title: [Pharyngeal constrictor muscles closure after total laryngectomy is that really beneficial?].
abstract: High pressure of pharyngo-esophageal segment is the most important factor of impaired development of alaryngeal speech (esophageal speech, tracheoesophageal speech) after total laryngectomy. To prevent pharyngo-esophageal spasm in Department of Otolaryngology in Szczecin are used: pharyngoesophageal plastic surgery with interposition of vascular thyroid flap, two-layer (only mucosa) non-muscular pharyngeal closure and tree-layer closure (mucosa and muscle layer leaving inferior pharyngeal constrictor unsutured).
  
  
  OBJECTIVE
  The aim of this study was to compare the pharyngo-esophageal pressure between patients after pharyngo-esophageal plastic surgery and following the non-muscular pharyngeal closure.
  
  
  METHODS
  One hundred eighty two subjects after total laryngectomy were enrolled in this study, and included 108 patients subjected to the pharyngo-esophageal plastic surgery, 44 patients who underwent the two-layer pharyngeal closure, and 30 patients with the tree-layer closure. To evaluate the pharyngo-esophageal pressures manometric tests were performed, and to asses the pharynx morphology videopharyngoscopy was used.
  
  
  RESULTS
  The average pharyngo-esophageal pressure in the group after the pharyngo-esophageal plastic surgery was 32 (min.-5, max. 50) mmHg. After the two-layer non-muscular pharyngeal closure mean pressure was 35 (min.-17, max.-40) mmHg, and after the tree-layer non-muscular pharyngeal closure the average pressure was 22,42 (min. 5, max. 40) mmHg. The average pharyngo-esophageal pressure was significantly lower (p < 0.01) among patients after the tree-layer non-muscular closure.
  
  
  CONCLUSIONS
  The study suggests that the tree-layer non-muscular pharyngeal closure with inferior pharyngeal constrictor unsutured is the preferable method to prevent pharyngo-esophageal spasm after total laryngectomy. However, the efficacy and safety of this surgical procedure should be explored in further multicenter studies.
authors.affiliation: Katedra i Klinika Otolaryngologii i Onkologii, Laryngologicznej Pomorskiej Akademii Medycznej--Szczecin. kkotolar@sci.pam.szczecin.pl
authors.forename: Czesława
authors.initials: C
authors.lastname: Tarnowska
authors.forename: Ewa
authors.initials: E
authors.lastname: Grochowska-Bohatyrewicz
authors.forename: Stanislaw
authors.initials: S
authors.lastname: Bień
authors.forename: Jarosław
authors.initials: J
authors.lastname: Sieczka
authors.forename: Ewa
authors.initials: E
authors.lastname: Jaworowska
authors.forename: Jakub
authors.initials: J
authors.lastname: Lubiński
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D015155:Esophageal Spasm, Diffuse / Q000517:prevention & control / Q000601:surgery; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000601:surgery; D007825:Laryngectomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010609:Pharyngeal Muscles / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods*; D011312:Pressure; D013072:Speech, Esophageal / Q000379:methods*; D013524:Surgical Flaps; D014832:Voice Disorders / Q000209:etiology; D014833:Voice Quality; D014834:Voice Training