• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.18 no.2
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• pp.134-137
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• 2007

Background and Objectives: The goals of laryngeal reconstruction have been prevention of aspiration, production of a functional voice, and maintenance of an adequate airway for decannulation. It is generally believed that the reconstruction of the glottic region after vertical partial laryngectomy (VPL) can improve laryngeal function. The objective of this study is to evaluate of voice function after VPL with mucosal flap and fat graft reconstruction. Materials and Methods: From 1994 to 2006, 13 patients, who had been treated with VPL with mucosal flap and fat graft reconstruction. The voice characteristics, acoustic, aerodynamic parameter were measured in 13 patients after vertical partial laryngectomy with mucosal flap and fat graft reconstruction. Acoustic analysis was carried out using Computerized Speech Lab (CSL) and aerodynamic analysis were carried out using Aerophon II,3 months and 12 months after surgery. Results: The GRBAS scale, jitter, shimmer, NHR were improved as time goes on after surgery. But, maximum phonation time was shortened after surgery and there is no significant differences between before and after surgery in mean flow rate. Conclusion: The voice function of the mucosal flap and fat graft reconstruction after VPL were satisfactory. This can be an excellent reconstruction method after vertical partial laryngectomy.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.19 no.1
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• pp.21-27
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• 2008

Total laryngectomy is the most useful procedure tor advanced laryngopharyngeal cancer, but it remains the major problem such as loss of voice. Voice restoration is essential for every patients who undergo a total laryngectomy. Ideal voice rehabilitation methods can resolve three factors. First, every laryngectomee can produce voice sufficient for communication, second every patient should be allowed to use both hands freely during phonation, and last, the voice restoration methods should be easy and safe without complication during and after treatment. Among various voice rehabilitation procedures during or after total laryngectomy, it can be divided electronic and pneumatic methods. In pneumatic methods, there are also divided both pulmonary air and non-pulmonary air methods. The non-pulmonary air methods include esophageal speech, buccal speech, and pharyngeal speech. Pulmonary air methods are divided into surgical and non-surgical such as pneumatic speech aid. In the surgical methods, there are neoglottic operation, tracheopharyngeal shunt, and tracheopharyngeal shunt operations. Recently, tracheoesophageal shunt with or without prosthesis are being recognized the most effective method. Blom-Singer low pressure prosthesis, Panje button, and Provox are well known types of prosthesis in the tracheoesophageal shunt operation. Amatsu method is a kind of famous tracheoesophageal shunt method without using prosthesis. Authors tried to review the published articles for evaluation of effectiveness and problems of tracheoesophageal shunt operation with or without prosthesis. In conclusion, indwelling type of prosthesis and pharyngeal myotomy and plexus neurectomy are recommended for higher success rate during tracheoesophageal puncture procedure. More over, Amatsu method is also one of the recommended voice rehabilitation procedure during total laryngectomy. In this situation, pharyngeal myotomy and plexus neurectomy may be helpful for better fluent communication.

• Korean Journal of Bronchoesophagology
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• v.4 no.1
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• pp.91-95
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• 1998

Background： Laryngeal cancer, the most common malignancy of head and neck, is being detected and treated in earlier and more effectively due to introduction of endoscope, continuous development of radiographic technology, and advancement in new surgical techniques such as laser surgery and conservation laryngeal surgery Objectives To compare the different treatment results for early laryngeal cancer to determine which methos provides the good prognosis. Materials and Methods： Retrospective study was done for 135 patients with early laryngeal squamous cell carcinoma(Stage I or II) who were treated at our institute between 1989 to 1996. There were 105 patients with glottic cancer(Stage I: 68 patients, Stage II：37 Patients) and 30 patients with supraglottic cancer(Stage I: 12 patients, Stage II：18 patients) Initial treatment included radiation therapy for 54 patients, endoscopic laser surgery for 8 patients, laryngofissure and cordectomy for 8 patients, vertical partial laryngectomy for 37 patients, supraglottic laryngecomy for 14 patients and supracricoid laryngectomy for 5 patiens, and total laryngectomy for 9 patients. Results : Salvage treatments, such as total laryngectomy, conservation laryngeal surgery, radiation therapy and neck dissection were performed for initial treatment failure with 9 patients after radiation therapy, 8 patients after conservation laryngeal surgery, 2 patients after endoscopic laser and 3 patients after total laryngectomy. Overall 3-year survival rate for glottic 71 was 92.4%, glottic f 84.3%, supraglottic 7172.7%, and supraglottic f was 63.%%. However, survival rate of the same stage was variable according to the choice of initial treatment. Conclusion New classification of the early laryngeal cancer was necessary and helpful for the choice of the initial treatment.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.29 no.1
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• pp.41-43
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• 2018

"Saber-sheath" trachea is a deformity of lower cervical or intrathoracic trachea. The configuration of the deformity is marked coronal narrowing associated with sagittal widening. This deformity is associated with chronic obstructive pulmonary disease. We report a case of patient with saber-sheath who underwent total laryngectomy. Although the patient had no tracheal collapse after the total laryngectomy, crusted discharge was increased. Diagnosis of the saber-sheath trachea, possible causes, and clinical implications are discussed.

• Speech Sciences
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• v.3
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• pp.5-17
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• 1998

Botulinum toxin, a neurotoxin derived from Clostridia Botulinum, has been injected into the target muscle(s) for the treatment of several kinds of voice and speech disorders at the Voice Clinic, Yonsei Institute of Logopedics and Phoniatrics since December 1995. Criteria for the diagnosis and method of injection for spasmodic dysphonia, mutational dysphonia, muscle tension dysphonia, dysphonia after total laryngectomy, and stuttering were summarized. Among 144 patients with adductor type spasmodic dysphonia, who were injected one time to maximum 8 times during the 27 months, 90% were recognized as having better than slight improvement. Even though the injected cases were small, not only the abductor type spasmodic dysphonia, but also the intractable mutational dysphonia or muscle tension dysphonia resistant to voice therapy revealed that botulinum toxin injection would be another options for treatment. Patients who cannot phonate after total laryngectomy and some forms of adulthood stutterers can also be candidates for the injection of botulinum toxin.

• Korean Journal of Bronchoesophagology
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• v.19 no.1
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• pp.25-27
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• 2013

A 47-year-old man was referred for TEF. He underwent tracheostomy three months ago to maintain prolonged ventilator care. Computed tomography (CT) scan and fiberoptic examination showed bilateral vocal cord palsy with median fixation and about 2 inch sized long segmental tracheoesophageal fistula (TEF) tract along the necrotic cricoid and tracheal cartilages. Narrow field total laryngectomy was performed to remove devitalized cartilages and mucosa, and repair TEF. He discharged without complication except mild stenotic change of tracheal fenestration 19 days later.

• Korean Journal of Head & Neck Oncology
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• v.23 no.1
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• pp.15-20
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• 2007

Background and Objectives：Supraglottic partial laryngectomy is oncologically sound surgical procedure for selected cases of laryngeal cancer which maintains physiologic speech and swallowing without permanent tracheostoma. The purpose of this study is to evaluate the oncologic and functional results of supraglottic partial laryngectomy and neck dissection for supraglottic cancer. Materials and Methods：Between 1991-2005, Twenty-three supraglottic cancer patients, underwent supraglottic partial laryngectomy, were studied retrospectively. There were 5 patients with cT1, 14 with cT2, 4 with cT3 and 11 patients with cN0, 1 with cN1, 10 with cN2, 1 with cN3. All patients underwent neck dissection and postoperative radiotherapy was added to twenty patients. They were reviewed with respect to primary subsites, extended subsites, treatment result, survival rate, factors affecting the prognosis, postoperative complication, time of decannulation and oral diet, and postoperative voice. Results：Among eleven patients with clinically negative node, six patients had pathologically positive nodes. So occult metastasis was 54.5%. Two patients recurred at cervical lymph node and one had distant metastasis to lung. Local and regional control were 100% and 91.3%. The overall 3-year and 5-year survival rate were 84%, 78%, respectively. Nineteen cases were squamous cell carcinomas and four were basaloid squamous cell carcinomas. Basaloid subtype was significantly affected to survival. Decannulation and oral feeding were possible in 100%. Conclusions：Supraglottic partial laryngectomy is oncologically safe and functionally good procedure in supraglottic cancers. Elective neck dissection is beneficial in management of occult cervical metastasis.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.13 no.2
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• pp.155-163
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• 2002

Background and Objectives : Esophageal voice, Silicone voice Prosthesis with tracheo-esophageal (T-E) puncture have been used as vocal rehabilitation methods for postlaryngectomy. However, long-term follow-up in the voice rehabilitation in the total laryngectomees has not been reported. The purpose of this study is to analyze practice of postlaryngectomy voice rehabilitation and to find the effective voice rehabilitation. Materials and Methods : From Jan 1992 until June 2002, 75 patients underwent a total laryngectomy at Yongdong Severance Hospital. We retrospectively studied voice rehabilitation methods commonly used, acquisition levels of esophageal speech, patients satisfaction scale (5 rating scale) according to the methods in 33 of them (40 died, 2 unavailable) by using charts review, telephone interview. Results : T-E speech is most commonly used by 14 patients (42.4%) : A tracheo-esophageal procedure (primary or secondary puncture) by 21 : and 8 patients removed Provox. 1 patient had no voice rehabilitation. 7 patients (21.2%) have used esophageal speech : 4 patients of them have used it after removing Provox. Electrolarynx has been used with other voice rehabilitation methods : 4 patients have only used this method and 3 patients with T-E speech, 1 patient with esophageal speech. However, 6 patients (18%) remained without a substitute voice rehabilitation. In the satisfaction with speech and management of voice rehabilitation methods, patients using esophageal speech were most satisfied (4.1), patients with T-E speech were unsatisfied (2.3). Regarding with the acquisition level of esophageal speech in 33 patients, 22 patients (66.6%) failed without functional speech. Conclusion : To increase patients satisfaction and to achieve successful voice rehabilitation after total laryngectomy, preoperative counseling, pretesting, appropriate patient selection of each method and team decision-making and postoperative voice therapy must be considered.

• Journal of Korean Public Health Nursing
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• v.19 no.2
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• pp.274-283
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• 2005

Purpose: To survey the functional status, self-esteem and depression of a community of indwelling clients with total laryngectomy, and to evaluate the correlation among these three variances. Methods: From May 2002 to October 2002, 76 clients who had undergone total laryngectomy more than three months ago were surveyed with using Baker's functional status in head & neck cancer-self report, Rosenberg's self rating self-esteem scale and Zung's self rating depression scale. Results: 1. The functionaI status score was $48.67{\pm}10.12$. The subjects aged 70 years or older had significantly higher scores than the subjects aged $50{\sim}59$ years. The group of clients who were operated on more than five years ago showed higher scores than the patients operated on within a year. 2. The self-esteem score was $30.47{\pm}6.44$. 3. The depression score was $47.26{\pm}8.01$. The subjects who bad three family members and the subjects who had five family members had significantly higher scores than the subjects who had two family members. 4. A significant correlation found between the functional status and self-esteem. Significant negative correlations were found between the functional status and depression and also between self-esteem and depression. Conclusion: Remarkable correlations were observed among functional status, self-esteem and depression. Nurses should consider the status of layngectomy patients and pay more attention to their pre- and post- operative nursing care and rehabilitation.

• Korean Journal of Head & Neck Oncology
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• v.3 no.1
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• pp.71-78
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• 1987

The supraglottic subtotal laryngectomy represents a conservation laryngeal procedure in which the upper portion of the larynx is removed without sacrificing the normal functions of the remaining larynx. The basis for this procedure rests in the embryologic derivation and consequent anatomic compartmentalization of the larynx and its lymphatics, which limit tumor spread. This procedure is performed for carcinoma involving the epiglottis and false cords, and can be extended to include carcinomas of the aryepiglottic fold and the anterior and lateral walls of the pyriform sinus and selected lesions involving the vallecula and base of the tongue. Recently the authors has experienced 4 cases of supraglottic cancer, which were performed supraglottic subtotal laryngectomy. One of which was died because of local recurrence, and the remaining cases were successful with satisfactory rehabilitation without local recurrence and impairment of voice and swallowing.