Effect of primary neopharyngeal repair on acoustic characteristics of tracheoesophageal voice after total laryngectomy

Abstract

The four hypopharyngeal repair types--primary pharyngoesophageal myotomy, pharyngeal plexus neurectomy, non-muscle vertical repair and transverse hypopharyngeal repair--were almost equivalent in prevention of pharyngoesophageal spasm in total laryngectomy patients who had undergone primary tracheoesophageal puncture for voice restoration.

Contemporary Review: Impact of primary neopharyngoplasty on acoustic characteristics of alaryngeal tracheoesophageal voice

“…Employment of this procedure, instead of myotomy, also reduced concern about possible reduction of the vascularity of the pharyngeal muscles caused by myotomy. The technique of pharyngeal plexus neurectomy has been described in detail by Singer et al16 and more recently by Albirmawy et al17 The procedure has been used effectively to prevent or treat pharyngospasm 11, 15–17…”

“…3). Clevens et al19 and Albirmawy et al17 concluded that nonmuscle closure is a relatively safe and effective alternative to the standard three‐layer technique with primary pharyngeal plexus neurectomy or pharyngoesophageal myotomy.…”

“…Most wide‐field laryngectomies allow for horizontal closure of the mucosa and constrictor muscles unless there is resection of the pyriform sinus. Hamaker and Cheesman21 and Albirmawy et al17 have reported that patients undergoing horizontal closure of the neopharynx were 100% successful in establishing voice. However, the majority of their pharynges were considered somewhat hypotonic in comparison with patients undergoing other techniques.…”

“…Acoustic characteristics of T‐E speech have been studied following different surgical modalities used to address the neopharynx. One commonly followed method of acoustic analysis is the use of acoustic signals to assess different quantitative and qualitative parameters 17, 23, 29. Patients are asked to produce a sustained “A” at a comfortable pitch and at a conversational loudness level, on a single deep breath for as long as possible, over three successive trials.…”

“…In their study, Albirmawy et al17 evaluated both quantitative and qualitative T‐E voice parameters in alaryngeal patients undergoing four types of primary neopharyngeal repair: myotomy, pharyngeal plexus neurectomy, nonmuscle repair, and transverse repair. No statistically significant differences were found for quantitative parameters, comparing the four surgical groups.…”