title: Voice rehabilitation after total laryngectomy and tracheoesophageal puncture using nonmuscle closure.
abstract: The successful production of voice with a tracheoesophageal puncture (TEP) and voice prosthesis requires a compliant pharyngoesophageal segment. Speech failure is commonly attributed to spasm of the pharyngoesophageal segment. During total laryngectomy (TL), a 3-layer closure is typically performed. This prospective single-arm study examines the safety and efficacy of TL and TEP with nonclosure of the pharyngeal musculature to prevent pharyngoesophageal spasm as an alternative to 3-layer closure with pharyngeal plexus neurectomy and/or pharyngeal constrictor myotomy. Twenty-one consecutive patients were enrolled by a single surgeon. The mean duration of follow-up was 19.5 +/- 7.9 months. Surgical complications and voice rehabilitation outcomes were examined. An overall complication rate of 28.5% was observed. Fluency was achieved in 75% of patients within a mean of 4.3 +/- 5.1 months. Speech failure was attributable to early primary site and neck recurrence (5%), hypoglossal nerve palsy (5%), hypopharyngeal stricture and recurrence (5%), dementia (5%), and intransigent alcohol abuse (5%). Pharyngoesophageal spasm was not observed in any subjects. We conclude that primary TEP with nonclosure of the pharyngeal muscle during TL is relatively safe. Furthermore, it is preferable over 3-layer closure because it avoids pharyngoesophageal spasm, a factor limiting voice rehabilitation.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Michigan Hospitals, Ann Arbor.
authors.forename: R A
authors.initials: RA
authors.lastname: Clevens
authors.forename: R M
authors.initials: RM
authors.lastname: Esclamado
authors.forename: D O
authors.initials: DO
authors.lastname: Hartshorn
authors.forename: J S
authors.initials: JS
authors.lastname: Lewin
mesh_terms: D004947:Esophagus / Q000601:surgery*; D005260:Female; D006801:Humans; D007825:Laryngectomy / Q000379:methods* / Q000534:rehabilitation; D007831:Larynx, Artificial; D008297:Male; D008875:Middle Aged; D010609:Pharyngeal Muscles / Q000601:surgery; D011446:Prospective Studies; D011677:Punctures; D013065:Speech Intelligibility; D014132:Trachea / Q000601:surgery*