Primer provox ses protezinin uygulanmasındaki başarı oranları, komplikasyonlar ve değiştirme nedenleri
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Dosyalar
Tarih
2011
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Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Provox ses protezinin konuşmadaki başarı oranını, insitu ömrünü, oluşan komplikasyonları ve protezin değiştirilme nedenlerini araştırmaktır. Ek olarak başarı oranıyla cerrahi uygulama ve radyoterapi arasındaki ilişkiyi saptamaktır. Yöntem: 32 hastaya total larenjektomi ile eş seanslı trakeoesofageal fistül işlemi ile Provox ses protezi uygulandı. Bu hastaların 9’una yalnızca total larenjektomi, 23’üne total larenjektomi ile beraber boyun diseksiyonu ve bu 23 hastadan 17’sine de boyun diseksiyonu sonrasında bir ay süre ile radyoterapi uygulandı. Hiçbir hastaya krikofarengeal myotomi uygulanmadı. Bulgular: Protez uygulanan 32 hastanın 19’u (% 59) başarılı konuşmakta, 8’i (%25) konuşamıyor ve 5’i (% 16) kalitesiz konuşmaktaydı. Konuşma protezinin ömrü en kısa 20 gün ve en uzun 20 ay olup ortalama 8.5 ay olarak bulundu. Protez değişiminin en sık iki nedeni, protez içinden sıvı gelmesi ve/veya protez çevresinden saliva gelmesi idi. Majör komplikasyon gözlenmedi. En sık gözlenen minör komplikasyon protezde mantar kolonizasyonu idi. Uygulanan cerrahi protokolün (total larenjektomi, total larenjektomi ile beraber boyun diseksiyonu ve radyoterapi) ses protezi ile konuşabilme başarısını etkilemediği saptandı. Radyoterapinin uzun dönemde konuşmanın üzerine olumsuz etkisi görülmemekle beraber trakeoesofageal fistülde genişleme (%18.8) ve migrasyon (%4) komplikasyonunu arttırdığı gözlendi. Boyun diseksiyonu uygulanan hastalarda konuşma becerisi olumsuz etkilenmemekle beraber konuşma egzersizlerine başlama 20. güne uzamakta idi. Sonuç: Trakeoesofageal fistül ile primer provox ses protezi tatbiki başarı oranı yüksek ve komplikasyon oranı düşük, basit ve kısa sürede uygulanabilen yararlı bir ses rehabilitasyonu yöntemidir. Radyoterapinin ve boyun diseksiyonunun uzun dönemde provox ses protezi ile konuşma üzerine olumsuz etkisi bulunmamaktadır.
Objective: To analyze the speech success, in situ lifetime, causes for replacement and the complications encountered in Provox Voice Prosthesis rehabilitation. In addition, to determine the relationship between the rate of speech success and surgical procedure and radiation therapy. Methods: A total of 32 male patients managed with Provox Voice Prosthesis voice rehabilitation were included. Nine patients underwent total laryngectomy and 23 patients underwent total laryngectomy combined with neck dissection. The indwelling Voice Prosthesis were inserted immediately at the time of primary tracheoesophageal puncture. Pharyngoesophageal myotomy was not performed. Seventeen patients were managed with postoperative radiotherapy. Results: Nineteen of 32 patients (59%) demonstrated successful speech, eight patients (25%) were found to be aphonic and five patients (16%) demonstrated less successful speech. The mean in situ lifetime of the Voice Prosthesis was 8.5 months (range; 20 days - 20 months). The most common causes for Voice Prosthesis replacement were; leakage of saliva around the prosthesis and leakage through the prosthesis. There was no major complication and the most common minor complication was fungus colonization on the prosthesis. Surgical procedure (total laryngectomy alone, total laryngectomy in combination with neck dissection and postoperative radiotherapy) was found to have no effect on speech success. Enlargement of the tracheoesophageal fistula (18.8%) and migration (4%) were more common in the patients who received postoperative radiotherapy. Phonation exercises were delayed until 20th day postoperatively in the patients who underwent neck dissection. Conclusion: Primary Provox voice prosthesis insertion via trachea-esophageal fistula is an easy and useful rehabilitation method with high success and low complication rates. Radiotherapy and neck dissection have no long term negative effect on speech success of Provox voice prosthesis.
Objective: To analyze the speech success, in situ lifetime, causes for replacement and the complications encountered in Provox Voice Prosthesis rehabilitation. In addition, to determine the relationship between the rate of speech success and surgical procedure and radiation therapy. Methods: A total of 32 male patients managed with Provox Voice Prosthesis voice rehabilitation were included. Nine patients underwent total laryngectomy and 23 patients underwent total laryngectomy combined with neck dissection. The indwelling Voice Prosthesis were inserted immediately at the time of primary tracheoesophageal puncture. Pharyngoesophageal myotomy was not performed. Seventeen patients were managed with postoperative radiotherapy. Results: Nineteen of 32 patients (59%) demonstrated successful speech, eight patients (25%) were found to be aphonic and five patients (16%) demonstrated less successful speech. The mean in situ lifetime of the Voice Prosthesis was 8.5 months (range; 20 days - 20 months). The most common causes for Voice Prosthesis replacement were; leakage of saliva around the prosthesis and leakage through the prosthesis. There was no major complication and the most common minor complication was fungus colonization on the prosthesis. Surgical procedure (total laryngectomy alone, total laryngectomy in combination with neck dissection and postoperative radiotherapy) was found to have no effect on speech success. Enlargement of the tracheoesophageal fistula (18.8%) and migration (4%) were more common in the patients who received postoperative radiotherapy. Phonation exercises were delayed until 20th day postoperatively in the patients who underwent neck dissection. Conclusion: Primary Provox voice prosthesis insertion via trachea-esophageal fistula is an easy and useful rehabilitation method with high success and low complication rates. Radiotherapy and neck dissection have no long term negative effect on speech success of Provox voice prosthesis.
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Genel ve Dahili Tıp
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9
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1
