Tracheoesophageal speech failure in the laryngectomee: the role of constrictor myotomy.
Drs. Singer and Blom pioneered the development of a valved voice prosthesis and controlled fistula between the tracheal and esophageal wall to generate fluent esophageal speech in laryngectomy patients. Since then numerous voice prostheses with different performance capacities have entered the marketplace. In spite of optimal choices and fitting of devices, there remains a population of patients refractory to this type of rehabilitation. It is our experience that a number of patients ultimately benefit from middle and inferior constrictor myotomy with marked improvement in their speech. Patient selection, evaluation, and operative techniques are discussed. Five patients who were unable to speak even after introduction of various commercially available devices showed marked improvement after middle and inferior constrictor surgical myotomy. Minimal complications were encountered even in irradiated patients. These patients were preoperatively injected with Xylocaine to produce a partial blockade. Their speech improved dramatically for the duration of Xylocaine blockade. Esophageal video fluoroscopy of attempted speech with the voice prosthesis in place confirmed constrictor spasm that opposed air flow to the oropharynx. Inferior and middle constrictor myotomy appears to be very beneficial in rehabilitation of failed alaryngeal speakers who demonstrate pharyngeal constrictor spasm.
D000368:Aged; D005260:Female; D006801:Humans; D007825:Laryngectomy / Q000534:rehabilitation*; D007831:Larynx, Artificial; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction; D009132:Muscles / Q000601:surgery*; D010609:Pharyngeal Muscles / Q000502:physiology / Q000601:surgery*; D013071:Speech, Alaryngeal