Voice restoration is one of the key rehabilitative steps after laryngectomy or total laryngopharyngectomy (TLP). Patients who undergo TLP require reconstruction – increasingly commonly with microvascular free flaps. Despite their advantages in terms of fistula rates and swallowing outcomes, these flaps can be associated with “wet”, less intelligible voice quality compared to typical transoesophageal speech (TES). The authors aimed to compare the functional voice outcomes between patients who had undergone TLP, using two commonly used free flaps: radial forearm flap (RFF) and jejunal free flap, and patients with traditional TES following laryngectomy alone. They collected quality-of-life data using validated questionnaires and voice recordings of standardised vocal tasks, from a total of 40 patients. Voice recordings were analysed objectively (software) and subjectively by trained and non-trained listeners. No significant difference in pitch, length of phonation or amplitude was found between the three groups.

Listeners judged post-laryngectomy TES superior to both groups of post-TLP patients in almost all parameters, including rate, dynamics, effectiveness, fluency, wetness etc. There was no significant difference between the two methods of free flap reconstruction.

Quality-of-life measurements mirrored these findings. This study is limited by small sample size, but is a rigorous examination of voice-related outcomes in major head and neck surgery, with a methodology that would extend well to larger studies. It provides more reliable evidence that free flap reconstruction may lead to inferior voice outcomes, but highlights that two commonly-used techniques are equivalent in this regard, aiding clinical decision making. 

Tracheoesophageal voice after total laryngopharyngectomy reconstruction: jejunum versus radial forearm free flap.
Deschler DG, Herr MW, Kmiecik JR, et al.
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Thomas Jacques

Royal National Throat, Nose and Ear Hospital, London, UK.

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