Selective Myotomy for Voice Restoration After Total Laryngectomy

TLDR

Reconstruction of the pharyngoesophagus after total laryngectomy prevents salivary fistulae and restores swallowing, while vocal rehabilitation relies on a pharyngoesophageal segment capable of sound production via air insufflation. Closure is achieved with multilayer tissue, selected sutures, postoperative radiation, and modified neck dissection, and the study assessed percutaneous pharyngeal plexus block followed by cricopharyngeus and pharyngeal constrictor myotomy in 14 patients. In a three‑year series of 129 patients, 12% failed to achieve satisfactory speech after tracheoesophageal puncture because of pharyngoesophageal spasm, indicating that increased pharyngoesophageal tone is a key factor in voice failure.

Abstract

Reconstruction of the pharyngoesophagus after total laryngectomy avoids the development of salivary fistulae and restores satisfactory swallowing. Successful techniques for closure include multiple layers of tissue, selected suture materials, the application of postoperative radiation therapy, and modified neck dissection. In addition, vocal rehabilitation has been traditionally associated with the formation of a pharyngoesophageal segment capable of producing sound after air insufflation. A three-year experience with 129 patients after they underwent a total laryngectomy and tracheoesophageal shunt showed that 16 patients (12%) failed to achieve satisfactory speech after tracheoesophageal puncture because of pharyngoesophageal spasm. Response to percutaneous block of the pharyngeal plexus and subsequent myotomy of the cricopharyngeus and pharyngeal constrictor muscles was assessed in 14 patients. Increased pharyngoesophageal tone after total laryngectomy seems to be an important factor in the failure to acquire esophageal voice.