[Prosthetic voice rehabilitation after laryngectomy. Failures and complications after previous radiation therapy].
BACKGROUND
Indwelling voice prostheses are state of the art for post-laryngectomy voice rehabilitation. The aim of this study was to identify the impact of radiation prior to tracheoesophageal puncture on success rate and complications.


METHODS
We undertook a retrospective study of 145 patients who had undergone prosthetic voice restoration between 1990 and 2002 (Provox) and Provox2). Risks of functional failure and complications in 17 patients with previous radiation therapy were compared to those of 128 patients without such therapy.


RESULTS
Previous radiation increased not only the risk of functional failure by 2.9 (P=0.023), but also the risk of shunt-related complications such as aspiration around the prosthesis (1.51; P=0.046), widening of the shunt (2.32; P=0.014), esophageal (2.51; P=0.013) or tracheal (3.29; P=0.0023) dislocation of the prosthesis and spontaneous (2.51; P=0.047) or surgical closure (3.76; P=0.037) of the shunt.


CONCLUSIONS
Primary tracheoesophageal puncture during laryngectomy is recommended in cases without previous radiation therapy, especially when post-laryngectomy radiation is likely. In patients with previous radiation therapy, generally good success rates decrease, however, without absolute contraindication of tracheoesophageal puncture. These results may affect salvage surgery concepts.
Kummer
P
P
Abteilung für Phoniatrie und Pädaudiologie, Universitätsklinikum Erlangen. peter.kummer@phoni.imed.uni-erlangen.de
Chahoud
M
M
Schuster
M
M
Eysholdt
U
U
Rosanowski
F
F
D000328:Adult; D000368:Aged; D019544:Equipment Failure Analysis; D004947:Esophagus / Q000528:radiation effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D007822:Laryngeal Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D007825:Laryngectomy / Q000534:rehabilitation*; D007831:Larynx, Artificial / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries / Q000150:complications; D012189:Retrospective Studies; D012306:Risk; D014132:Trachea / Q000528:radiation effects