Speech Performance after Anterolateral Thigh Phonatory Tube Reconstruction for Total Laryngectomy

Abstract

Objective: Traditionally, after total laryngopharyngectomy (TLP), patients cannot speak without a prosthesis or an artificial larynx. In Taiwan, most patients use a commercialized pneumatic laryngeal device (PLD). Phonatory tube reconstruction with the anterolateral thigh (ALT) flap is a novel, modified version of synchronous digestive and phonatory reconstruction involving a free muscular cutaneous flap. This study reviewed and compared speech performance between patients who underwent novel flap reconstruction and conventional PLD users.Method: We retrospectively reviewed patients with laryngeal or hypopharyngeal cancer who underwent TLP from August 2017 to September 2019. The voice handicap index (VHI), speech intelligibility, acoustic and aerodynamic analysis results, and speech range profile (SRP) were compared between patients who underwent ALT phonatory tube reconstruction (ALT group) and those using PLDs (PLD group).Results: Twenty patients were included; 13 patients were included in the ALT group, and 7 patients were included in the PLD group. Compared to the PLD group, the ALT group had a better fundamental frequency range (P < .001) and semitone range (P < .001) during speech but showed worse jitter, shimmer, and harmonic-to-noise ratios. The two groups showed comparable VHI and speech intelligibility performance.Conclusions: The ALT phonatory tube, a novel flap for reconstruction, can restore digestive and voice functions simultaneously. Compared with PLD use, ALT phonatory tube reconstruction yields an improved speech range and comparable levels of voice handicap and speech intelligibility, suggesting that the technique is a good alternative for patients after TLP.

Socioeconomic Influence on Speech Rehabilitation After Total Laryngectomy

“…Likewise, the development and refinement of novel reconstructive techniques including the anterolateral thigh phonatory tube have the potential to alleviate the costs of long-term maintenance, although at the expense of increasing upfront operative or hospital costs. 19 As the definitions of health care value shift toward patientcentered models, state insurers and policymakers should be urged to revisit coverage details given the impact of postlaryngectomy communication on quality of life. 3,4 The influence of psychosocial factors on speech outcomes is complex and inadequately studied.…”

Comparison of the outcomes of anterolateral thigh flap and peroneal flap in total laryngectomy reconstruction

“…In the reconstruction of total laryngectomy, our study found that the ALT flap was more reliable than the peroneal flap. ALT flaps have a large skin donor site, dependable perforators, and adequate volume to fill the dead space and are simple to design with a monitor flap and phonatory tube 25,29 . The multilayer fascial underlay technique can also be used to reduce the rate of fistula formation even further 30 .…”

Comprehensive Evaluation of Vocal Outcomes and Quality of Life after Total Laryngectomy and Voice Restoration with J-Flap and Tracheoesophageal Puncture

“…In this context, the J-flap technique, first described by Tsao in 2020 [14], exploits a similar mechanism to TEP, i.e., the tracheoesophageal fistula, without the need for a voice prosthesis as the J tube conformation acts as a valve itself. This technique has already been proved to have satisfactory vocal results [11], but comparisons with the gold standard voice restoration method TEP have never been conducted. This study was designed to comprehensively assess various aspects of the voice rehabilitation outcome: the patients' subjective perception of their voice (VHI) and QoL (UW-QoL), the professional assessment by speech pathologists (GIRBAS, speech intelligibility and speech accuracy) and the objective evaluation of phonatory and acoustic parameters.…”

“…We asked the patients to produce a sustained vowel, namely, /a/, at a conversational pitch and loudness. The instrument analyzed the voice produced to calculate the fundamental frequency (F0), jitter, shimmer and harmonic-tonoise ratio (HNR) [11].…”

“…The authors recently published their voice restoration technique using a J-shaped anterolateral thigh (ALT) free flap, shaped into a phonatory tube, called "J-flap". The functional results demonstrated the J tube could provide a reliable and satisfactory voice rehabilitation method [11]. This study aimed to compare the functional outcomes and the QoL of patients who underwent voice rehabilitation with the J-flap technique and the gold standard vocal rehabilitation method of TEP with voice prostheses.…”