VOCAL FUNCTION FOLLOWING VERTICAL HEMILARYNGECTOMY - COMPARISON OF 4 RECONSTRUCTION TECHNIQUES IN THE CANINE

The goals of laryngeal reconstruction have been prevention of aspirati on, production of a functional voice, and maintenance of an adequate a irway for decannulation. A number of procedures for partial laryngeal reconstruction have accomplished these objectives. However, few studie s have attempted to compare patients' vocal characteristics following different reconstruction procedures. In this study, an in vivo canine model was used to compare acoustic and aerodynamic measures of vocal f unction for the following vertical hemilaryngectomy reconstruction tec hniques: 1) a superiorly based sternohyoid muscle flap, 2) a modified epiglottic laryngoplasty, 3) a new procedure using a layered vasculari zed buccal mucosal flap and a transversely oriented sternohyoid muscle flap, and 4) hemilaryngeal transplantation combined with arytenoid ad duction. Hemitransplantation provided the most efficient phonation of the four techniques. The vascularized buccal mucosa flap produced the best phonation of the autologous tissue techniques examined. Both vasc ularized buccal mucosa flap and hemilaryngeal transplantation subjects demonstrated a mucosal wave on stroboscopy. The results indicate that vocal function will improve as the layered structure of the vocal fol d is more accurately replicated in a reconstructed hemilarynx. Endosco pic findings and whole organ sections are presented.