Revision surgery of a stenotic speaking shunt in near-total laryngectomy patients.
A near-total operation to create a speaking shunt is generally considered a suitable option in most T3 laryngopharyngeal cancer cases. However, some of these cases incur postoperative problems, including aspiration and shunt stenosis. In this 8-year study, 15 of 60 patients who had received near-total laryngectomies could not speak well with their shunts. Revision surgery was performed on 11. Under local anesthesia, the lumen of the stenotic segment of the shunt was opened. A 4-F silicone tube was stented in the shunt. Then, for mildly stenotic cases, the small mucosal defect of the shunt was covered by a sternohyoid myofascial flap. For moderate to severe cases, the larger mucosal defect was reconstructed with a free skin graft. Thereafter, a sternohyoid muscle flap was used to cover the skin graft, which would finally form the inner lining of the new speaking shunt. The outcome was that 9 of the 11 patients acquired intelligible shunt speech. These results demonstrate that the augmentation procedures described herein have considerable potential for restoring the function of a stenotic speaking shunt in a near-total laryngectomy.
Department of Otolaryngology, Chang Gung Medical College and Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
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D000368:Aged; D005260:Female; D006801:Humans; D007825:Laryngectomy / Q000379:methods*; D007829:Laryngostenosis / Q000601:surgery*; D007830:Larynx / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D013065:Speech Intelligibility