Nonclosure of Pharyngeal Muscle after Laryngectomy

Abstract

A prospective study was carried out to evaluate a new technique of pharyngeal repair following laryngectomy. The purpose of this study was to see whether satisfactory healing would occur if the pharyngeal constrictors were not sutured across the closure in the pharynx. If healing proved to be satisfactory the procedure might eliminate the need for primary or secondary myotomy or pharyngeal plexus neurectomy to facilitate tracheoesophageal speech. The results indicate that healing is as good in the group who did not have muscle closure as in those who did.

Videostroboscopy of the pharyngoesophageal segment in total laryngectomees

“…Such features translated into better overall mucosal wave characteristics and thus better quality TEP speech, analogous to the synchronous and fluid pattern of vocal fold vibration seen with normal laryngeal‐driven voice. Although studies suggest that TEP voice quality is better for patients who undergo nonmuscle versus muscle (multilayer) reconstructive closure of the PES because of decreased spasms associated with the former technique, 4,5 we found no discernible difference videostroboscopically or with perceptual voice quality measures between these two groups of patients in our study. However, Clevens et al 5 studied only speech fluency to judge TEP voice quality; therefore making comparisons between studies is difficult.…”

“…The total laryngectomy procedure produces a defect in the hypopharynx that must be reconstructed to form the pharyngoesophageal segment (PES) 1–5 . This tubularshaped region, composed largely of skeletal muscle tissue, serves as the neoglottis and enables production of esophageal voice.…”

Alternative Voice After Laryngectomy Using a Sound‐Producing Voice Prosthesis

“… 9 Previous research 24 and the current study, however, indicate that sound‐producing voice prostheses yield optimal results in laryngectomees with a hypotonic PE segment. Four different methods to decrease tonicity of the PE segment are described in the literature: 1) myotomy of the PE segment muscles, 25 2) nonclosure of the pharyngeal musculature, 26 3) unilateral pharyngeal plexus neurectomy, 27 and 4) botulinum toxin injections of the cricopharyngeal muscle complex. 28 The residual tension in the PE segment after each of these procedures is hard to predict, giving rise to a certain risk of hypotonicity.…”

Tracheoesophageal Voice Restoration: Origin – Evolution – State-of-the-Art

“…Nonmuscle reconstruction of the hypopharynx during total laryngectomy provides a third method of relaxing the pharynx to facili-tate esophageal and tracheoesophageal acquisition [18,19]. In this method, the hypopharyngeal defect is closed in two layers consisting of the mucosa and submucosa, leaving the pharyngeal constrictor muscles open.…”