[Considerations on bilateral neck dissection in laryngeal neoplasms].
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The author discusses his long-term experience which suggests that the term of reconstruction surgery following removal of maxillofacial and laryngeal malignancies should be determined in each particular case. Moreover, primary and early reconstruction should be carried out only after removal of localized stage I and II neoplasms and small-size recurrences. Primary reconstruction may be indicated to close cervical neurovascular fascicle, brain tissues, etc., to avoid fatal outcome. Otherwise, reconstruction surgery should be performed at later terms-- 8--12 months or more after removal of tumor, because by this time the latent period of recurrences and metastases, if they occur, is over and general biological and reparative processes come back to normal after radiation and chemotherapy.
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Swallowing disorders due to oro-pharyngo-laryngeal cancer, or due to the consequences of surgical resection and radiotherapy, should be accurately evaluated to manage properly both nutritional therapy and dysphagia rehabilitation techniques. The site, size, and local spread of such tumors and, especially, the nature and extent of surgical resection and reconstruction, are important factors which are closely related to the functional disorders of deglutition. The aim of this paper is to demonstrate video-fluoroscopy capability to evaluate the incidence, type, and severity of such functional disorders. For this purpose we studied by means of dynamic radiology 23 patients with oral cancer and 33 patients with pharyngeal-laryngeal cancer, most of them after surgical and/or radiological treatment. Eighty-four per cent of the patients had swallowing disorders such as poor oral processing (25%), retention of the bolus in the pharynx (41%), penetration (41%) or aspiration (37%) of the bolus in the airway, dysmotility of upper esophageal sphincter (9%), and structural lesions (61%). The association of these functional disorders was closely related to the pathological background of each patient. In conclusion, a dynamic radiological study is recommended for both pre and postoperative evaluation of these patients, to choose the appropriate nutritional therapy and dysphagia rehabilitation technique.
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