title: Results of vocal rehabilitation using tracheoesophageal voice prosthesis after total laryngectomy and their predictive factors.
abstract: The aims of this retrospective study were to evaluate prosthetic voice restoration by tracheoesophageal puncture (TEP) in laryngectomized patients and to identify clinical factors correlated with functional outcomes. Between 2000 and 2008, 103 patients who underwent total laryngectomy or pharyngolaryngectomy (TPL) were included in our study. Functional outcomes were recorded 6 months postoperatively, and results were scored from 0 to 2 for oral diet and speech intelligibility. Lifetime of voice prosthesis and early and late complications were recorded. The impact of several clinical factors on functional outcomes, prosthetic valve lifetime and complications was assessed in univariate analysis. A total of 87 patients (84%) underwent TEP and speech valve placement (79 primary and 8 secondary punctures). Hypopharyngeal tumors (P = 0.005), circular TPL (P = 0.003) and use of a pectoralis major myocutaneous flap (P = 0.0003) were significantly associated with secondary TEP. Successful voice rehabilitation was obtained by 77 of 82 evaluable patients (82%). A high level of comorbidity (ASA score > or = 3; P = 0.003) was correlated to speech rehabilitation failure. The median device lifetimes were 7.6 and 3.7 months for Provox I and II speech valves, respectively. Minor leakage around the valve occurred in 26% of the patients. Late complications occurred in 14 patients (16%) including: severe enlargement of the fistula (n = 3), prosthesis displacement (n = 7) and granulation tissue-formation (n = 4). In conclusion the use of voice prosthesis showed a high success rate of vocal rehabilitation with an acceptable complication rate.
authors.affiliation: Département de Chirurgie, Institut Universitaire de la Face et du Cou, Centre Antoine Lacassagne, 33 avenue de Valombrose, 06189 Nice, France. alexandre.bozec@nice.fnclcc.fr
authors.forename: Alexandre
authors.initials: A
authors.lastname: Bozec
authors.forename: Gilles
authors.initials: G
authors.lastname: Poissonnet
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Chamorey
authors.forename: François
authors.initials: F
authors.lastname: Demard
authors.forename: José
authors.initials: J
authors.lastname: Santini
authors.forename: Frédéric
authors.initials: F
authors.lastname: Peyrade
authors.forename: Cécile
authors.initials: C
authors.lastname: Ortholan
authors.forename: Karen
authors.initials: K
authors.lastname: Benezery
authors.forename: Juliette
authors.initials: J
authors.lastname: Thariat
authors.forename: Anne
authors.initials: A
authors.lastname: Sudaka
authors.forename: Katia
authors.initials: K
authors.lastname: Anselme
authors.forename: Brigitte
authors.initials: B
authors.lastname: Adrey
authors.forename: Paul
authors.initials: P
authors.lastname: Giacchero
authors.forename: Olivier
authors.initials: O
authors.lastname: Dassonville
mesh_terms: D000328:Adult; D000368:Aged; D055154:Dysphonia / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D006801:Humans; D007825:Laryngectomy / Q000379:methods*; D007831:Larynx, Artificial; D008297:Male; D008875:Middle Aged; D010611:Pharyngectomy / Q000379:methods; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014138:Tracheoesophageal Fistula; D014833:Voice Quality; D014834:Voice Training