title: Complications that affect postlaryngectomy voice restoration: primary surgery vs salvage surgery.
abstract: OBJECTIVE
  To assess the effect of primary treatment on tracheoesophageal voice prosthesis (TEP) complications.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  The Johns Hopkins Medical Institutions, Baltimore, Maryland.
  
  
  METHODS
  Patients who underwent total laryngectomy and TEP between January 1, 1998, and December 31, 2008, were divided into 3 subgroups according to primary treatment: surgery (n = 81), radiotherapy (n = 61), and chemoradiotherapy (n = 32).
  
  
  METHODS
  Number of weeks before leakage through the TEP, occurrence of leakage around the TEP, TEP dislodgement, and size changes 6 months or longer after laryngectomy.
  
  
  RESULTS
  A total of 174 patients met the study criteria. Of the 81 patients who underwent primary surgery, 81% (n = 66) underwent adjuvant therapy with postoperative radiotherapy or chemoradiotherapy. The incidence of leakage around the prosthesis, prosthesis dislodgement, and size changes 6 months or longer after laryngectomy were significantly higher for patients who required salvage total laryngectomy after chemoradiotherapy or radiotherapy (P < .05). In addition, significantly more patients who underwent salvage total laryngectomy required extended laryngectomy or free tissue reconstruction.
  
  
  CONCLUSIONS
  Voice prosthesis complications are more frequently encountered in those who require salvage laryngectomy. Understanding the potential for such complications reinforces the need for close communication and follow-up with these patients by the speech language pathologist.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, MD 21287, USA. hstarme1@jhmi.edu
authors.forename: Heather M
authors.initials: HM
authors.lastname: Starmer
authors.forename: Stacey L
authors.initials: SL
authors.lastname: Ishman
authors.forename: Paul W
authors.initials: PW
authors.lastname: Flint
authors.forename: Nasir I
authors.initials: NI
authors.lastname: Bhatti
authors.forename: Jeremy
authors.initials: J
authors.lastname: Richmon
authors.forename: Wayne
authors.initials: W
authors.lastname: Koch
authors.forename: Kimberly
authors.initials: K
authors.lastname: Webster
authors.forename: Ralph
authors.initials: R
authors.lastname: Tufano
authors.forename: Christine G
authors.initials: CG
authors.lastname: Gourin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007822:Laryngeal Neoplasms / Q000601:surgery*; D007825:Laryngectomy / Q000009:adverse effects*; D007831:Larynx, Artificial; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D011475:Prosthesis Failure; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D014832:Voice Disorders / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D014833:Voice Quality / Q000502:physiology*