic factors. Radiation doses were equivalent to 60-70 Gy in 6-7 weeks, with a mean fraction dose of 2.4 Gy on the cobalt 60 equipment and 2 Gy on the linear accelerator. Significant differences were found between both oropharyngeal subsites. Three-year overall survival was 57% in tonsillar carcinoma and 38% in base of the tongue (P = 0.006); disease-specific survival was 70% and 47%, respectively (P = 0.005); and local control rates were 82% and 61% (P = 0.02). Late damage to normal tissues, like persistent dysphagia and osteomyelitis, were seen in 11% of patients. Patients with large tumours in the tongue based developed significantly more complications (P = 0.04). T-stage and tumour subsite predicted local control independently before start of the treatment (P = 0.02 in both cases). A significant nonlinear correlation between Normalised Total Dose (using an alpha/beta ratio of 15 Gy) and local control rate was found (P = 0.006), the middle range having the worst prognosis. The size of radiation field and overall treatment time did not correlate with local control in either site. Response at the end of radiotherapy and 6 weeks later have additional prognostic value for local control, irrespective of the initial stage or subsite (P = 0.004 and < 0.001, respectively).
Adult↗
Pectoralis major muscle transposition: an adjunct to laryngeal preservation in severe chondroradionecrosis.
Radiation-induced chondronecrosis of the larynx in early glottic cancer is a rare but serious complication, sometimes requiring total laryngectomy. We describe two patients who developed the major complication of chondroradionecrosis of the larynx 11 and 18 years after completion of radiotherapy. Both cases underwent excision of the overlying skin and of all infected and devitalized thyroid cartilage, followed by pectoralis major muscle transposition and split thickness skin grafting. This procedure resulted in a preservation of all laryngeal functions and also an acceptable cosmetic outcome.
Adult↗
Malignant schwannoma of the parapharyngeal space in von Recklinghausen's disease: a case report and review of the literature.
Neurofibromatosis (NF) or von Recklinghausen's disease is frequently accompanied by malignant tumours, which can occur at any site in the body. These malignancies are mainly of soft tissue origin. Of all head and neck malignancies, the number of soft tissue sarcomas is limited and in combination with NF this type of tumour is a rare event. In this report we describe the clinical course of a young female patient with NF, who presented with a massive malignant schwannoma in the parapharyngeal space, and review the pertinent literature.
Adolescent↗
Squamous cell carcinoma of the tonsillar region and the base of the tongue: a morphological and immunohistochemical comparative pilot study.
Sixteen squamous cell carcinomas of the tonsillar region and 13 carcinomas of the base of the tongue were studied in a search for significant differences between the tumours of these two oropharyngeal subsites, which are known to carry a significantly different prognosis. The characteristics of the tumour cells and the tumour-host relationship were scored on H & E-stained slides, as well as on slides stained with a panel of antibodies. The results obtained were cross-tabulated and analysed with respect to the subsite. Ten variables were tested: cytonuclear pleomorphism, mitotic activity, the presence of atypical mitoses, keratinization, tumour grade, presence of eosinophils, severity of inflammatory response, and the expression of keratin-10, blood group antigens and collagen IV. When split up by site, only cytonuclear pleomorphism revealed a significant difference, tonsillar carcinomas more often exhibiting marked pleomorphism (p = 0.04). Despite having some prognostic relevance for squamous cell carcinomas of the head and neck, the variables tested could not provide an explanation for the difference in biological behaviour of the tumours studied.
Adult↗
[Uni- and multivariate analysis of prognostic factors in T3 laryngeal cancers].
In 511 patients with T3N0-3M0 laryngeal carcinoma, 24 possible prognostic factors were analysed retrospectively. The factors were age, sex, mode of treatment, duration of several clinical symptoms, the presence of sore throat, otalgia, dyspnoea, and dysphagia, previous tracheotomy, tumour extension, lymph node status (five items), histologic grading, smoking habits, and alcohol intake. For 300 patients in whom surgery was part of the primary treatment, pathologic staging of the primary tumour and of lymph nodes in neck dissection specimens, cartilage invasion, radicality of the operation, differentiation grade, and subglottic extension were also evaluated. Univariate analysis revealed prognostic significance on survival for tumour extension (limited to the glottic region), lymph node status (clinically palpable lymph nodes, cytologically confirmed positive lymph nodes), level of lymph node metastasis (high and midjugular site), histologic grading (poor differentiation grade), and treatment modality (planned combined therapy). In the group that underwent surgery, all factors derived from specimens of the larynx and neck dissections had prognostic significance. Multivariate analysis revealed that the glottic site of the tumour, the presence of cyto- and histopathologically proven metastatic lymph nodes, pretreatment tracheotomy, positive resection margins, and planned combined treatment had a significant influence on corrected actuarial survival.
Adult↗
Ploidy status and the response of T1 glottic carcinoma to radiotherapy.
Flow cytometric DNA ploidy measurements were performed on formalin fixed paraffin embedded tumour specimens from patients with a T1 glottic laryngeal carcinoma in order to evaluate the role of DNA content in relation to local control. From 1980 to 1987, a consecutive series of 90 patients with a T1 glottic laryngeal carcinoma were treated by radiotherapy with curative intent. Biopsies from 44 of these patients were readily available for DNA flow cytometry. In this group aneuploidy was associated with a significantly higher risk (P = 0.018) of local recurrence within 2 years after completion of radiotherapy (38% vs. 9% in the diploid group).
Aged↗