Marta Filauro1,2,3, Francesco Missale4,5, Alberto Vallin6,7, Francesco Mora1,2, Valeria Marrosu8, Filippo Carta8, Roberto Puxeddu8, Giorgio Peretti1,2. 1. IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy. 2. Unit of Otorhinolaryngology, Head and Neck Surgery, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Largo Rosanna Benzi, 16132, Genoa, Italy. 3. Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy. 4. Department of Molecular and Translational Medicine, University of Brescia, 25121, Brescia, Italy. 5. Department of Head & Neck Oncology & Surgery Otorhinolaryngology, Antoni Van Leeuwenhoek, Nederlands Kanker Instituut, 1066, Amsterdam, The Netherlands. 6. IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy. a.vallin07@gmail.com. 7. Unit of Otorhinolaryngology, Head and Neck Surgery, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Largo Rosanna Benzi, 16132, Genoa, Italy. a.vallin07@gmail.com. 8. Department of Otorhinolaryngology-Head and Neck Surgery, University of Cagliari, 09124, Cagliari, Italy.
Abstract
PURPOSE: The aim of this study is to evaluate functional outcomes in terms of decannulation rate and quality of life of patients affected by PGS (Grades I-IV) treated only by transoral CO2 laser microsurgery (TOLMS) in two tertiary centers. METHODS: An observational retrospective study was carried out, enrolling 22 patients affected by PGS who were treated by a transoral approach at two tertiary referral centers. Surgical treatment included TOLMS with tailored laser resection of the scar tissue combined with posterior cordotomy, resurfacing of the raw area with mucosal microflap, or placement of a Montgomery T-tube or Keel stent. All patients were evaluated and staged preoperatively and postoperatively, at least 6 months after the surgery. Functional outcomes were objectively evaluated by the Airway-Dysphonia-Voice-Swallowing (ADVS) staging system, Voice Handicap Index-30 (VHI-30), and Eating Assessment Tool-10 (EAT-10) questionnaires. RESULTS: Quality of life significantly improved as measured by the VHI-30 questionnaire with a median variation of - 31.0 (p = 0.003), the EAT-10 with a median variation of - 4.0 (p = 0.042), and the ADVS with a median variation of - 3.5 (p < 0.001). No significant changes were observed in swallowing scores. We were able to decannulate 7 of 9 patients (almost 80%) with previous tracheotomy. CONCLUSION: In conclusion, even if there is still no general agreement on an exact therapeutic algorithm to treat PGS, our results confirm that transoral surgery, in terms of scar tissue removal, combined in selected patients with posterior cordotomy and pedicled local flaps and/or placement of stents, represents a safe and effective surgical approach even for more severe PGS.
PURPOSE: The aim of this study is to evaluate functional outcomes in terms of decannulation rate and quality of life of patients affected by PGS (Grades I-IV) treated only by transoral CO2 laser microsurgery (TOLMS) in two tertiary centers. METHODS: An observational retrospective study was carried out, enrolling 22 patients affected by PGS who were treated by a transoral approach at two tertiary referral centers. Surgical treatment included TOLMS with tailored laser resection of the scar tissue combined with posterior cordotomy, resurfacing of the raw area with mucosal microflap, or placement of a Montgomery T-tube or Keel stent. All patients were evaluated and staged preoperatively and postoperatively, at least 6 months after the surgery. Functional outcomes were objectively evaluated by the Airway-Dysphonia-Voice-Swallowing (ADVS) staging system, Voice Handicap Index-30 (VHI-30), and Eating Assessment Tool-10 (EAT-10) questionnaires. RESULTS: Quality of life significantly improved as measured by the VHI-30 questionnaire with a median variation of - 31.0 (p = 0.003), the EAT-10 with a median variation of - 4.0 (p = 0.042), and the ADVS with a median variation of - 3.5 (p < 0.001). No significant changes were observed in swallowing scores. We were able to decannulate 7 of 9 patients (almost 80%) with previous tracheotomy. CONCLUSION: In conclusion, even if there is still no general agreement on an exact therapeutic algorithm to treat PGS, our results confirm that transoral surgery, in terms of scar tissue removal, combined in selected patients with posterior cordotomy and pedicled local flaps and/or placement of stents, represents a safe and effective surgical approach even for more severe PGS.
Authors: Alexander T Hillel; Selmin Karatayli-Ozgursoy; Idris Samad; Simon R A Best; Vinciya Pandian; Laureano Giraldez; Jennifer Gross; Christopher Wootten; Alexander Gelbard; Lee M Akst; Michael M Johns Journal: Ann Otol Rhinol Laryngol Date: 2015-10-14 Impact factor: 1.547
Authors: Ihab Atallah; M Krishniah Manjunath; Ahmad Al Omari; Christian Adrien Righini; Paul F Castellanos Journal: Laryngoscope Date: 2016-08-24 Impact factor: 3.325