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Tracheoesophageal shunt method with omohyoid muscle loop for voice restoration
Hitoshi Saito1, Shigeharu Fujieda, Toshio Ohtsubo
1Department of Otorhinolaryngology, Fukui Medical University, Japan.
Objective:
To decrease the aspiration rate of the previously reported simple mucodermal tracheoesophageal (TE) shunt method for voice restoration after total laryngectomy with the use of omohyoid muscle loop.
Design:
Retrospective clinical analysis.
Setting:
Department of Otorhinolaryngology, Fukui Medical University, Fukui, Japan.
Patients:
Ten male patients underwent total laryngectomy and received TE shunt by the omohyoid muscle loop method for voice restoration. There were 5 patients with glottic laryngeal cancer, 2 with supraglottic laryngeal cancer, and 3 with hypopharyngeal cancer. Patients' age ranged from 46 to 66 years.
Intervention:
The dermal incision on the neck was U-shaped with a superiorly pedicled, small U-shaped dermal flap. This small flap was used to form the anterior wall of the shunt. Bilateral omohyoid muscles were preserved at the total laryngectomy site with or without neck dissection. After creating a TE shunt directly on the posterior wall of the tracheal stump, the bilateral omohyoid muscles were looped through each other beneath the TE shunt.
Main Outcome Measurements:
Maximum phonation time, maximum phonation intensity, and rating scales of shunt voice, aspiration rate, and survival time.
Results:
Mean maximum phonation time was 20 seconds, while mean maximum phonation intensity was 83 dB. The first voice was obtained on postoperative day 29 on average. Of the 10 patients, 9 could phonate, with 1 case (10%) of slight aspiration 3 months after the surgery.
Conclusions:
Although this omohyoid muscle loop method needs to preserve the hyoid bone with those muscles, aspiration was prevented more effectively compared with the former, direct mucodermal TE shunt method. The indication for this method is preferably glottic laryngeal cancer.