Complications of pharyngeal myotomy for alaryngeal voice rehabilitation

Abstract

Over the eight-year period to May 1991,256 patients were referred for post-laryngectomy voice rehabilitation. Videofluoroscopy identified 81 (32 per cent) who required pharyngeal myotomy for a spastic pharyngooesophageal segment. Forty-two of these (37 male, 5 female and average age 63 years) had their surgery performed at this unit with a complication rate of 17 per cent and an average post-operative stay of 10 days (range 4–41 days). The place of the operation for pharyngeal myotomy in post-laryngectomy voice rehabilitation is discussed.

Comparison of pharyngoesophageal segment pressure in total laryngectomy patients with and without pharyngeal neurectomy

“…PES tonus is classified as normotonic, hypotonic, hypertonic, spasm, and stricture, depending on acoustic and manometric measurements 26. Hypertonicity, spasm, and stricture are the most important reasons for failure in production of esophageal or tracheoesophageal speech 18, 27. Failure related to pharyngoesophageal (PES) spasm was first noted by Singer and Blom 1.…”

“…Complications like hypotonic PES, residual spasm, reapproximation of the transected muscle fibers, infection, hemorrhage, gastroesophageal reflux, stomal stenosis, and pharyngocutaneous fistula have been reported after myotomy 2, 10, 11, 18, 25. Among these complications, especially pharyngocutaneous fistula encountered in 11% to 19% of patients lengthens hospitalization period 10, 27. This complication has been attributed to mucosal ischemia caused by the drain or impairment of the vascular supply by transection of the muscles 15, 27…”

“…Among these complications, especially pharyngocutaneous fistula encountered in 11% to 19% of patients lengthens hospitalization period 10, 27. This complication has been attributed to mucosal ischemia caused by the drain or impairment of the vascular supply by transection of the muscles 15, 27…”

The treatment of hypertonicity of the pharyngo-oesophageal segment after laryngectomy

“…This changes the upper oesophageal sphincter and changes the tonicity. 3 During total laryngectomy a two‐ 4 or three‐layer closure 3 is usually performed: the mucosa, submucosa and pharyngeal constrictor muscles are each closed in a separate layer to create the new pharynx. 5 , 6 The term upper oesophageal sphincter is an operational definition given to an intraluminal zone of high pressure that exists between the pharynx and the oesophageal body.…”

“…This one‐stage procedure lead to the introduction of oesophageal speech as a primary method of alaryngeal speech. 3 Oesophageal voice has historically been the method of choice for alaryngeal speech. In this method air is injected or inhaled into the cervical oesophagus and immediately expelled, setting the opposing surfaces of the pharyngo‐oesophagus into vibration.…”