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With a plethora of different reconstructive options and techniques available after laryngectomy, it can be difficult to clearly see which give the lowest complication rates and best functional outcomes. This article aims to summarise the current evidence in swallowing and speech outcomes in laryngectomy and pharyngolaryngectomy, as well as incidence of pharyngocutaneous fistula formation and a comparison of primary vs delayed tracheooesophageal puncture (TEP). Where primary closure of a primary laryngectomy is performed, the authors report a higher risk of fistula formation in the vertical closure group when compared with a ‘T’ type closure. In salvage laryngectomy and pharyngolaryngectomy, closure with a fasciocutaneous patch (radial forearm or ALT free flaps) gave significantly better 12-month oral diet and speech understandability scores than the use of a musculocutaneous patch (pectoralis major flap), although it does not appear to be superior to primary pharyngeal closure with muscle onlay, where this is possible. Voice results from primary vs. delayed TEP appear to be similar, but a similar reported rate of complications (pharyngo-cutaneous fistula) between the techniques may be due to a lack of evidence. The evidence, as presented here, seems to be of variable quality and is far from conclusive. However, for anyone who needs the current reconstructive decision-making questions summarised with supporting evidence, this article makes for a useful quick update.

Current opinions in otolaryngology and head and neck surgery: functional considerations in reconstruction after laryngectomy.
Elson NC, Martinez DC, Cervenka BP.
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Matthew Coates

Freeman Hospital, Newcastle-Upon-Tyne, UK.

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