Speech outcome of supracricoid partial laryngectomy: comparison with total laryngectomy and anatomic considerations.

摘要

OBJECTIVE: We studied speech after a supracricoid partial laryngectomy (SCPL) and compared it to speech after a total laryngectomy and insertion of voice prosthesis (TL-VP). We also determined the anatomical factors related to speech after SCPL. STUDY DESIGN AND SETTING: Historic cohort study. Patients were recruited for data collection. SUBJECTS AND METHODS: We enrolled 28 patients who had undergone SCPL or TL-VP for laryngeal cancer from 1995 to 2005 (15 with SCPL and 13 with TL-VP). Patients had no recurrence, no respiratory problems, and were followed-up more than one year. Using sustained vowel phonation and standard paragraph reading, maximum phonation time, maximum loudness, total time for reading the paragraph, number of syllables per breath, and speech intelligibility were tested, and the patients' self satisfaction was evaluated using the Voice Handicap Index questionnaire. In addition, we performed stroboscopic examination for the SCPL group to study the configuration of the neoglottis during phonation. RESULTS: Maximum phonation time was longer in the TL-VP group than in the SCPL group (P = 0.048). There was no significant difference in the other parameters between the groups. With stroboscopic examination, we observed widely variable findings with reference to arytenoid mobility, mucosal vibration, and neoglottic occlusion in the SCPL group. CONCLUSIONS: Speech after SCPL was not better than speech after TL-VP and was widely variable. The configuration of the neoglottis during phonation in the SCPL group was also variable. We believe that some technical refinement during the operation could improve speech outcome after SCPL.