Neoglottic formation from posterior pharyngeal wall conserved in surgery for hypopharyngeal cancer

Iwai, Hiroshi; Tsuji, Hiroyuki; Tachikawa, Takuya; Inoue, Tomio; Izumikawa, Masahiko; Yamamichi, Keigo; Yamashita, Toshio

doi:10.1016/s0385-8146(01)00147-x

Cited by 9 publications

(3 citation statements)

References 10 publications

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“…Hui et al 20 reported that, although a pharyngeal remnant of 1.5 cm was adequate to maintain swallowing function after primary closure, insertion of a voice prosthesis did not enable satisfactory phonation in patients with a neopharynx of such a small diameter. Iwai et al 21 found that primary closure of a pharyngeal remnant smaller than 3 cm often resulted in neopharyngeal stenosis or phonation dysfunction several years after surgery.…”

Section: Discussionmentioning

confidence: 99%

Effect of primary, cross-over, zigzag neopharyngoplasty on acoustic characteristics of alaryngeal, tracheoesophageal voice

Albirmawy

2011

J. Laryngol. Otol.

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Section: Discussionmentioning

confidence: 99%

Effect of primary, cross-over, zigzag neopharyngoplasty on acoustic characteristics of alaryngeal, tracheoesophageal voice

Albirmawy

2011

J. Laryngol. Otol.

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“…In the literature, various variables were found to affect functional outcomes. Among these, besides the extent of the resection, are the surgical method of pharynx closure and reconstruction (muscle closing techniques, donor site tissue properties), the conservation of the posterior pharyngeal wall, the degree and level of neoglottic closure during phonation (presence and place of the neoglottic bar and distance and intensity of contact between posterior and anterior wall), the pressure built up below the neoglottic bar during phonation (intraluminal pressure), the diameter of the pharynx (pharyngeal and esophageal volume and extension), previous or post-operative (chemo-)radiotherapy, and (the extent of) neck dissections [14,[16][17][18][19][20][21][22][23][24][25][26][27][28]. Although the extent of the surgical resection is primarly dictated by tumor extent, surgical techniques, such as neurectomy and upper esophageal myotomy, and the technique of pharynx (muscle) closure and type of reconstruction thus seem to be important phonosurgical aspects of TL.…”

Section: Introductionmentioning

confidence: 99%

Voice quality and surgical detail in post-laryngectomy tracheoesophageal speakers

Jacobi

Timmermans

Hilgers

et al. 2015

Eur Arch Otorhinolaryngol

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The objective of this study is to assess surgical parameters correlating with voice quality after total laryngectomy (TL) by relating voice and speech outcomes of TL speakers to surgical details. Seventy-six tracheoesophageal patients' voice recordings of running speech and sustained vowel were assessed in terms of voice characteristics. Measurements were related to data retrieved from surgical reports and patient records. In standard TL (sTL), harmonics-to-noise ratio was more favorable after primary TL + postoperative RT than after salvage TL. Pause/breathing time increased when RT preceded TL, after extensive base of tongue resection, and after neck dissections. Fundamental frequency (f0) measures were better after neurectomy. Females showed higher minimum f0 and higher second formants. While voice quality differed widely after sTL, gastric pull-ups and non-circumferential pharyngeal reconstructions using (myo-)cutaneous flaps scored worst in voice and speech measures and the two tubed free flaps best. Formant/resonance measures in/a/indicated differences in pharyngeal lumen properties and cranio-caudal place of the neoglottic bar between pharyngeal reconstructions, and indicate that narrower pharynges and/or more superiorly located neoglottic bars bring with them favorable voice quality. Ranges in functional outcome after TL in the present data, and the effects of treatment and surgical variables such as radiotherapy, neurectomy, neck dissection, and differences between partial or circumferential reconstructions on different aspects of voice and speech underline the importance of these variables for voice quality. Using running speech, next to sustained/a/, renders more reliable results. More balanced data, and better detail in surgical reporting will improve our knowledge on voice quality after TL.

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“…Hui et al25 reported that although a pharyngeal remnant of 1.5 cm is adequate to maintain swallowing function after primary closure, insertion of a voice prosthesis may cause dysphonia in patients with a neopharynx of such small diameter. Iwai et al26 reported that primary closure of a pharyngeal remnant smaller than 3 cm often results in neopharyngeal stenosis or dysfunction of phonation several years after surgery, despite repeated balloon dilatation procedures for the stenotic neopharynx. Among patients in whom the diameter of the closure was augmented with a patch flap (free radial forearm, free jejunum or pectoralis major myocutaneous) to widen the neopharyngeal diameter, better long‐term results were achieved with regard to swallowing and phonation.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2012

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The physiology of the vibratory mechanism in alaryngeal tracheoesophageal speech depends on several factors. The structure and resulting function of the neoglottis (or neopharynx) varies from patient to patient depending on the individual details of the surgical procedure performed, as well as the patient's anatomy. In general, the vibratory segment is a blending of the pharyngeal constrictor muscles, cricopharyngeus, and upper circular fibers of the esophagus. Limited ability to visualize dynamically these three-dimensional structures during rapid events of voice and speech production impedes complete understanding of the vibratory function of the neopharynx. Acoustic studies have elucidated some general characteristics of the pharyngoesophagus and neoglottic vibratory mechanism in the laryngectomized population. A critical degree of tonicity is necessary for apposition of mucosal surfaces in the production of tracheoesophageal voice. Deficiencies in the vibratory segment can usually be managed with various surgical procedures (neopharyngoplasty), resulting in reduced intraesophageal pressure and corresponding increase in fluent, intelligible, effortless speech. The acoustic measures, when correlated with neopharyngoplasty variables, produce many significant associations. Some of them are paramount and deserve further attention.

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Neoglottic formation from posterior pharyngeal wall conserved in surgery for hypopharyngeal cancer

Cited by 9 publications

References 10 publications

Effect of primary, cross-over, zigzag neopharyngoplasty on acoustic characteristics of alaryngeal, tracheoesophageal voice

Effect of primary, cross-over, zigzag neopharyngoplasty on acoustic characteristics of alaryngeal, tracheoesophageal voice

Voice quality and surgical detail in post-laryngectomy tracheoesophageal speakers

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

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