Surgical voice restoration after total laryngectomy: An overview.

Total laryngectomy is potentially a debilitative surgery resulting in compromise of some of the most basic functions of life including speech and swallowing. This may have a profound adverse effect on the patient's physical, functional, and emotional health, and may result in a decreased quality of life (QOL). Until the 1980s, total laryngectomy was regarded as a dreadful, but often, life-saving procedure for which there was little alternative, and was used as a last resort. At that time survival at any cost in terms of QOL was paramount and many laryngectomies were forced into an isolated life as a mute and dysphasic recluse. Most attempts at voice restoration produced inconsistent results and often techniques were laborious, expensive, and ineffective, particularly when carried out as a salvage procedure after failed radiotherapy. Progress in voice rehabilitation, following total laryngectomy, over the last 30 years, has made an enormous difference in the whole concept of the management of laryngeal cancers. Currently there are several options available for these patients, namely, esophageal speech, artificial larynx, and tracheoesophageal speech. The choice of speech rehabilitation varies from patient to patient, but tracheoesophageal voice has become the preferred method. This article provides a brief account of surgical voice restoration after total laryngectomy. Special emphasis has been given to the surgical technique, special considerations, complications, and the prevention / treatment of tracheoesophageal voice restoration.

Voice outcome with provox prosthesis after total laryngectomy

The treatment and method of rehabilitation of laryngeal cancer depends on the clinical staging and site of the tumour .The early detection of laryngeal cancer and less tissue loss leads to good results of rehabilitation. Current methods of vocal rehabilitation after total laryngectomy include development of esophageal speech, use of electro-larynx and Trach-eoesophageal fistula with prosthesis. Also the early detection of laryngeal cancer will make a minor tissue loss after procedures, and so limit the problems of rehabilitation [speech and swallowing]. The aim of this study is to compare the voice results of patients who underwent: total laryngectomy with provox prosthesis and conservative laryngectomy. This study included 2 groups; 19 patients who underwent laryngectomy for control of laryngeal carcinoma subdivided into 2 groups according to surgical procedures 9 patients with total laryngectomy with provox processes and 10 patients with conservative laryngectomy and 6 normal as control group. After voice analysis for the two test groups and comparison to the control group, there was significant difference between conservative group and provox group as regards intelligibility score and number of words per minute and also Shimmer and noise to harmonic tests of this study showed that conservative laryngectomy group is relatively better than provox group in many parameters of analysis; this may be due less tissue loss in conservative group