Tracheoesoplastic Procedure for Voice Reconstruction Following Total Laryngectomy.

Accession number;03A0307805
Title;Tracheoesoplastic Procedure for Voice Reconstruction Following Total Laryngectomy.
Author; MORI MITSUHIRO (Kobe Univ., Graduate School of Medicine, JPN) KINISHI MINORU (Sanda Municipal Hospital, JPN) AMATSU MUTSUO (Shinsumabyoin Jibiinkoka)
Journal Title;Journal of the Japan Broncho-Esophagological Society
Journal Code:Z0674A
ISSN:0029-0645
VOL.54;NO.2;PAGE.66-72(2003)
Figure&Table&Reference;FIG.8, TBL.5, REF.14
Pub. Country;Japan
Language;Japanese
Abstract;Over the past 26 years, we have performed tracheoesophageal (TE) fistulization on 376 patients for voice reconstruction after total laryngectomy. Primary lesions were laryngeal carcinoma in 306 patients, mesopharyngeal carcinoma in 7, and hypopharyngeal carcinoma in 63. The essential part of our technique consists of the construction of a TE fistula using the membranous part of the trachea. Recently, an esophageal muscular loop around the esophagus and the TE fistula has been added to our original method to prevent aspiration. Out of a total number of 376 patients, 297 (79%) succeed in attaining postoperative TE speech. Their rate of aspiration clearly improved from 59% in the original technique to 89% with the new one. The major reasons for reconstruction failure were obstruction, destruction of the TE fistula or a lack of motivation in patients. In most cases of hypopharyngeal carcinoma, radical surgery includes a total laryngectomy with partial or circular resection of the hypopharynx and cervical esophagus. We have performed different kinds of voice reconstructive surgery depending on the following. When the pharyngeal mucosa is adequate for primary closure of the pharynx, or is able to be closed with a patch of the PMMC flap, TE fistulization is performed. When the pharynx is resected circularly and reconstructed with a free jejunum flap, tracheojejunal fistulization is performed. (author abst.)
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