TRACHEOESOPHAGEAL VOICE FOLLOWING TUBED FREE RADIAL FOREARM FLAP RECONSTRUCTION OF THE NEOPHARYNX

Tracheoesophageal voice restoration after laryngectomy is possible wit h a variety of neopharyngeal reconstructions. We have used the tubed r adial forearm free flap for neopharyngeal reconstruction since 1991. S ix patients have undergone voice restoration with the Blom-Singer pros thesis and were available for quantitative and qualitative speech anal ysis. These patients were compared to five laryngectomy patients with standard pharyngeal closures and similar voice restorations. The free flap patients produced similar loudness levels compared to the standar ds with soft speech (52.06 dB and 47.19 dB, respectively) and loud spe ech (62.66 dB and 60.91 dB, respectively). The free flap patients demo nstrated adequate intelligibility, with fundamental frequencies compar able to standards (124.82 Hz and 135.66 Hz, respectively), although wi th increased jitter (5.00% versus 1.96%). No differences were statisti cally significant, but evaluation by trained and naive listeners demon strated significant differences in voice quality. This quantitative an d qualitative analysis of tracheoesophageal speech after radial forear m free flap reconstruction of the neopharynx demonstrates that accepta ble voice can be achieved, but with limitations.