VOICE REHABILITATION AFTER TOTAL LARYNGECTOMY AND TRACHEOESOPHAGEAL PUNCTURE USING NONMUSCLE CLOSURE

The successful production of voice with a tracheoesophageal puncture ( TEP) and voice prosthesis requires a compliant pharyngoesophageal segm ent. Speech failure is commonly attributed to spasm of the pharyngoeso phageal segment. During total laryngectomy (TL), a 3-layer closure is typically performed. This prospective single-arm study examines the sa fety and efficacy of TL and TEP with nonclosure of the pharyngeal musc ulature to prevent pharyngoesophageal spasm as an alternative to 3-lay er closure with pharyngeal plexus neurectomy and/or pharyngeal constri ctor myotomy. Twenty-one consecutive patients were enrolled by a singl e surgeon. The mean duration of follow-up was 19.5 +/- 7.9 months. Sur gical complications and voice rehabilitation outcomes were examined. A n overall complication rate of 28.5% was observed. Fluency was achieve d in 75% of patients within a mean of 4.3 +/- 5.1 months. Speech failu re was attributable to early primary site and neck recurrence (5%), hy poglossal nerve palsy (5%), hypopharyngeal structure and recurrence (5 %), dementia (5%), and intransigent alcohol abuse (5%). Pharyngeosopha geal spasm was not observed in any subjects. We conclude that primary TEP with nonclosure of the pharyngeal muscle during TL is relatively s afe. Furthermore, it is preferable over 3-layer closure because it avo ids pharyngeosophageal spasm, a factor limiting voice rehabilitation.