title: Myomucosal shunt following total laryngectomy: a report of 31 cases.
abstract: An original technique of voice rehabilitation following total laryngectomy based on the concept of a myomuscosal unit was originally described by Strome. Thirty-one cases of myomucosal shunts (MMS) are analyzed in the present report. The 14 initial cases failed because of a lack clinical and surgical experience and insufficient selection of the patients. Among the last 17 cases, 1 was lost to follow-up, 1 had an insufficient follow-up, and 2 patients refused to speak with the MMS instead of a patent shunt; 5 of the remaining patients had voices evaluated as excellent, 7 had voices interpreted as good and only 1 patient had a voice evaluated as poor. Aspiration was not a problem. Eleven patients were found to stenose their shunt, but fistula were recalibrated successfully. The MMs can be used safely in oncological surgery and only 1 of 31 deaths in our total experience was due to a local recurrence. These findings show that the MMS is a reliable procedure for voice restoration following total laryngectomy; a prosthesis is not required and there are currently no oncological limits to the procedure. However, a very close follow-up of the patients is required after surgery.
authors.affiliation: Service d'Otorhinolaryngologie, Hôpital Laënnec, Université René Descartes, Paris, France.
authors.forename: D
authors.initials: D
authors.lastname: Brasnu
authors.forename: M
authors.initials: M
authors.lastname: Strome
authors.forename: M
authors.initials: M
authors.lastname: Ménard
authors.forename: M C
authors.initials: MC
authors.lastname: Pfauwadel
authors.forename: P
authors.initials: P
authors.lastname: Martinez
authors.forename: F
authors.initials: F
authors.lastname: Janot
authors.forename: H
authors.initials: H
authors.lastname: Laccourreye
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D004944:Esophagoplasty / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007822:Laryngeal Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D007825:Laryngectomy; D008297:Male; D011183:Postoperative Complications / Q000534:rehabilitation*; D013071:Speech, Alaryngeal / Q000379:methods*; D013072:Speech, Esophageal / Q000379:methods*; D013536:Suture Techniques; D014132:Trachea / Q000601:surgery*; D014833:Voice Quality / Q000528:radiation effects