Accurate clinical assessment of laryngeal involvement with LPRD is likely to be difficult because laryngeal physical findings cannot be reliably determined from clinician to clinician. Such variability makes the precise laryngoscopic diagnosis of LPRD highly subjective.

Several authors have eloquently described the characteristics of vocal fold scar, a long-term consequence of vocal fold injury. However, events in the acute stage of mucosal injury, which lead up to fibrosis, have been largely overlooked. The current study describes acute events with regard to mucosal re-formation in a rabbit model. Vocal fold injury was induced surgically. A fibrinous clot was present 1 day after injury. Massive cellular infiltration was noted on day 3, and complete epithelial coverage was achieved by day 5. Also, neo-matrix deposition was noted as early as 5 days after injury, and more mature collagen was seen by day 7. The general timetable described in the current study can contribute to the experimental foundation for the development of regenerative models of healing in the vocal folds. Most notably, the proliferation phase of wound healing appears to occur approximately 3 days after injury, indicating a critical time for intervention. Manipulation and/or alteration of naturally occurring neo-matrix deposition and organization may yield improved biophysical function of the injured vocal fold.

The current study retro specti vely review ed the cases of 68 patient s who had undergone total laryn gectomy and tracheoesophageal pun cture (TEP) ove r a lo-year period. Fifty-one patients under went p rimary TEP and i 7 underw ent seconda ry TEP. Nearly 80% of pati ents who received TEP at the time of laryngectomy achieved excellent voice quality perceptu ally. in contrast, only 50% of secondary TEP patients achieved excellent voice ratings. This diff erence was statistically robust (p = 0.03). A lthough both surgical and prosthesis-related comp lications occurred more fre quently fo llo wing prim ary TEp, statistically significant differences were not achieved. Neith er pre-nor p ostoperati ve radi oth erapy had any effe ct on voice restoration or complication rates. Based on thes e data, p rimary TEP may be pref erable fo r several reasons, ineluding a greater likelihood ofsuccessful voice restorati on, a sho rter duration ofpostoperat ive aphonia, and the elimination ofthe needf or a second opera tion and interim tube f eedin gs.

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