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Medicina
Croatian Medical Association - Rijeka branch
ISSN: 0025-7729
Vol. 45, No. 2, 2009, pp. 165-171
Bioline Code: me09022
Full paper language: Croatian
Document type: Research Article
Document available free of charge

Medicina, Vol. 45, No. 2, 2009, pp. 165-171

 en Voice Restoration Using Tracheoesophageal Voice Prostheses Following Total Laryngectomy
Tićac, Robert; Tićac, Brigita; Maljevac, Boris; Velepić, Marko; Malvić, Goran; Vučković, Darinka & Manestar, Darko

Abstract

Aim: Total laryngectomy is an expansive operation and can be performed with or without neck dissection. During this procedure the entire larynx is removed, the windpipe is brought out to the skin and secured there in the form of a permanent tracheostome. The most difficult aspect of laryngeal function to reconstruct, and the one to which most research is dedicated to is the reattainment of speech. The main options for voice restoration after total laryngectomy are esophageal speech, electrolarynx speech, and tracheoesophageal speech. Tracheoesophageal puncture with prosthesis is currently the surgical method of choice for vocal restoration after total laryngectomy. This puncture tract can be created primarily, at the time of total laryngectomy, or secondarily, weeks or years following the laryngectomy.
Patients and Methods: Between the period of 01.01.2004. and 31.12.2008., 125 laryngectomized patients have been rehabilitated at the Otorhynolaryngology Department of the Clinical Hospital Center Rijeka. The indication for total laryngectomy was T3 or T4 laryngeal carcinoma in 58 (46%) patients, and 67 (54%) patients underwent a partial laryngectomy.
Results: The methods of voice rehabilitation were tracheoesophageal speech (91%), esophageal speech (6%) and artificial larynx (3%). A voice prosthesis could be inserted in 49 patients by primary puncture, in 36 patients by secondary puncture. The median device lifetime was 7,9 months. 10 % of the prostheses were replaced with a lifetime of less than 3 months, 46% from 3 to 6 months, and 44% devices longer than 6 months.
Conclusion: Effective restoration of voice is critical to enabling the patient to return to normal functioning in their life. Tracheoesophageal speech has become the method of choice for postlaryngectomy voice restoration.

Keywords
total laringectomy, tracheoesophageal puncture, vocal prostheses

 
 hr Rehabilitacija glasa traheoezofagealnim govornim protezama nakon totalne laringektomije
Tićac, Robert; Tićac, Brigita; Maljevac, Boris; Velepić, Marko; Malvić, Goran; Vučković, Darinka & Manestar, Darko


Cilj: Totalna laringektomija opsežan je operativni zahvat koji se može izvesti sa ili bez resekcije vrata. Tijekom ovog postupka u potpunosti se odstranjuje grkljan, a traheja se mobilizira te pričvrsti za kožu u obliku trajnog otvora za disanje – traheostome. Najsloženiji problem u vezi s rekonstrukcijom funkcije larinksa, kojemu je posvećen najveći broj istraživanja, ponovno je uspostavljanje govora. Osnovne mogućnosti govorne rehabilitacije nakon totalne laringektomije jesu razvijanje vještine ezofagealnog govora, korištenje elektrolarinksa i traheoezofagealna punkcija s uporabom govorne proteze. Traheoezofagealna punkcija s govornom protezom je kirurška metoda izbora za govornu rehabilitaciju bolesnika. Punkcija može biti izvedena primarno, istovremeno s laringektomijom, i sekundarno, tjednima ili godinama nakon izvršene laringektomije.
Materijali i metode: U razdoblju od 1. 1. 2004. do 31.12. 2008. godine na Klinici za otorinolaringologiju KBC-a u Rijeci liječeno je 125 laringektomiranih bolesnika. Indikacija za izvođenje totalne laringektomije bio je T3 ili T4 karcinom larinksa u 58 (46%) bolesnika, a u 67 (54%) bolesnika izvršena je parcijalna laringektomija.
Rezultati: Metode govorne rehabilitacije bile su uspostava traheoezofagealnog (91%) i ezofagealnog (6%) govora i uporaba elektrolarinksa (3%). Govorne proteze postavljene su u 49 bolesnika primarnom punkcijom, a u 36 bolesnika sekundarnom punkcijom. Srednje vrijeme trajanja proteza iznosilo je 7,9 mjeseci. 10% proteza zamijenjeno je nakon manje od 3 mjeseca korištenja, 46% nakon 3 do 6 mjeseci, a 44% proteza korišteno je dulje od 6 mjeseci.
Zaključak: Učinkovita rehabilitacija glasa bitna je i omogućava bolesniku povratak normalnim životnim funkcijama. Traheoezofagealni govor postao je metoda izbora za govornu rehabilitaciju nakon izvršene laringektomije.


govorne proteze, totalna laringektomija, traheoezofagealna punkcija

 
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