Microvascular reconstruction of the larynx following total laryngectomy

Abstract

Total laryngectomy still is a standard procedure for the treatment of advanced laryngeal or hypopharyngeal carcinoma. The unavoidable loss of voice may lead to serious impairments in quality of life. The most common technique of voice restoration is the tracheal-esophageal puncture combined with the application of a voice prosthesis. Laryngeal reconstruction with a radial forearm flap represents a possible surgical method of voice restoration. This study is a mono-center retrospective analysis of patients receiving a so-called laryngoplasty after total laryngectomy between 2006 and 2015, focusing on long-term functional outcome and complications. 39 patients were included. Sufficient phonation was possible in 77 %, finger-free speaking was achieved in 62 %. Exclusion of irradiated patients revealed a rehabilitation rate of 91 %. The most common early complication was cervical hematoma in 15 %, whereas no loss of flap was assessed. Stenosis of the laryngoplasty was seen in 7 cases, mainly post-irradiation. The rate of successful voice restoration is equal in both, laryngoplasty and voice prosthesis patients. However, voice quality is better after surgical reconstruction. Complications induced by the voice prosthesis, which may be severe in some cases, were not seen in the study group. Furthermore, life-long support by an ENT specialist regarding voice prosthesis exchange is not necessary. Assuming correct choice of candidates, laryngoplasty is a sufficient method for voice restoration after laryngectomy.