New surgical technique for primary and secondary voice restoration using a free ileocecal patch graft after total laryngectomy

• Published in: Surgery today (Tokyo, Japan) Japan), 2003-11, Vol.33 (11), p.817-822
• Main Authors: Kobayashi, Makoto, Onozuka, Naoya, Fukuda, Akinari, Matsubara, Atsushi, Kobayashi, Wataru
• Format: Article
• Language: English
• Subjects: Adult; Aged; Cecum - transplantation; Female; Humans; Ileum - transplantation; Laryngeal Neoplasms - diagnosis; Laryngeal Neoplasms - surgery; Laryngectomy - methods; Male; Middle Aged; Reconstructive Surgical Procedures - methods; Risk Assessment; Sampling Studies; Speech, Alaryngeal; Surgical Flaps; Treatment Outcome; Voice Disorders - etiology; Voice Disorders - surgery; Voice Quality
• ISSN: 0941-1291; 1436-2813
• DOI: 10.1007/s00595-003-2616-1

We devised a new surgical technique to restore the voice after laryngectomy. This procedure is designed to repair the hypopharyngeal defect by using a free ileocecal patch for voice rehabilitation. We performed this procedure in seven patients; for primary voice restoration in six and for secondary voice restoration in one. The technique involved resecting an ileocecal segment containing the ileocecal valve and cutting a patch from the cecum, the size of which was equalized with the hypopharyngeal defect. After patch repair of the defect, the tracheopharyngeal shunt was completed by an anastomosis between the ileum and trachea. One patient died from sudden rupture of the carotid artery, but all six survivors were able to speak and swallow without aspiration, achieving fair to good articulation. The advantages of our method are as follows. (1) The operative procedure is simple and does not require complicated remodeling of the intestinal graft for voice production. (2) The ileocecal valve can prevent aspiration. (3) The patch expands the pharynx and prevents narrowing. (4) Using this procedure, it is possible to achieve voice restoration even in patients who have undergone total laryngectomy in the past.