Drs. Singer and Blom pioneered the development of a valved
voice prosthesis and controlled
fistula between the tracheal and esophageal wall to generate fluent
esophageal speech in
laryngectomy patients. Since then numerous
voice prostheses with different performance capacities have entered the marketplace. In spite of optimal choices and fitting of devices, there remains a population of patients refractory to this type of rehabilitation. It is our experience that a number of patients ultimately benefit from middle and inferior constrictor
myotomy with marked improvement in their speech. Patient selection, evaluation, and operative techniques are discussed. Five patients who were unable to speak even after introduction of various commercially available devices showed marked improvement after middle and inferior constrictor surgical
myotomy. Minimal complications were encountered even in irradiated patients. These patients were preoperatively injected with
Xylocaine to produce a partial blockade. Their speech improved dramatically for the duration of
Xylocaine blockade. Esophageal video fluoroscopy of attempted speech with the
voice prosthesis in place confirmed constrictor
spasm that opposed air flow to the oropharynx. Inferior and middle constrictor
myotomy appears to be very beneficial in rehabilitation of failed alaryngeal speakers who demonstrate pharyngeal constrictor
spasm.