A one stage surgical technique for postlaryngectomy voice rehabilitation

A new one-stage surgical technique for postlaryngectomy speech was applied to 30 patients and its results are described. The essential part of this technique consists of the construction of a tracheoesophageal shunt using the posterior part of the trachea exposed at the time of the laryngectomy to reestablish an air communication between the trachea and the esophagus. Twenty-three of the 30 patients operated on developed conversational ability equivalent to that of a normal subject, except that they had to use a finger during speaking for the occlusion of the tracheal opening. The duration of phonation averaged 15 seconds. Speech developed in an average of 20 days after the operation was performed. Aspiration of liquids during deglutition was recognized in 9 patients. This was effectively controlled by digital pressure on the shunt during deglutition. The technique as described is applicable to nearly all candidates for total laryngectomy, with radical neck dissection and preoperative irradiation therapy.