Aspiration and speech shunt stenosis in near-total laryngectomy patients.

A near-total laryngectomy or near-total laryngopharyngectomy with the creation of a speech shunt was carried out on 66 laryngopharyngeal cancer patients. Intelligible shunt speech was obtained in 50 patients (76%), while stenosis of the shunt occurred in 13 patients (20%), and asymptomatic aspiration in 4 (6%). Poor voice production was usually due to shunt stenosis, a fibrotic band surrounding the shunt, or local recurrence of tumor. Perioperative wound infection and postoperative irradiation did not interfere with the development of shunt speech. In 12 patients with shunt stenosis, revision surgeries were performed to augment the shunt openings. During these procedures, the stenotic shunt was opened and a silastic tube was introduced into the shunt lumen to serve as a stent. For the moderately to severely stenotic shunt, the mucosal defect present was covered with a free skin graft or a sternocleidomastoid myoperiosteal flap. Following treatment, results demonstrated that 10 of the 12 patients acquired satisfactory shunt speech. In two unsuccessful cases, the causes of failure were wound infection and graft necrosis and were presumed to be complications of previous irradiation.