Singer M I, Blom E D, Hamaker R C
Auris Nasus Larynx. 1985;12 Suppl 2:S206-9. doi: 10.1016/s0385-8146(85)80060-2.
The goal of pharyngeal reconstruction after laryngectomy is to prevent fistulization and to permit rapid resumption of satisfactory deglutition. Alaryngeal speech acquisition by the traditional method of esophageal speech is effective if insufflation is rapidly learned and tolerated by the pharyngoesophageal segment. Experience with tracheoesophageal phonation revealed an incidence of pharyngoesophageal spasm in 40% of an esophageal speech failure population which prevented useful air flow for speech production. This is related to esophageal distention and reflexive upper esophageal sphincter hypertension. It is suggested that pharyngeal reconstruction after total laryngectomy may permit higher wall tension than is desirable for speech acquisition. The problem of post laryngectomy pharyngoesophageal spasm may be reduced by myotomy of the pharyngeal constrictors with resultant higher air flows in the residual vocal tract for speech. Alterations in the pharyngeal wall tonicity will affect the pitch of the speech and listener acceptability. Recently identification and division of the pharyngeal plexus has produced a similar result in improved phonatory air flows with subjective vocal pitch approximating more normal voices. The above mentioned techniques are readily applied to the laryngectomy procedure and enhance the likelihood of alaryngeal speech acquisition.
喉切除术后咽重建的目标是防止形成瘘管，并使吞咽功能迅速恢复至满意状态。如果咽食管段能迅速学会并耐受吹气动作，那么通过传统食管语音方法进行无喉语音训练是有效的。经气管食管造瘘发声的经验表明，在食管语音训练失败的人群中，咽食管痉挛的发生率为40%，这会阻碍产生语音所需的有效气流。这与食管扩张和食管上括约肌反射性高血压有关。有人认为，全喉切除术后的咽重建可能会导致咽壁张力高于语音训练所需的理想水平。通过对咽缩肌进行肌切开术，可减少喉切除术后咽食管痉挛的问题，从而使残余声道中产生更高的气流以用于发声。咽壁张力的改变会影响语音的音高和听众的接受度。最近，识别并切断咽丛也产生了类似的效果，即改善了发声气流，主观语音音高更接近正常声音。上述技术可很容易地应用于喉切除手术中，并提高无喉语音训练成功的可能性。
