Cineradiography of the pharyngoesophageal segment in postlaryngectomy patients

The use of tracheoesophageal voice prostheses has gained wide acceptance in the field of vocal rehabilitation after total laryngectomy. In a randomize d study with 3 arms, alaryngeal speech proficiency was assessed in 60 postl aryngectomy patients: 20 patients underwent primary unilateral pharyngeal m yotomy, 21 patients underwent neurectomy of the pharyngeal plexus in additi on to pharyngeal myotomy, and 19 patients did not undergo an additional sur gical procedure. Pharyngoesophageal (PE) dynamics were examined during esop hageal and tracheoesophageal speech. A single vibrating PE segment was seen in good alaryngeal speakers. Hypertonicity, spasm, strictures, and hypoton icity of the PE segment were correlated significantly with poor or moderate alaryngeal speech. Unilateral myotomy with or without unilateral neurectom y prevented hypertonicity or spasm of the PE segment. The acquisition of al aryngeal speech did not differ significantly between the 2 groups who had u ndergone an additional surgical procedure. Evaluation of anatomic and physi ological factors may be helpful in subsequent clinical management to achiev e effective alaryngeal speech.