title: Tracheoesophageal voice after total laryngopharyngectomy reconstruction: Jejunum versus radial forearm free flap.
abstract: OBJECTIVE
  Tracheoesophageal (TE) voice restoration after laryngopharyngectomy with jejunal (Jej) flap and radial forearm flap (RFF) reconstruction has been successfully completed and studied for both techniques, but no direct comparisons exist. We undertook this study to directly compare TE voice in patients with total laryngopharyngectomy (TLP) reconstruction using the Jej and the RFF in a comprehensive and rigorous manner.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Forty patients after total laryngectomy or TLP were grouped by pharyngeal closure method: 18 primary closure (STL), 10 jejunal flap (TLP-Jej), and 12 radial forearm flap (TLP-RFF). Voice recordings underwent objective acoustic analysis and blinded subjective assessment by trained and naïve listeners. Quality-of-life (QOL) assessments were obtained in all subjects using general health, disease-specific, and voice-specific survey tools.
  
  
  RESULTS
  All studies groups had similar demographics. Acoustic analysis demonstrated no differences in fundamental frequency or intensity levels. Subjective assessment demonstrated statistically significant inferior voice function of the reconstructed patients (TLP-Jej and TLP-RFF) compared to STL subjects for nearly all parameters tested by both naïve and trained listeners. No differences were noted between TLP-Jej and TLP-RFF subjects for any of the parameters evaluated. Overall, trained listeners assessed TE voice more favorably compared to naïve listeners in a significant manner. The three QOL surveys revealed no significant differences between TLP-Jej and TLP-RFF subjects.
  
  
  CONCLUSIONS
  Tracheoesophageal voice in TLP-Jej and TLP-RFF subjects was equivalent but inferior to STL subjects. Reconstructed subjects had no differences in general, disease-specific, and voice-specific quality of life.
  
  
  METHODS
  2b.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Deschler
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Brooke Army Medical Center, San Antonio, Texas.
authors.forename: Marc W
authors.initials: MW
authors.lastname: Herr
authors.affiliation: Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.
authors.forename: Joann R
authors.initials: JR
authors.lastname: Kmiecik
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts.
authors.forename: Rosh
authors.initials: R
authors.lastname: Sethi
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts.
authors.forename: Glenn
authors.initials: G
authors.lastname: Bunting
mesh_terms: D000368:Aged; D005260:Female; D005542:Forearm; D058752:Free Tissue Flaps / Q000706:statistics & numerical data*; D006801:Humans; D007583:Jejunum; D007825:Laryngectomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010611:Pharyngectomy / Q000379:methods*; D011788:Quality of Life; D012189:Retrospective Studies; D013071:Speech, Alaryngeal / Q000379:methods* / Q000523:psychology; D014833:Voice Quality
keywords: Total laryngopharyngectomy; jejunal free flap; quality of life; radial forearm free flap; tracheoesophageal voice