[Patients excluded from voice restoration after total laryngectomy]

Concerning 73 radical laryngectomy operations carried out at the Hôpital Tenon in the period between july 1985 and july 1989, the authors studied the mode of vocal restoration used and the patient population not benefitting from any of the procedures used. Esophageal voice was utilized initially in 19 patients; a tracheo-esophageal fistula (surgical shunt or puncture with Blom-Singer prosthesis) was created during laryngectomy in 19 patients, and secondary tracheo-esophageal puncture was performed in 13 others. Twenty patients had no vocal restoration operation performed. In a large number of the patients, the tracheo-esophageal fistulas restored a normal voice. In the end, 38% of the laryngectomized patients did not have their voice restored. The various causes for such a high percentage of exclusions that are discernable are discussed. Lack for motivation on the part of the patients is a major reason, irrespective of the technique used.