title: Rehabilitation program for prosthetic tracheojejunal voice production and swallowing function following circumferential pharyngolaryngectomy and neopharyngeal reconstruction with a jejunal free flap.
abstract: The case of a 68-year-old woman with postoperative speech and swallowing problems following a circumferential pharyngolaryngectomy and neopharyngeal reconstruction with a jejunal free flap is presented. The primary tumor was an extended papillary thyroid carcinoma (pT4N0M0). For vocal restoration, an indwelling Provox(®) 1 voice prosthesis was inserted secondarily. The patient received speech and swallowing therapy, including digital maneuvers at the level of the proximal (cervical) part of the jejunal graft to improve speech and swallowing function. Pre- and/ or post-treatment data on speech and swallowing function were gathered using the following assessment methods: esophageal insufflation test, Voice Handicap Index (VHI), videofluoroscopy of phonation (VFSph), digital high-speed endoscopy of jejunal vibration during voice production, fiber-optic endoscopic evaluation of swallowing (FEES), and videofluoroscopy of swallowing (VFSs). This case clearly demonstrates that even after extensive laryngopharyngectomy with jejunal free flap reconstruction, a tailored rehabilitation program can improve both voice and swallowing function, and that these results clearly can be objectified/visualized, underlining the validity of this approach.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Centre, P. O. Box 5800, 6202 AZ Maastricht, The Netherlands. laura.baijens@mumc.nl
authors.forename: Laura W J
authors.initials: LW
authors.lastname: Baijens
authors.forename: Renée
authors.initials: R
authors.lastname: Speyer
authors.forename: Nel
authors.initials: N
authors.lastname: Roodenburg
authors.forename: Frans J M
authors.initials: FJ
authors.lastname: Hilgers
mesh_terms: D000368:Aged; D003679:Deglutition; D003680:Deglutition Disorders / Q000209:etiology / Q000534:rehabilitation* / Q000601:surgery; D005260:Female; D005471:Fluoroscopy; D058752:Free Tissue Flaps; D006801:Humans; D007583:Jejunum / Q000601:surgery; D007825:Laryngectomy / Q000009:adverse effects*; D007831:Larynx, Artificial; D010611:Pharyngectomy / Q000009:adverse effects*; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D014132:Trachea; D016896:Treatment Outcome; D014741:Video Recording; D014832:Voice Disorders / Q000209:etiology / Q000534:rehabilitation* / Q000601:surgery