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Tracheoesophageal voice after total laryngopharyngectomy reconstruction: Jejunum versus radial forearm free flap
Author(s) -
Deschler Daniel G.,
Herr Marc W.,
Kmiecik Joann R.,
Sethi Rosh,
Bunting Glenn
Publication year - 2015
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.25404
Subject(s) - laryngectomy , medicine , demographics , forearm , audiology , surgery , larynx , demography , sociology
Objective/Hypothesis Tracheoesophageal (TE) voice restoration after laryngopharyngectomy with jejunal (Jej) flap and radial forearm flap (RFF) reconstruction has been successfully completed and studied for both techniques, but no direct comparisons exist. We undertook this study to directly compare TE voice in patients with total laryngopharyngectomy (TLP) reconstruction using the Jej and the RFF in a comprehensive and rigorous manner. Study Design Retrospective cohort study. Methods Forty patients after total laryngectomy or TLP were grouped by pharyngeal closure method: 18 primary closure (STL), 10 jejunal flap (TLP‐Jej), and 12 radial forearm flap (TLP‐RFF). Voice recordings underwent objective acoustic analysis and blinded subjective assessment by trained and naïve listeners. Quality‐of‐life (QOL) assessments were obtained in all subjects using general health, disease‐specific, and voice‐specific survey tools. Results All studies groups had similar demographics. Acoustic analysis demonstrated no differences in fundamental frequency or intensity levels. Subjective assessment demonstrated statistically significant inferior voice function of the reconstructed patients (TLP‐Jej and TLP‐RFF) compared to STL subjects for nearly all parameters tested by both naïve and trained listeners. No differences were noted between TLP‐Jej and TLP‐RFF subjects for any of the parameters evaluated. Overall, trained listeners assessed TE voice more favorably compared to naïve listeners in a significant manner. The three QOL surveys revealed no significant differences between TLP‐Jej and TLP‐RFF subjects. Conclusion Tracheoesophageal voice in TLP‐Jej and TLP‐RFF subjects was equivalent but inferior to STL subjects. Reconstructed subjects had no differences in general, disease‐specific, and voice‐specific quality of life. Level of Evidence 2b. Laryngoscope , 125:2715–2721, 2015