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Voice rehabilitation after total laryngectomy and tracheoesophageal puncture using nonmuscle closure.

Abstract
The successful production of voice with a tracheoesophageal puncture (TEP) and voice prosthesis requires a compliant pharyngoesophageal segment. Speech failure is commonly attributed to spasm of the pharyngoesophageal segment. During total laryngectomy (TL), a 3-layer closure is typically performed. This prospective single-arm study examines the safety and efficacy of TL and TEP with nonclosure of the pharyngeal musculature to prevent pharyngoesophageal spasm as an alternative to 3-layer closure with pharyngeal plexus neurectomy and/or pharyngeal constrictor myotomy. Twenty-one consecutive patients were enrolled by a single surgeon. The mean duration of follow-up was 19.5 +/- 7.9 months. Surgical complications and voice rehabilitation outcomes were examined. An overall complication rate of 28.5% was observed. Fluency was achieved in 75% of patients within a mean of 4.3 +/- 5.1 months. Speech failure was attributable to early primary site and neck recurrence (5%), hypoglossal nerve palsy (5%), hypopharyngeal stricture and recurrence (5%), dementia (5%), and intransigent alcohol abuse (5%). Pharyngoesophageal spasm was not observed in any subjects. We conclude that primary TEP with nonclosure of the pharyngeal muscle during TL is relatively safe. Furthermore, it is preferable over 3-layer closure because it avoids pharyngoesophageal spasm, a factor limiting voice rehabilitation.
AuthorsR A Clevens, R M Esclamado, D O Hartshorn, J S Lewin
JournalThe Annals of otology, rhinology, and laryngology (Ann Otol Rhinol Laryngol) Vol. 102 Issue 10 Pg. 792-6 (Oct 1993) ISSN: 0003-4894 [Print] UNITED STATES
PMID8215100 (Publication Type: Journal Article)
Topics
  • Esophagus (surgery)
  • Female
  • Humans
  • Laryngectomy (methods, rehabilitation)
  • Larynx, Artificial
  • Male
  • Middle Aged
  • Pharyngeal Muscles (surgery)
  • Prospective Studies
  • Punctures
  • Speech Intelligibility
  • Trachea (surgery)

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