Laryngeal reconstruction for voice restoration after laryngectomy – a benefit for the patient?

Introduction:

Standard technique for voice restoration after total laryngectomy (LE) is the tracheoesophageal puncture (TEP) with voice prosthesis (VP) application. Surgical microvascular reconstruction is an alternative method. High quality of voice and swallowing can be achieved with both procedures; however, there are specific complications in both techniques. This study compares long-term functional results of both methods.

Methods:

All patients who received LE without any pharyngeal resection between 2006 and 2015 within a unique head and neck department were analyzed retrospectively. Voice rehabilitation was performed according to an internal algorithm and to the patients' choice. Success of voice restoration and swallowing function by VP or radial forearm flap was assess by an phoniatry expert.

Results:

74 Patients received LE without pharyngeal resection. 39 of these cases were reconstructed with a so-called laryngoplasty. The success rate of both methods, VP and laryngoplasty was equal. 14% of VP patients and 8% of laryngoplasty patients developed dysphagia. Major long-term complication was insufficiency of the fistula with aspiration (31%) in VP patients and stenosis of the laryngoplasty (21%) in the other group.

Discussion:

TEP with application of VP is the standard procedure for voice restoration after LE. Laryngoplasty is an alternative with a differing spectrum of long-term complications. Profound or fatal complications were rare, they only occurred in the VP group. Presuming a correct indication, laryngoplasty may be a reasonable alternative to TEP and VP in LE patients for voice restoration although it is associated with a higher surgical effort.

Publication History

Publication Date:
18 April 2018 (online)