Voice rehabilitation after total laryngectomy.

More than 100 years after the first laryngectomy, voice preservation remains a remarkable challenge. A number of surgical techniques have been proposed, yet complications related to aspiration, recurrent disease, or voice failure have been frequent. Representative historical examples are described and their results reviewed. The advent of tracheo-esophageal phonation with a silicone voice prosthesis simplified the approach to this perplexing problem. The principles learned from the secondary application of this method are applied to a primary technique for vocal rehabilitation immediately after laryngectomy. The results are promising without risking alteration of the basic laryngectomy technique and expected cure rates.