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

Journal Article (Journal Article)

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.

Full Text

Duke Authors

Cited Authors

  • Clevens, RA; Esclamado, RM; Hartshorn, DO; Lewin, JS

Published Date

  • October 1993

Published In

Volume / Issue

  • 102 / 10

Start / End Page

  • 792 - 796

PubMed ID

  • 8215100

International Standard Serial Number (ISSN)

  • 0003-4894

Digital Object Identifier (DOI)

  • 10.1177/000348949310201010

Language

  • eng

Conference Location

  • United States