Prevention of pharyngoesophageal spasm after laryngectomy with a half-muscle closure technique

Because pharyngoesophageal spasm can limit successful voice restoration aft er total laryngectomy, 24 patients underwent a modified pharyngeal closure in an effort to avoid this problem. All patients underwent total laryngecto my with appropriate neck dissections and pharyngeal closure with a half-mus cle closure technique in which only one side of the remnant constrictor mus cles was used to reinforce the primary closure. Twenty-three patients under went voice restoration. Twenty-two (96%) had a functional voice, and 1 pati ent (4%) had pharyngoesophageal spasm that required a secondary myotomy. On e fistula (4%) occurred and resolved with conservative measures. Quantitati ve voice analysis demonstrated no significant differences between half-clos ure patients and control patients for fundamental frequency (96 Hz versus 1 01 Hz) or intensity (57 dB versus 64 dB). Extensive qualitative analysis by trained and naive listeners revealed no differences. This preliminary repo rt indicates the half-muscle closure modification of the pharyngeal closure at primary laryngectomy may provide a simple and effective means of avoidi ng pharyngoesophageal spasm and maintaining an effective voice without incr eased complications.