Voice function in patients after extended fronto-lateral laryngectomy

The main purpose of this study was subjective and objective evaluation of v oice function before and after extended frontolateral laryngectomy, followe d by reconstruction with a mucochondrial graft from the nose. The next aim of this study was analysis of phoniatric and acoustic results depending on: (1)the extent and localization of the neoplastic process; (2) the wound-he aling process (including the time of decannulation and effective deglutitio n); (3) the substitute mechanism of phonation. In all, 40 patients (37 men and 3 women) having TIE (67.5%) and T2 (32.5%) glottic cancers were examine d before and after the operation. The ENT investigation included each patie nt's history from the beginning of illness, a subjective evaluation of the voice by patients before and after the operation, determination of laryngea l mobility of the larynx and indirect laryngoscopy during phonation. Phonia tric examination included voice recordings, average voice pitch, voice rang e, maximum phonation time, microlaryngoscopy and microstroboscopy. Acoustic analysis covered the harmonic structure of the voice, jitter, shimmer, noi se components and basic frequency. Results showed that the extent of the ne oplastic process before operation did not affect essential voice quality af ter operation in stage T1B and T2 disease. The maximum phonation time was s hortened in TIE patients from 16.5 s to 9.28 s and in T2 from 16.7 s to 9.8 s. The average voice pitch was decreased in TIE from 177.3 Hz to 111.74 Hz and in T2. from 163.8 to 99 Hz. A correlation between acoustic analysis an d phoniatric examinations was found. The value of the first formant decreas ed by 15.1 Hz, jitter increased 2%, shimmer increased 0.9 dB and basic freq uency decreased. The voice quality after operation showed a statistically s ignificant dependence on the mechanism of phonation. The best results were found in patients in whom phonation was the result of removing the vocal fo ld and postoperative scar vibration. The worst results were found in those patients with a sphincter mechanism of phonation.