RESUMEN

OBJECTIVE: Multilevel surgery for obstructive sleep apnea syndrome (OSA) may improve success. This study's goal is to prospectively evaluate the feasibility and short-term subjective effectiveness of a new tongue-suspension technique. METHODS: A multicenter nonrandomized open enrollment trial used the Repose device to treat tongue obstruction in 39 snoring and OSA patients. Outcomes include 1- and 2-month subjective reports of general health, snoring, and sleep. RESULTS: Twenty-three patients completed 1 month and 19 completed 2 months of follow-up. In OSA patients, activity level, energy/fatigue, and sleepiness improved. Two-month outcomes were less (activity level, energy/fatigue, and sleepiness). Fewer changes were observed in snorers than in OSA patients. There were 6 complications (18%), including sialadenitis (4), gastrointestinal bleeding (1), and dehydration (1) after the procedure. CONCLUSION: A pharyngeal suspension suture changes subjective outcomes. Improvement is incomplete. The procedure is nonexcisional, but significant complications may occur. Further evaluation is required to demonstrate effectiveness.

Asunto(s)

Tornillos Óseos , Faringe/cirugía , Complicaciones Posoperatorias/etiología , Apnea Obstructiva del Sueño/cirugía , Técnicas de Sutura/instrumentación , Lengua/cirugía , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Hipofaringe/cirugía , Masculino , Persona de Mediana Edad , Polisomnografía , Estudios Prospectivos , Apnea Obstructiva del Sueño/etiología , Resultado del Tratamiento

RESUMEN

In 1990 we reported an initial prospective study of 100 patients using a four-stage system for classification of chronic rhinosinusitis. Between January 1988 and July 1992, we used this system in staging an additional 1814 patients, on whom 2980 intranasal sphenoethmoidectomies were performed. In this staging system a protocol trial of medication was given for 2 weeks, followed by axial and coronal computed tomography. Medication consisted of a second-generation cephalosporin antibiotic, usually cefuroxime; a 4-day burst of intraoral steroids, usually prednisone; and an antihistamine decongestant if not contraindicated. The stages of chronic hyperplastic rhinosinusitis included the stages described in the 1990 report (i.e., stage I, single-focus disease; stage II, discontiguous disease throughout the ethmoid labyrinth; stage III, diffuse disease responsive to medication; and stage IV, diffuse disease unresponsive to or poorly responsive to medication). The results of this study have shown that the computed tomography staging system based on computed tomography extent of disease after medical therapy is a simple, easily remembered, and very effective modality for the classification of chronic sinusitis. This system provides a rationale for discussing and planning surgery with patients and physicians and is a convenient reference for the reporting of end results. More importantly, a linear relationship between disease stage and outcomes is demonstrated. This statistically highly significant feature of the staging system provides a firm basis for the production of outcomes after various treatment strategies, particularly ethmoidectomy and the treatment of sinusitis.

Asunto(s)

Rinitis/clasificación , Sinusitis/clasificación , Beclometasona/administración & dosificación , Beclometasona/uso terapéutico , Cefuroxima/administración & dosificación , Cefuroxima/uso terapéutico , Enfermedad Crónica , Protocolos Clínicos , Terapia Combinada , Senos Etmoidales/cirugía , Sinusitis del Etmoides/clasificación , Sinusitis del Etmoides/diagnóstico por imagen , Sinusitis del Etmoides/tratamiento farmacológico , Sinusitis del Etmoides/cirugía , Estudios de Seguimiento , Guaifenesina/administración & dosificación , Guaifenesina/uso terapéutico , Antagonistas de los Receptores Histamínicos H1/administración & dosificación , Antagonistas de los Receptores Histamínicos H1/uso terapéutico , Humanos , Hiperplasia , Descongestionantes Nasales/uso terapéutico , Planificación de Atención al Paciente , Prednisona/administración & dosificación , Prednisona/uso terapéutico , Estudios Prospectivos , Recurrencia , Rinitis/diagnóstico por imagen , Rinitis/tratamiento farmacológico , Rinitis/cirugía , Sinusitis/diagnóstico por imagen , Sinusitis/tratamiento farmacológico , Sinusitis/cirugía , Seno Esfenoidal/cirugía , Tomografía Computarizada por Rayos X , Resultado del Tratamiento

RESUMEN

Intranasal sphenoethmoidectomy was originally used primarily for the provision of adequate drainage of acute and subacute bacterial sinusitis. However, the spectrum of inflammatory sinus disease has changed dramatically since the popularization of broad-spectrum antibiotics, and chronic hyperplastic rhinosinusitis has replaced acute sinusitis as the primary indication for ethmoidectomy. In such cases total or almost total disease removal is crucial to providing long-term drainage and ventilation. We describe several modifications of the Yankauer sphenoethmoidectomy technique that enable the sinus surgeon to provide clearance of disease and excellent drainage for all sinuses by complete marsupialization of the sphenoid, ethmoid, and maxillary sinuses. These modifications include (1) complete rather than partial removal of the middle turbinate, (2) extended middle meatal antrostomy with palatine bone resection to the pterygoid process with delineation of the inferior and medial orbital wall, and (3) introduction of operative endoscopes as adjunctive tools in areas inaccessible to conventional visualization. The current technique and results in nearly 2000 procedures are described.

Asunto(s)

Senos Etmoidales/cirugía , Seno Maxilar/cirugía , Nariz/cirugía , Rinitis/cirugía , Sinusitis/cirugía , Seno Esfenoidal/cirugía , Enfermedad Crónica , Drenaje , Endoscopía , Estudios de Seguimiento , Humanos , Hiperplasia , Pólipos Nasales/cirugía , Tabique Nasal/cirugía , Órbita/cirugía , Hueso Paladar/cirugía , Complicaciones Posoperatorias , Recurrencia , Hueso Esfenoides/cirugía , Cornetes Nasales/cirugía

RESUMEN

A four-stage system is proposed for the classification of chronic hyperplastic rhinosinusitis. The system is comprehensive, simple to use, and has demonstrated extreme clinical usefulness. There is a linear correlation between recurrence rates and stage of disease. The system has virtually mandated treatment strategies for chronic sinusitis. Stage I disease is considered primarily medical, while Stages II, III and IV are surgical. The author's long-standing study is in agreement with Kennedy, Mackey and Lund in their view that radiographic assessment of extent of disease is the major determinant for staging and prognosis. This study, which began in 1988 and has been reported progressively since that time, has proven both useful and accurate for physicians using it, and more importantly has been a boon in explaining to patients the prognosis, needed treatment strategies, and potential outcomes in the treatment of their chronic sinusitis.

Asunto(s)

Senos Paranasales/diagnóstico por imagen , Sinusitis/diagnóstico por imagen , Asma/cirugía , Enfermedad Crónica , Humanos , Senos Paranasales/cirugía , Pronóstico , Recurrencia , Análisis de Regresión , Sinusitis/clasificación , Sinusitis/tratamiento farmacológico , Sinusitis/cirugía , Tomografía Computarizada por Rayos X , Resultado del Tratamiento

RESUMEN

Twenty patients with obstructive sleep apnea (OSA) underwent complete polysomnography and simultaneous upper airway pressure monitoring with a custom-made, soft silicone-covered catheter measuring 2.3 mm in diameter. The catheter had four solid-state microtip pressure sensors positioned in the posterior nasopharynx, immediately caudal to the tip of the uvula, at the level of the hyoid bone, and in the midesophagus. The level(s) of airway collapse was determined by changes in the pressure patterns between transducers. In 14 of the 20 patients, airway collapse was confined or initiated at the oropharyngeal region. The obstruction extended to the base of tongue in 7 and to the entire collapsible upper airway in 2 patients. Four patients had collapse at the base of the tongue and 2 had collapse at the hypopharynx. The site of airway collapse remained fairly constant through various sleep stages and positions. Uvulopalatopharyngoplasty (UPPP) and postoperative polysomnography were performed in 4 patients (2 with hypopharyngeal, 1 with base of tongue, and 1 with oropharyngeal airway collapse). Two patients had a favorable response to UPPP.

Asunto(s)

Faringe/fisiopatología , Síndromes de la Apnea del Sueño/fisiopatología , Femenino , Humanos , Hipofaringe/fisiopatología , Masculino , Persona de Mediana Edad , Orofaringe/fisiopatología , Polisomnografía , Presión , Síndromes de la Apnea del Sueño/cirugía , Lengua/fisiopatología

RESUMEN

The palatine bone is an important posterior landmark in the performance of ethmoidectomy. This usually unrecognized structure forms the posterior one third of the lateral nasal wall. Resection of a portion of the palatine bone completes the marsupialization of the sphenoethmoidal recess and medial maxilla. It is a major landmark for localization of the sphenopalatine artery at its entrance into the nose. Middle meatal antrostomy is enhanced by removal of the part of the palatine bone that forms the posterior medial wall of the maxillary sinus. In 1110 consecutive sphenoethmoidectomies, marsupialization of the maxillary sinuses has included partial removal of the perpendicular plate of the palatine bone. Patency has been maintained in all of these antrostomies. Pertinent anatomy and surgical technique are reviewed.

Asunto(s)

Hueso Paladar/cirugía , Humanos , Hueso Paladar/anatomía & histología , Enfermedades de los Senos Paranasales/cirugía , Procedimientos Quirúrgicos Operativos/métodos

RESUMEN

Recurring disease in the maxillary sinus, despite inferior meatal antrostomies, has led to the widespread use of middle meatal antrostomy or simple decompression of the natural ostium of the middle meatus in attempts to restore function to the maxillary sinus. We have reported recurrent disease in the maxillary sinus in patients with stage III or stage IV hyperplastic rhinosinusitis in whom attempts at functional surgery of the middle meatus were unsuccessful in reversal of retrograde changes. One hundred patients who had previously undergone intranasal sphenoethmoidectomy with removal of the middle turbinate, decompression of the maxillary ostium, and removal of overt hyperplastic disease of the middle meatus underwent revision transantral ethmoidectomy. All recurrent or residual diseased mucosa was removed, including polyps, occasional mucoceles, and hyperplastic changes that occurred despite patency of a middle meatal maxillary ostium. In many of these patients the maxillary sinus was widely marsupialized secondarily into the posterior nasal vault. While the initial overall polyp recurrence rate after intranasal sphenoethmoidectomy in these patients was as high as 19.2%, the rate of polyp recurrence after transantral revision was less than 5% in from 18 to 48 months postoperatively. The experience in this series suggests that mucosal changes have played a primary role in unsuccessful treatment, independent of whether or not adequate functional egress for maxillary secretion, drainage, or ventilation has been created or restored.(ABSTRACT TRUNCATED AT 250 WORDS)

Asunto(s)

Senos Etmoidales/cirugía , Sinusitis del Etmoides/cirugía , Sinusitis Maxilar/cirugía , Seno Esfenoidal/cirugía , Humanos , Membrana Mucosa , Recurrencia , Reoperación/métodos

RESUMEN

In this study, the computed tomography scans of 100 patients with chronic hyperplastic rhinosinusitis were reviewed to establish a clinical staging system. Fourteen percent of the patients were classified as Stage I (single-focus disease); 36% as Stage II (multifocal disease responsive to conservative therapy); 32% as Stage III (diffuse disease partially responsive to medication); and 16% as Stage IV (diffuse disease associated with bony changes and poorly responsive to conservative treatment). The incidence of recurrent or persistent disease ranged from 13% for Stage II to 30% for Stage IV. Stage I and III patients had 13% and 18% recurrence rates, respectively. Computed tomography staging is shown to be useful in outlining operative strategies and is a reliable prognosticator of the disease process.

Asunto(s)

Senos Paranasales/diagnóstico por imagen , Sinusitis/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Enfermedad Crónica , Humanos , Hiperplasia , Rinitis/clasificación , Rinitis/diagnóstico por imagen , Rinitis/terapia , Sinusitis/clasificación , Sinusitis/terapia

RESUMEN

In this retrospective study, 72 obstructive sleep apnea patients with polysomnograms taken before and after uvulopalatopharyngoplasty were evaluated. Postoperatively, there was a significant improvement of sleep architecture and respiratory indices. In addition, a second group of 17 patients also had position recordings with their polysomnograms. Time spent in supine and lateral sleep positions changed postoperatively. There was significant decrease of the apnea plus hypopnea index in the lateral position. This study indicates that there is significant improvement of sleep architecture and respiratory indices in the majority of patients after uvulopalatopharyngoplasty, particularly in the lateral sleep position.

Asunto(s)

Hueso Paladar/cirugía , Faringe/cirugía , Síndromes de la Apnea del Sueño/fisiopatología , Síndromes de la Apnea del Sueño/cirugía , Sueño/fisiología , Úvula/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Postura , Respiración/fisiología , Estudios Retrospectivos

RESUMEN

In this retrospective study, 34 patients with recurrent hyperplastic rhinosinusitis who subsequently underwent further surgical intervention were evaluated with computed tomography scans in order to assess the role of computed tomography in revision sinus surgery. Fourteen of these patients had originally undergone sphenoethmoidectomies, 8 had endoscopic sinus surgeries, 6 had Caldwell-Luc operations, and 6 had intranasal antrostomies. Computed tomography scan was instrumental in correctly identifying the site and reasons for failure and assisted in localizing further surgical intervention to the appropriate sites in 30 patients. The indications for computed tomography and revision surgery are discussed and defined.

Asunto(s)

Sinusitis del Etmoides/diagnóstico por imagen , Sinusitis Maxilar/diagnóstico por imagen , Sinusitis del Esfenoides/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Sinusitis del Etmoides/cirugía , Femenino , Humanos , Hiperplasia , Masculino , Sinusitis Maxilar/cirugía , Reoperación , Estudios Retrospectivos , Sinusitis del Esfenoides/cirugía

RESUMEN

Ethmoidectomy is an operation that has engendered controversy concerning the best route of surgical access. The purpose of this study was to present the results of the authors' experience in more than 1300 intranasal sphenoethmoidectomies and transantral sphenoethmoidectomies performed over a 20-year period. The authors contend that the most effective ethmoidectomy is the most complete ethmoidectomy and have previously presented a case for ethmoid marsupialization. Polyp recurrence rates of less than 20% and a major complication rate of less than 1% were reported in this study.

Asunto(s)

Sinusitis del Etmoides/cirugía , Pólipos Nasales/cirugía , Sinusitis del Esfenoides/cirugía , Drenaje/métodos , Endoscopía , Humanos , Métodos , Cavidad Nasal/cirugía , Tomografía Computarizada por Rayos X , Cornetes Nasales/cirugía

RESUMEN

An increasing number of loud snorers seek medical attention because of the social impact of snoring as well as its association with sleep apnea. Uvulopalatopharyngoplasty is reported to reduce or eliminate snoring in the majority of patients; however, little data are available to document the procedure's success. From February 1987 through August 1988, 125 patients underwent uvulopalatopharyngoplasty for habitual snoring; many of these patients had also documented sleep apnea. Of the 74 patients who responded to a postoperative questionnaire, 64 (86.48%) indicated that their snoring was either completely eliminated or markedly reduced. Only two patients reported significant side effects.

Asunto(s)

Comportamiento del Consumidor , Ronquido/cirugía , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Paladar Blando/cirugía , Faringe/cirugía , Complicaciones Posoperatorias , Sueño , Úvula/cirugía

RESUMEN

In 1981, we described a new surgical technique featuring en bloc removal of infratemporal fossa malignancies. This approach offered a systematic resection of cancers in this region and was designated "stylohamular dissection" because the medial boundary of the bloc is surgical plane between the styloid process and the hamulus of the pterygoid. All structures lateral to this plane are removed, sparing the internal carotid artery. Since 1977, twenty infratemporal fossa and lateral skull base dissections have been performed for palliation of metastatic or recurrent disease in the infratemporal fossa. Most patients obtained palliation of trismus, facial pain, or relief from an unmanageable ulcerating lesion. This technique offers improved average disease-free intervals, as well as enhanced survival rates compared to non-en bloc resections. A summary of the case presentations, survival statistics, and surgical technique with detailed cadaver dissections are presented.

Asunto(s)

Neoplasias de la Boca/cirugía , Neoplasias Craneales/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Métodos , Persona de Mediana Edad , Neoplasias Faríngeas/cirugía , Neoplasias Craneales/secundario

RESUMEN

Advanced malignancies of the parotid gland frequently invade the parapharyngeal space and the infratemporal fossa. The majority of these lesions have not been cured by surgery and/or radiotherapy, and palliation or cure can only be achieved by en bloc resection of this region. Stylohamular dissection is a systematic method for en bloc resection of the infratemporal fossa and lateral skull base. From January 1980 until December 1987, 18 patients with advanced parotid malignancies underwent stylohamular dissection. Pathologic examination revealed the following diagnosis: adenocarcinoma (7), squamous cell carcinoma (5), high-grade mucoepidermoid carcinoma (2), metastatic adenocarcinoma (1), fibrosarcoma (1), malignant hemangiopericytoma (1), and melanoma (1). Nine patients in this series are alive after a mean follow-up period of 3.5 years (range 1 to 9 years). Three patients are dead of uncontrolled local disease and three of distant metastasis. Three patients died of unrelated causes. All patients except the three who had uncontrolled disease experienced marked palliation from their pain, trismus, and unmanageable ulcerative lesions after surgery. The operative morbidity was relatively low.

Asunto(s)

Neoplasias de la Parótida/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Métodos , Persona de Mediana Edad , Neoplasias de la Parótida/diagnóstico por imagen , Neoplasias de la Parótida/mortalidad , Neoplasias de la Parótida/patología , Radiografía , Tasa de Supervivencia

RESUMEN

This article reviews the most commonly performed intranasal and extranasal sinus operations. The indications, complications, and functional results of each are presented. Endoscopic approaches should be used in conjunction with standard techniques in order to supplement and improve the efficiency of standard techniques of sinus surgery.

Asunto(s)

Enfermedades de los Senos Paranasales/cirugía , Procedimientos Quirúrgicos Operativos/métodos , Humanos

RESUMEN

Flexible pharyngoscopy with the Müller maneuver has been proposed as a method for selection of uvulopalatopharyngoplasty candidates. In this prospective study, its predictive efficacy has been evaluated in 24 consecutive obstructive sleep apnea patients undergoing uvulopalatopharyngoplasty. FPMM enabled us to accurately predict the uvulopalatopharyngoplasty outcome in 12 of the 24 patients (50%). Although flexible pharyngoscopy with the Müller maneuver appears to be helpful in the selection of candidates for UPP, its distinct predictive efficacy is low.

Asunto(s)

Obstrucción de las Vías Aéreas/fisiopatología , Paladar Blando/cirugía , Faringe/cirugía , Síndromes de la Apnea del Sueño/cirugía , Úvula/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Endoscopía , Femenino , Humanos , Hipofaringe/fisiopatología , Masculino , Persona de Mediana Edad , Paladar Blando/fisiopatología , Faringe/fisiopatología , Valor Predictivo de las Pruebas , Cuidados Preoperatorios , Estudios Prospectivos , Síndromes de la Apnea del Sueño/fisiopatología , Úvula/fisiopatología

RESUMEN

Recently, neurotization has been proposed for providing mobility to the pectoralis major, or other myocutaneous flap in lingual reconstruction following total glossectomy. The development of an active tongue-like structure may offer the patient higher potential for rehabilitation of speech and deglutition. The purpose of this thesis is to report experimental and clinical observations on neurotization of the pectoralis major myocutaneous flap. The pectoralis major myoflap of 16 rats was reinnervated by either a hypoglossal nerve pedicle of hypoglossal-genioglossus muscle neuromuscular pedicle. Functional flap reinnervation was confirmed in eight of the 16 animals. The author's clinical experience with reconstruction of the tongue utilizing neurotized pectoralis major myocutaneous flap is presented.

Asunto(s)

Nervio Hipogloso/trasplante , Músculos Pectorales/trasplante , Colgajos Quirúrgicos , Lengua/cirugía , Adulto , Anciano , Animales , Electromiografía , Potenciales Evocados , Femenino , Glosectomía , Humanos , Nervio Hipogloso/anatomía & histología , Nervio Hipogloso/fisiología , Contracción Isométrica , Masculino , Persona de Mediana Edad , Miosinas/análisis , Fibras Nerviosas/ultraestructura , Regeneración Nerviosa , Músculos Pectorales/enzimología , Músculos Pectorales/inervación , Ratas

RESUMEN

From July, 1982 through March, 1986, 253 patients with moderate to severe sleep apnea (OSA) were treated and had polysomnographic assessment of treatment. The treatment modalities were: 1. uvulopalatopharyngoplasty (UPP), 2. nasal continuous positive airway pressure (CPAP), 3. tracheostomy, 4. medication (tricyclic antidepressants), 5. tongue retaining device (TRD), and 6. orthodontic device. Uvulopalatopharyngoplasty was performed in 98 patients. The patients were categorized according to post-treatment improvement in the apnea/hypopnea index (A+HI) and severity index (SI) into good, moderate, and poor responders. There were 37 (37.7%) good, 33 (33.6%) moderate, and 28 (28.5%) poor responders in this group. Twenty-four patients underwent tracheostomy. Eighteen (75%) patients continue to have their tracheostomies without complications (mean follow-up time 32 months). One hundred thirty-eight patients were evaluated with CPAP. Of the 100 patients who began home CPAP use, 53 continue to use CPAP successfully at 18 months. Medical treatment (tricyclic antidepressants) was used in 35 patients. The response to this modality was generally poor. Six patients were fitted with TRD. The compliance to this device was poor, although two have had significant improvement in their apnea. An orthodontic appliance was used in two patients with one responding successfully.

Asunto(s)

Síndromes de la Apnea del Sueño/terapia , Antidepresivos Tricíclicos/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Aparatos Ortodóncicos Removibles , Hueso Paladar/cirugía , Faringe/cirugía , Respiración con Presión Positiva , Traqueostomía , Úvula/cirugía

RESUMEN

This report presents our experience with nasopharyngeal complications of UPPP in 85 patients undergoing the procedure from May, 1982 to January, 1985. Three patients developed nasopharyngeal stenosis and one patient developed permanent velopharyngeal insufficiency. Surgical management in two patients with nasopharyngeal stenosis resulted in adequate nasopharyngeal airway, while one patient still has a moderate stenosis following two surgical procedures. The patient with velopharyngeal insufficiency underwent Teflon paste injection in the posterior pharyngeal wall. This resulted in complete alleviation of his nasal regurgitation.

Asunto(s)

Hueso Paladar/cirugía , Faringe/cirugía , Complicaciones Posoperatorias , Síndromes de la Apnea del Sueño/cirugía , Úvula/cirugía , Constricción Patológica , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Nasofaríngeas/etiología , Insuficiencia Velofaríngea/etiología

RESUMEN

In this retrospective study, the accuracy of preoperative staging by high-resolution CT and clinical evaluation (indirect-direct laryngoscopy) is compared to the postsurgical pathologic staging of laryngeal cancer. Forty-two patients who were admitted to St. Louis University Hospital between the years of 1978 to 1985 with diagnoses of laryngeal cancer were included. All patients received high-resolution CT scan of the larynx preoperatively and subsequently underwent total or partial laryngectomy. None of these patients received preoperative radiotherapy. The accuracy of the clinical vs. CT staging--as well as the accuracy of the staging by combination of the two modalities--was determined by comparison with the postsurgical pathologic staging. The accuracy was assessed separately for glottic, supraglottic, and transglottic carcinoma. The accuracy of CT staging for glottic carcinoma was 75%. However, clinical evaluation in this group of lesions was very reliable, offering 92.9% accuracy. The accuracy of CT staging increased in the supraglottic and transglottic lesions, to become superior to the clinical staging. With combined information gained by both examinations, the preoperative staging accuracy was 91.4% for supraglottic carcinoma and 87.5% for transglottic carcinoma. It is, therefore, recommended that high-resolution CT should be included in the preoperative staging of laryngeal cancer.

Asunto(s)

Carcinoma/diagnóstico por imagen , Neoplasias Laríngeas/diagnóstico por imagen , Estadificación de Neoplasias , Tomografía Computarizada por Rayos X , Carcinoma/patología , Carcinoma/cirugía , Humanos , Neoplasias Laríngeas/patología , Neoplasias Laríngeas/cirugía , Laringectomía , Laringoscopía , Estudios Retrospectivos