Effects of Neck Dissection and Radiotherapy on Short-Term Speech Success in Voice Prosthesis Restoration Patients

Total laryngectomy with primary tracheoesophageal puncture: Intraoperative versus delayed voice prosthesis placement

“…Conversely to some initial clinical concerns, changing to the use of intraoperative voice prosthesis placement after primary TEP did not result in additional complications, such as peripheral leakage or voice prosthesis embedding. This finding is consistent with other retrospective studies that report no complications with intraoperative prosthesis placement at the time of primary TEP formation . The low incidence of postoperative complications observed in both groups in the current study was also consistent with other studies…”

“…Although voice rehabilitation was able to commence sooner in the intraoperative group, both groups were determined to have similar early voice outcomes at 1 month postsurgery, with half of the participants in both groups producing speech that was classified as “usually to always understandable.” Whereas no other study has compared the speech outcomes of patients managed by the 2 protocols, Gultekin et al found that 56% of their 32 patients who received intraoperative voice prosthesis placement at the time of primary TEP achieved successful speech by 3 to 4 weeks. Similarly, in a large clinical sample of patients who received intraoperative placement, Op de Coul et al noted that 51% achieved good speech and 3% were rated as excellent, although the exact timepoint at which their data were collected is unclear.…”

“…Studies have also described benefits associated with performing intraoperative voice prosthesis placement at the time of primary TEP formation . Proponents of intraoperative voice prosthesis placement at the time of primary TEP discuss numerous potential advantages of using this technique and report low complication rates .…”

“…However, although performing intraoperative voice prosthesis placement at the time of primary TEP formation has been proposed to have numerous advantages, no studies to date have compared intraoperative placement with delayed voice prosthesis insertion to quantify the extent of these benefits. Rather, the current evidence supporting intraoperative placement has been derived from reviews of large retrospective cohorts where all or most patients have undergone this approach . Although the existing research evidence has great value for proving the safety and success of this procedure, data supporting the extent of the benefits of intraoperative over delayed voice prosthesis placement during primary TEP formation is needed in order to inform practice change in clinical centers considering adoption of intraoperative placement.…”

Riabilitazione vocale post laringectomia con voce protesica: 15 anni di esperienza della Clinica Otorinolaringoiatrica dell’Università di Catania. Analisi retrospettiva dei dati e revisione della letteratura

“…Radiation therapy may cause lack of wound healing because of tissue necrosis, scar formation, and vascular impairment and may deteriorate the pliability of the pharyngo-oesophageal mucosa 36 - 41 , but considering long-term speech success, no significant influence of postoperative radiotherapy and primary or secondary VP rehabilitation was found on speech quality; in this context, many retrospective studies have reported the absence of consequences on quality of voice or complication rates 4 5 37 . In addition, a report suggested that neck dissection in conjunction with postoperative radiotherapy does not adversely affect short-term speech success in VP rehabilitation patients 38 .…”