Riabilitazione vocale post laringectomia con voce protesica: 15 anni di esperienza della Clinica Otorinolaringoiatrica dell’Università di Catania. Analisi retrospettiva dei dati e revisione della letteratura

Abstract

L’obiettivo dello studio è stato quello di riportare 15 anni di esperienza, nel territorio Siciliano, con l’utilizzo della voce protesica (VP), analizzando le differenti variabili che hanno influenzato il successo o il fallimento riabilitativo vocale. L’analisi clinica retrospettiva è stata condotta revisionando le storie cliniche di 95 pazienti affetti da carcinoma laringeo, nei quali una protesi vocale era stata posizionata a mezzo di una puntura tracheoesofagea tra il 1998 e il 2013. Età, tipologia neoplastica, tipo di chirurgia, utilizzo di radioterapia, complicanze e cause di successo o fallimento protesico riabilitativo erano analizzate. I risultati hanno mostrato una Harrison-Robillard- Schultz (HRS) TEP rating scale media di 11,8 in TEP primaria e di 12,6 in TEP secondaria (P =0,613). PORT non ha influito sul successo riabilitativo globale. In questi pazienti l’HRS media è stata di 11.2 in primaria e 12 in TEP secondaria (P =0,648). Complessivamente, il successo a lungo termine è stato 87,5%, con 84% in primaria e 91% in TEP secondaria. I risultati ottenuti dall’analisi retrospettiva su 15 anni di attività protesico riabilitativa condotta nel territorio siciliano hanno evidenziato un elevato standard riabilitativo, in termini di complicanze intra e postoperatorie, patologia fistolo correlata e successo riabilitativo globale.

Patterns of alaryngeal voice adoption and predictive factors of vocal rehabilitation failure following total laryngectomy

“…The proportion of patients who ultimately failed to acquire any form of verbal communication following laryngectomy (41.0%) in this study differs substantially from reported proportions in the literature (5%-15%). [16][17][18][19][20] Explanations for this variation can be identified by examining methodological differences between studies. As a matter of fact, there is currently no universally accepted criterion that can be used to evaluate the success or failure of vocal rehabilitation.…”

“…Despite the multitude of options available today for postoperative vocal rehabilitation (VR), voice restoration following TL is not always successful. Even in specialized centers, approximately 5%–15% of laryngectomized patients never develop functional verbal communication following the procedure 16–20 . For these patients, a definitive solution remains to be found.…”

“…Even in specialized centers, approximately 5%-15% of laryngectomized patients never develop functional verbal communication following the procedure. [16][17][18][19][20] For these patients, a definitive solution remains to be found. However, progress may still be facilitated by the early recognition and prompt management of detrimental factors and barriers to speech acquisition.…”

Tissue augmentation treatment for periprosthetic leakage in patients who have undergone a total laryngectomy: A systematic review

“…This can be a serious complication resulting in leakage of food, fluid or saliva around the prosthesis into the airway, reported in 7%–42% of patients with TEP 8,9 . There is controversy regarding the factors that could influence the development of this type of leakage 8,10–13 . Apart from individual predisposition, various factors have been discussed in the literature including local inflammatory responses in the region of the fistula, atrophy of the tracheoesophageal wall as a late effect of preoperative or postoperative radiotherapy or chemoradiotherapy, the VP diameter or weight, the timing of VP puncture, the VP insertion, the patient's nutritional status, the patient's length of follow‐up, a continuing history of tobacco exposure, the gastroesophageal reflux, a microbial colonisation the gastroesophageal reflux, a microbial colonisation, an extensive laryngopharyngeal resection and postoperative stricture, or the presence of conditions that have previously been proposed in the literature as predisposing factors that could affect the duration of VP (e.g., diabetes, hypertension, lymph node metastases, thyroid dysfunction, or tumour recurrence).…”

Subtotal laryngectomy with formation of a laryngotracheal shunt in vocal rehabilitation of patients with stage III and IV locally advanced larynx and laryngopharynx cancer (literature review)

“…По результатам многочисленных исследований, главные преимущества голосового протезированиякороткий срок реабилитации и возможность достичь высокого качества звучной речи. Вместе с тем этот метод имеет ряд недостатков: необходимость частой замены протеза (каждые 3-6 мес), аспирация слюны и пищи (до 75 %), микобактериальное инфицирование протезного клапана [19].…”