Voice rehabilitation after laryngectomy: problems, complications and ways of their elimination

Topicality: According to the 2019-2020 cancer registry, incidence of laryngeal and laryngopharyngeal remains high in Ukraine. Malignant tumours larynx rank first among ENT organs accounting for 50-70%. The has a tendency constantly increase. At same time, 70% patients with malignant are men working age which is 41-60 years. vast majority cases (60-75%) diagnosed stage 3-4 disease, when main method treatment laryngectomy. Total laryngectomy, necessary from an oncological point view, leads deep disability patient, namely loss voice. Difficulty or inability communicate, social isolation cause severe psychological trauma reason refusal radical surgery. various authors, 35% after extirpation use whispered speech, 30% writing communication. Rehabilitation voice function such would not only improve functional results quality life, but also facilitate adaptation, thus reducing number refusals surgical treatment. Department Oncological Diseases Organs State Institution “O. S. Kolomiychenko Institute Otolaryngology National Academy Medical Sciences Ukraine” restore TEP technique used Рrovox, Provox2, Vega, Voice Master prostheses low pressure long-term use. principle sound formation during rehabilitation shunting common based on strong flow air lungs (about 3 litres), directed into pharynx exhalation closed tracheostomy. formed at level socalled neoglottis. Thus, sufficient volume, speech intelligibility, fluidity, emotional colouring ensured, individual characteristics each patient preserved. barrier transmission mechanism (prosthesis, shunt) great importance as it ensures absence return current respiratory tract swallowing. However, this noted have problems that can be predicted prevented, particularly intraoperative period. Aim: analyse difficulties complications laryngectomy develop measures their prevention. Materials methods: observation included 74 who underwent “O.S. Ukraine”. There were 65 9 women aged 41-75 average was 58 All cancer. Eighteen simultaneous TEP, 44 had delayed prosthesis fitting (within 2 months years), 6 pharyngostomy, previously shunt. Patients lesions parts laryngopharynx (with subsequent recurrence tumour), stages 4 prosthetic patients. course pre- postoperative radiation therapy, polychemotherapy, total resection pharynx, tongue root, thyroid gland, selective neck dissection, combinations these methods. In addition, 7 Results discussion: Surgical by carried out. obtained showed following surgery: - Impossibility posterior tracheal wall perforation due its cicatricial-sclerotic changes area tracheostomy, narrowing deformation – 5 cases; Injury walls esophagus tube trocar (in case cicatricial changes, tracheostoma deformations, cervical osteochondrosis) Detachment band (due excessive tension, rigidity tissues, stoma difficulty manipulations area) Swallowing aspiration 1 case; Bleeding edges fistula Difficulties esophagoscope introduction (difficulty extending osteochondrosis, pharyngoesophageal junction, opening mouth) 12 Prosthesis descent (the length does match cases. It should some combination above mentioned complications. To overcome arising surgery prevent complications, diagnostic been introduced. permanent tracheostomy important operation. period condition depend shape size opening. under influence force tracheobronchial apparatus, trachea stump lowered varying degrees, contributes stoma. gross post-operative post-radiation scar negatively affect effectiveness plastic area. forming racquet-shaped excision skin around (suggested Professor O. 1943) stretch there developed consists cutting anterior half parallel ring, then obliquely top, subcutaneous fatty tissue fixation connective sternoclavicular joint 8 hours. cases, pedicles sternocleidomastoid muscle crossed (patent No. 117057 12.06.17). proposed makes possible avoid using day period, form correct further rehabilitation, reduces risk limit plan surgery, make difficult perform inserting importance. implementation straight extension patient’s complicated factors as: fibrosis, keloidosis soft tissues front surface pharynx. This increases fracture tooth injury, well injury esophagus. Inst itute Ukraine”, TES improved changing design tube, minimal trauma, time intervention, improves outcomes treated 117058). Conclusions: create group (hypersthenics, small diameter trachea, resection), An esophageal expands possibilities rehabilitat ion pat ients. Thorough preoperative preparation taking account situation, compliance indications specified improvements help most TEP.