OBJECTIVE ASSESSMENT OF COMBINED SOFT TISSUE FLAP IN DEFECT REPAIR OF LARYNGEAL CARCINOMA OPERATION_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SUNFenglin , YUHaiyang , XUHuijuan , XURong , WANGHaipeng , XIAYongjun ,  WANGHuizhong

Department of Otorhinolaryngology, Central Hospital of Zibo, Zibo Shandong, 255031, P. R. China;

Corresponding author：

WANGHuizhong, Email: zbwhz1216@163.com

Keywords：

Glottic carcinoma; Partial laryngectomy; Laryngeal defect repair; Acoustic analysis; Glottic morphology

DOI：

10.7507/1002-1892.20140243

Video：

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Objective To objectively evaluate the effectiveness of the ventricular fold pull-down combined with strip myofascial flap to repair laryngeal defect after early glottic carcinoma operation with glottic morphological parameters and voice parameters. Methods Between January 2008 and December 2012, 47 patients with early glottic carcinoma and anterior commissure involvement underwent partial laryngectomy. All patients were male, aged from 60 to 75 years (mean, 68.5 years). The disease duration was 4-11 months (mean, 7.2 months). According to American Joint Committee on Cancer (AJCC) TNM criteria, 28 cases were classified as T_1aN₀M₀, 14 cases as T_1bN₀M₀, and 5 cases as T₂N₀M₀. Laryngeal defect after resection of tumor was repaired by ventricular fold pull-down combined with strip myofascial flap. At 1 day before operation and at 1 year after operation, multilayer spiral CT was used to scan larynx, to measure and compare the anteroposterior diameter of vocal area, the distance between both sides of the vocal process, and the thickness of soft tissue of vocal area, and the effect of combined soft tissue flap was objectively assessed in laryngeal morphology reconstruction. The actual voice parameters[including F₀, Jitter, Shimmer, normalized noise energy (NNE), and maximum phonatory time (MPT)] were tested and compared, and the effect of the combined soft tissue flap on postoperative laryngeal pronunciation was evaluated. Results Postoperative pathological examination revealed well-differentiated squamous cell carcinoma in 38 cases, and moderately-differentiated squamous cell carcinoma in 9 cases; no tumor was found in the resection margin. Healing of neck incision was obtained in all patients at 7-9 days after operation. Forty-four cases were decannulated at 9-11 days after operation and the remaining 3 cases were decannulated at 3 weeks after operation. Oral feeding usually started in all cases at 3-4 days after operation. All patients were followed up 1 year. At 1 year after operation, the anteroposterior diameter of vocal area was significantly reduced when compared with preoperative one (t=15.161, P=0.000); the distance between both sides of the vocal process and the thickness of soft tissue of vocal area had no significant changes (P > 0.05). Compared with preoperative ones, there were significant differences in Shimmer, NNE, and MPT (P < 0.05), but no significant difference was found in F₀ and Jitter (P > 0.05) at 1 year after operation. Conclusion Ventricular fold pull-down combined with strip myofascial flap can repair laryngeal defect effectively after partial laryngectomy and maintain the effective airway after operation. It not only has no effect on postoperative laryngeal morphology, but also can be used as new laryngeal voice vibration body.

Citation： SUNFenglin, YUHaiyang, XUHuijuan, XURong, WANGHaipeng, XIAYongjun, WANGHuizhong. OBJECTIVE ASSESSMENT OF COMBINED SOFT TISSUE FLAP IN DEFECT REPAIR OF LARYNGEAL CARCINOMA OPERATION. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(9): 1115-1119. doi: 10.7507/1002-1892.20140243 Copy

1.	Lucioni M, Bertolin A, Rizzotto G, et al.CO₂ laser surgery in elderly patients with glottic carcinoma:Univariate and multivariate analyses of results.Head Neck, 2012, 34(12):1804-1809.
2.	Higgins KM.What treatment for early-stage glottis carcinoma among adult patients:CO₂ endolaryngeal laser excision versus standard fractionated external beam radiation is superior in term of cost utility? Laryngoscope, 2011, 121(1):116-134.
3.	Vilaseca I, Ballesteros F, Martíne-Vidal BM, et al.Quality of life after transoral laser microresection of laryngeal cancer:a longitudinal study.J Surg Oncol, 2013, 108(1):52-56.
4.	Overman MJ, Fournier K, Hu CY, et al.Improving the AJCC/TNM staging for adenocarcinomas of the appendix:the prognostic impact of histological grade.Ann Surg, 2013, 257(6):1072-1078.
5.	金童, 潘新良, 雷大鹏, 等.晚期喉鳞状细胞癌的功能保留手术临床分析.中华耳鼻咽喉头颈外科杂志, 2013, 48(11):924-929.
6.	Galletti B, Freni F, Cammaroto G, et al.Vocal outcome after CO₂ laser cordectomy performed on patients affected by early glottis carcinoma.J Voice, 2012, 26(6):801-805.
7.	González-Márquez R, Rodrigo JP, Llorente JL, et al.Transoral CO₂ laser surgery for supraglottic cancer.Eur Arch Otorhinolaryngol, 2012, 269(9):2081-2086.
8.	Suárez C, Rodrigo JP, Silver CE, et al.Laser surgery for early to moderately advanced glottic, supraglottic, and hypopharyngeal cancers.Head Neck, 2012, 34(7):1028-1035.
9.	Peretti G, Piazza C, Cocco D, et al.Transoral CO₂ laser treatment for Tis-T3 glottic cancer:the University of Brescia experience on 595 patients.Head Neck, 2010, 32(8):977-983.
10.	Lee HS, Chun BG, Kim SW, et al.Transoral laser microsurgery for early glottic cancer as one-stage single-modality therapy.Laryngoscope, 2013, 123(11):2670-2674.
11.	张发岐, 黄金中.颈部带状肌瓣重建喉癌术后声带缺如31例报告.临床耳鼻咽喉科杂志, 2003, 17(8):488-489.
12.	庞太忠, 吴允刚, 李晓瑜, 等.会厌瓣及胸骨舌骨肌肌筋膜瓣在声门型喉癌术中的应用.中华耳鼻咽喉头颈外科杂志, 2012, 47(6):501-503.
13.	王惠忠, 栾信庸, 李勇.会厌在外伤性喉气管狭窄整复中的应用.中国修复重建外科杂志, 2005, 19(2):138-140.
14.	黄益灯, 周水淼, 郑宏良, 等.成人杓状软骨切除术前后声门测量及嗓音分析.中华耳鼻咽喉科杂志, 2004, 39(9):554-557.
15.	胡巧, 朱尚勇, 高泳, 等.声带和室带的超声生理径线测值及分析.中国超声医学杂志, 2009, 25(1):24-26.
16.	Luo CM, Fang TJ, Lin CY, et al.Transoral laser microsurgery elevates fundamental frequency in early glottic cancer.J Voice, 2012, 26(5):596-601.
17.	周杰玉, 吴昊, 周维镕.声门型喉癌患者喉部分切除术后发声功能评估.南通医学院报, 2009, 29(5):348-350.
18.	Singh A, Kazi R, De Cordova J, et al.Multidimensional assessment of voice after vertical partial laryngectomy:a comparison with normal and total laryngectomy voice.J Voice, 2008, 22(6):740-745.

1. Lucioni M, Bertolin A, Rizzotto G, et al.CO₂ laser surgery in elderly patients with glottic carcinoma:Univariate and multivariate analyses of results.Head Neck, 2012, 34(12):1804-1809.
2. Higgins KM.What treatment for early-stage glottis carcinoma among adult patients:CO₂ endolaryngeal laser excision versus standard fractionated external beam radiation is superior in term of cost utility? Laryngoscope, 2011, 121(1):116-134.
3. Vilaseca I, Ballesteros F, Martíne-Vidal BM, et al.Quality of life after transoral laser microresection of laryngeal cancer:a longitudinal study.J Surg Oncol, 2013, 108(1):52-56.
4. Overman MJ, Fournier K, Hu CY, et al.Improving the AJCC/TNM staging for adenocarcinomas of the appendix:the prognostic impact of histological grade.Ann Surg, 2013, 257(6):1072-1078.
5. 金童, 潘新良, 雷大鹏, 等.晚期喉鳞状细胞癌的功能保留手术临床分析.中华耳鼻咽喉头颈外科杂志, 2013, 48(11):924-929.
6. Galletti B, Freni F, Cammaroto G, et al.Vocal outcome after CO₂ laser cordectomy performed on patients affected by early glottis carcinoma.J Voice, 2012, 26(6):801-805.
7. González-Márquez R, Rodrigo JP, Llorente JL, et al.Transoral CO₂ laser surgery for supraglottic cancer.Eur Arch Otorhinolaryngol, 2012, 269(9):2081-2086.
8. Suárez C, Rodrigo JP, Silver CE, et al.Laser surgery for early to moderately advanced glottic, supraglottic, and hypopharyngeal cancers.Head Neck, 2012, 34(7):1028-1035.
9. Peretti G, Piazza C, Cocco D, et al.Transoral CO₂ laser treatment for Tis-T3 glottic cancer:the University of Brescia experience on 595 patients.Head Neck, 2010, 32(8):977-983.
10. Lee HS, Chun BG, Kim SW, et al.Transoral laser microsurgery for early glottic cancer as one-stage single-modality therapy.Laryngoscope, 2013, 123(11):2670-2674.
11. 张发岐, 黄金中.颈部带状肌瓣重建喉癌术后声带缺如31例报告.临床耳鼻咽喉科杂志, 2003, 17(8):488-489.
12. 庞太忠, 吴允刚, 李晓瑜, 等.会厌瓣及胸骨舌骨肌肌筋膜瓣在声门型喉癌术中的应用.中华耳鼻咽喉头颈外科杂志, 2012, 47(6):501-503.
13. 王惠忠, 栾信庸, 李勇.会厌在外伤性喉气管狭窄整复中的应用.中国修复重建外科杂志, 2005, 19(2):138-140.
14. 黄益灯, 周水淼, 郑宏良, 等.成人杓状软骨切除术前后声门测量及嗓音分析.中华耳鼻咽喉科杂志, 2004, 39(9):554-557.
15. 胡巧, 朱尚勇, 高泳, 等.声带和室带的超声生理径线测值及分析.中国超声医学杂志, 2009, 25(1):24-26.
16. Luo CM, Fang TJ, Lin CY, et al.Transoral laser microsurgery elevates fundamental frequency in early glottic cancer.J Voice, 2012, 26(5):596-601.
17. 周杰玉, 吴昊, 周维镕.声门型喉癌患者喉部分切除术后发声功能评估.南通医学院报, 2009, 29(5):348-350.
18. Singh A, Kazi R, De Cordova J, et al.Multidimensional assessment of voice after vertical partial laryngectomy:a comparison with normal and total laryngectomy voice.J Voice, 2008, 22(6):740-745.

Chinese Journal of Reparative and Reconstructive Surgery

OBJECTIVE ASSESSMENT OF COMBINED SOFT TISSUE FLAP IN DEFECT REPAIR OF LARYNGEAL CARCINOMA OPERATION

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