Myomucosal shunt following total laryngectomy: a report of 31 cases.
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.
Brasnu
D
D
Service d'Otorhinolaryngologie, Hôpital Laënnec, Université René Descartes, Paris, France.
Strome
M
M
Ménard
M
M
Pfauwadel
M C
MC
Martinez
P
P
Janot
F
F
Laccourreye
H
H
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