Revision surgery of a stenotic speaking shunt in near-total laryngectomy patients.

A near-total operation to create a speaking shunt is generally considered a suitable option in most T3 laryngopharyngeal cancer cases. However, some of these cases incur postoperative problems, including aspiration and shunt stenosis. In this 8-year study, 15 of 60 patients who had received near-total laryngectomies could not speak well with their shunts. Revision surgery was performed on 11. Under local anesthesia, the lumen of the stenotic segment of the shunt was opened. A 4-F silicone tube was stented in the shunt. Then, for mildly stenotic cases, the small mucosal defect of the shunt was covered by a sternohyoid myofascial flap. For moderate to severe cases, the larger mucosal defect was reconstructed with a free skin graft. Thereafter, a sternohyoid muscle flap was used to cover the skin graft, which would finally form the inner lining of the new speaking shunt. The outcome was that 9 of the 11 patients acquired intelligible shunt speech. These results demonstrate that the augmentation procedures described herein have considerable potential for restoring the function of a stenotic speaking shunt in a near-total laryngectomy.