Voice rehabilitation following laryngectomy. Myomucosal tracheoesophageal shunt.

Surgical procedures for speech rehabilitation following laryngectomy lack wide support owing to tumor recurrence, aspiration, stenosis of the fistula, and multiple surgical stages of limited usefulness in irradiated patients. The recent prostheses and their modifications have approximately a 70% success rate but similarly remain limited by the requisite maintenance and soilage. A mucosa-lined tracheoesophageal fistula with a functioning proximal muscle sphincter, created in one stage at laryngectomy, is described. This myomucosal unit can function with or without a prosthesis and potentially eliminates aspiration. Evolution of the flap design in an animal model is delineated and the clinical trial in six patients high-lighted. Five of the six have an excellent vocal quality without an associated air leak on phonation. Three function without a prosthesis.