Vol.96 No.2 contentsPRACTICA OTO-RHINO-LARYNGOLOGICA
Vol. 96 No. 2 February 2003
Total Laryngectomy for Misswallowing in
Patients with Advanced Disease
Takeshi Akisada, Tamotsu Harada, Shigeo Hirai,
Hisaki Fukushima and Katsumi Masuda
(Kawasaki Medical School)
Over the past 9 years, total laryngectomy was performed on 12 patients advanced disease involving misswallowing after full discussion with the rehabilitation department. The patients were 10 men and 2 women aged 56 to 83 years (mean 71.1 years). The primary disease was cerebrovascular disorder in 7 cases, the post-treatment of head and neck carcinoma in 3, postoperative lung carcinoma in 1 and post generalized burn in 1. Aspiration pneumonia was observed preoperatively in 10 patients, 9 of whom had multiple episodes. All patients had undergone tracheotomy and found it difficult to speak. The duration of illness ranged from 5 months to 15 years. The surgery was simple total laryngectomy through a cervical median incision. The average duration of surgery was about 2 hours and 34 minutes. The average volume of blood loss during surgery was 131.5 ml and there were no complications noted intraoperatively. Except for one patient who was transferred to another hospital, all the patients were postoperatively capable of oral ingestion and 8 of them were able to take rice gruel, achieving the operative goal. The patients' satisfaction with surgery in response to a questionnaire was favorable. Total laryngectomy is a surgical procedure that should considered in severely ill patients with advanced vocal and speech dysfunction complicated by misswallowing.
Key words : total laryngectomy, misswallowing, questionnaire