Experimental Laryngeal Function Reconstruction In Total Laryngectomy

Laryngeal cancer is a common cancer in head and neck and the total laryngectomy is the main treatment method for the terminal laryngeal cancer in T4. The most basic functions of laryngeal carcinoma patients after total laryngectomy will be the loss of pronunciation, breathing and swallowing. With the rapid development of science and technology, we can help patients with no laryngeal to recover laryngeal functions by esophageal voice, tracheo-esophageal phonationso, artificial-larynx and laryngeal transplant, that make some of them communicate with others. These methods have advantages and disadvantages and can not recover the normal breathing or pronunciation function. This study provides a basis for the future medical science through animal experimental model.Objective:Through the animal experimental model, we are explore the new method of laryngeal function reconstruction, and summarize the existing methods. Finally, we can apply our research results to improve the cure rate and prolong the survival time and improve the quality of life on the patients.Method:The 9 healthy Beagles were randomly paired into three groups, labeled A, B, C, and record the normal pronunciation and sound distance, that represents sound intensity. In the A group, Beagles received total laryngectomy and membranous laryngeal reconstruction. In the B group, the Beagles underwent total laryngectomy and autogenous costal constructed laryngeal cartilage skeleton, then neck strap muscles and fascia of bilateral constructed vocal cord. In the C group, we use the neck muscle flap to reconstruct new epiglottis on the basis of B. After the surgery, we give the Beagles antibiotics, intravenous nutrition and tube feeding until taking food by mouth. We are judged by swallowing, pronunciation and breathing.Result:In the group of A, swallowing function recovered on III or IV stage in the average 11 day. The Beagles had "hum"sound, low and rough, whose hearing distance is 8 meters and they can not breath without endotracheal tube. In the group of B, swallowing function recovered on III stage in the average 6.33 day. The Beagles had a powerful "rumbling" sound and the hearing distance is 8.33 meters. Among them, B1, B2 can breath without endotracheal tube in the ninth days after surgery. In the group of C, swallowing function recovered in the average 9 day. C1 and C2 recovery swallowing function respectively to Ⅳ grade in 9 day and 10 day after surgery. The Beagles had a rough "ha-ha" sound and the hearing distance is 2.5 meters. Among them, C1 breath last for 4 hours without endotracheal tube in the 13th days and C2 recovery is in the 13th days and last for 6 hours after surgery. However, pharyngeal fistula of C3 was largely due to severe wound infection and swallowing function is just on grade Ⅰ, and finally died of sputum scab and granulation tissue blocking the trachea catheter.Conclusion:After total laryngectomy, laryngeal function reconstruction surgery, such as construct cartilage skeleton of vocal cords and new epiglottis surgery, can recover part of the swallowing, pronunciation and respiratory function in the study. But we should be circumspect in clinical application of this method.