Voice restoration after circumferential pharyngolaryngectomy with free jejunum repair

Speech restoration after circumferential pharyngolaryngectomy with free jej unal repair for advanced tumors of the hypopharyngo-esophageal tract remain s a difficult problem to solve. We report here the results of secondary voi ce restoration in six patients who received a Provox 2 type prosthesis and intensive speech therapy after circumferential pharyngolaryngectomy with fr ee jejunum repair. No patient had operative or post-operative complications due to insertion of the prosthesis. No patient had to have the prosthesis removed during the follow-up (8 to 14 months). Analysis of some acoustic pa rameters of voice (fundamental frequency, waveform perturbations) and quali tative characteristics of speech (intelligibility, pleasantness and accepta bility) demonstrated that all the patients were able to produce satisfactor y speech after tracheojejunum puncture and speech therapy and were satisfie d with their own ability to communicate. Our results are reassuring and we therefore advise that in patients undergoing free jejunum flap reconstructi on of the hypopharyngo-esophageal tract voice restoration should be attempt ed by placing a voice prosthesis through a secondary tracheo-esophageal pun cture and providing intensive speech training.