An Endoscopic Technique for Restoration of Voice after Laryngectomy

TLDR

Reports of voice restoration after total laryngectomy have used diversion of exhaled air via fistulae and modified tracheal cannulas, but these techniques suffer from aspiration, scar closure, wound complications, and inconsistent voice outcomes. The study reports a two‑year experience with an endoscopic method employing a unique valved prosthesis that eliminates the need for complex surgical reconstructions, aspiration, and stenosis. The endoscopic procedure uses a valved prosthesis, requires brief hospitalization and a short speech‑therapy period, making it a cost‑effective voice rehabilitation program. In 90 % of 60 patients the technique produced fluent voices with only one swallowing issue, and the majority had prior radiation or neck dissection; the method was simple, complication‑free, and encouraging.

Abstract

Reports of restoration of voice after total laryngectomy include diversion of exhaled pulmonary air though planned or spontaneous fistulae with a variety of modified tracheal cannulas and valves. Limitations of these techniques include aspiration, scar closure of the shunts, wound complications, and failure to achieve voice consistently. We report a two-year experience with an endoscopic method using a unique valved prosthesis eliminating complicated surgical reconstructions, aspiration, and stenosis. Fifty-four of 60 patients (90%) achieved fluent voices with one deglutition problem. Radiation therapy preceded voice restoration in 63% of the patients and radical neck dissection in 72%. The endoscopic procedure, hospitalization and period of speech therapy are short and constitute a cost-effective voice rehabilitation program. The results of this simple method and lack of complications are encouraging.