Primary Tracheoesophageal Puncture with Supraclavicular Artery Island Flap after Total Laryngectomy or Laryngopharyngectomy

Abstract

Objectives: (1) Describe our perioperative experience of primary tracheoesophageal puncture (TEP) with intraoperative placement of voice prosthesis for patients undergoing total laryngectomy (TL) or laryngectomy with partial pharyngectomy requiring supraclavicular artery island flap (SCAIF) reconstruction. (2) Assess TEP voice outcomes in this patient group. Methods: Retrospective chart review of all patients undergoing SCAIF reconstruction following TL or laryngectomy with partial pharyngectomy at a single institution between 2011 and 2013 (N = 14). There were no exclusion criteria. Results: We identified 7 patients who underwent primary TEP with intraoperative placement of voice prosthesis (mean age = 64.1, 5M:2F). Six patients had prior chemoradiation for laryngeal squamous cell carcinoma. One patient had a dysfunctional larynx from radiation treatment for tonsillar squamous cell carcinoma. Five patients underwent TL and 2 patients underwent TL with partial pharyngectomy. Indwelling 16 French Blom-Singer prosthesis was placed intraoperatively prior to SCAIF reconstruction. There were no TEP-related complications, such as prosthesis displacement or leakage, intraoperatively or in the perioperative period. One patient developed a peristomal pharyngocutaneous fistula. In terms of voice outcomes, 6 patients achieved tracheoesophageal voice production within 10 months after TEP placement, and most occurred earlier (mean time = 2.9 months, SD= 3.1). One patient remained aphonic. Of the 6 patients who achieved successful voice acquisition, 2 required cricopharyngeal segment Botox injections with good response. Conclusions: Similar to free tissue transfer reconstruction, primary TEP with intraoperative placement of the voice prosthesis at the time of SCAIF reconstruction is safe and effective. Six of 7 patients had successful voice acquisition within 10 months.