Evaluation of the Effects of Primary Myotomy in Total Laryngectomy on the Neoglottis With the Use of Quantitative Videofluoroscopy

Abstract

Quantitative videofluoroscopy enables study of the influence of myotomy on the anatomic and morphologic characteristics of the neoglottis. Our results suggest that a planned myotomy of the upper esophageal sphincter is beneficial when prosthetic voice rehabilitation is applied after total laryngectomy.

The pharyngoesophageal segment in laryngectomees—videoradiographic, acoustic, and voice quality perceptual data

“…All five TE speakers, who had continuing air supply during phonation, but also two out of four of the E speakers, raised their PE segment by 0.5Á1.5 vertebra from rest position to phonation. This finding corroborates data in earlier studies (18,19), where an upward shift of the PE segment was seen in several of the TE speakers. In the present study there were some differences between the TE and the E speakers regarding the location of the PE segment during phonation.…”

“…In the study by Op de Coul et al (19), the methodology regarding the VRG measurements is used for comparisons between myotomy and anatomy/morphology of the PE segment in TE speakers. Twelve out of 19 subjects in that study had had a myotomy done at the time of the laryngectomy, while the remaining 7 subjects had not.…”

“…Evaluation of voice quality in alaryngeal speech has often included parameters such as fluency, speech rate, loudness, and pitch (6). In some studies the voice quality has been assessed with a more overall parameter, using scale categories such as 'good', 'fair'/'reasonable', and 'poor' (12,18,19). In clinical practice, the evaluation of laryngeal voice quality is often based on perceptual assessment of parameters directly connected to phonation characteristics such as breathiness, roughness, hypo-or hypertension.…”

Surgical Improvement of Hypotonicity in Tracheoesophageal Speech

“…In case of hypertonicity, characterized by a strained voice with a short phonation time, several good preventative and therapeutic options are available. During primary surgery, a short myotomy of the cricopharyngeus muscle or upper esophageal sphincter can prevent the development of hypertonicity to a great extent 5 and also other surgical options, like non‐ or half‐closure of the constrictor pharyngeus muscles or unilateral neurectomy of the pharyngeal plexus have been described (for a recent review, see 6 ). The therapeutic option presently preferred, in case the problem occurs after surgery, is chemodenervation of the pharyngoesophageal musculature with botulinum toxin with a long constrictor pharyngeus myotomy as a backup method in cases refractory for Botox treatment 7 .…”

Anatomical and Functional Correlates of Voice Quality in Tracheoesophageal Speech

“…1,2 During voicing especially, a good (lateral) image of the dynamics of the new sound source in persons having had laryngectomies can be obtained. After the introduction of voice prostheses in 1980, 3 several VF studies were performed to investigate possible differences between the neoglottis in esophageal and in tracheoesophageal (TE) speech and to investigate the role of the neoglottis in TE speech.…”