Alison Perry

Surgical Voice Restoration with the Blom-Singer Prosthesis following Laryngopharyngoesophagectomy and Pharyngogastric Anastomosis

Surgical voice restoration using the Blom-Singer technique is a well-established procedure in patients who have undergone simple laryngectomy. Operations for hypopharyngeal carcinoma are more extensive and require reconstruction using regional skin or myocutaneous flaps, or reanastomosis with colon, jejunum, or stomach. We report the use of the Blom-Singer prosthesis in four patients who had undergone pharyngogastric repair following laryngopharyngoesophagectomy and who had failed to achieve a satisfactory voice. All patients initially developed good speech using the prosthesis. Two patients subsequently had their prostheses removed: One because of recurrent malignant disease and one because the procedure had not significantly altered the quality of the voice. The remaining two patients have continued to use the device at 2 and 5 years after insertion with good voice production.

Complications of pharyngeal myotomy for alaryngeal voice rehabilitation.

Over the eight-year period to May 1991, 256 patients were referred for post-laryngectomy voice rehabilitation. Videofluoroscopy identified 81 (32 per cent) who required pharyngeal myotomy for a spastic pharyngo-oesophageal segment. Forty-two of these (37 male, 5 female and average age 63 years) had their surgery performed at this unit with a complication rate of 17 per cent and an average post-operative stay of 10 days (range 4-41 days). The place of the operation for pharyngeal myotomy in post-laryngectomy voice rehabilitation is discussed.

Use of a "hands-free" tracheostoma valve in patients with laryngectomy and tracheoesophageal puncture.

The goals of the study were 1) to investigate the relationship between tracheal air pressure and the tracheostoma valve seal in patients with laryngectomy and tracheoesophageal puncture (TEP) and 2) to assess whether tracheal pressure contributes to the duration of the valve seal. Ten patients with TEP after laryngectomy underwent training with an outer Blom-Singer tracheostoma valve and a 30-day trial with this “hands-free” speaking valve. We found that tracheal pressure was not a significant predictor variable in assessing the duration of the outer tracheostoma valve seal achieved by the patients with TEP. Factors other than tracheal pressure appeared to affect the duration of the tracheostoma valve seal. Mastery of use of the tracheostoma valve, the subjects neck anatomy, and the amount of time, training, and experience that was given to each subject were significant predictors of the valve seal. Tracheal pressure measurements might be of use in deciding between a standard or a low-pressure outer tracheostoma valve for an individual patient.

Recent advances in the assessment of ‘failed’ oesophageal speakers

By means of videofluoroscopy laryngectomy patients can be clearly categorised into five mutually exclusive groups. It has been shown that difficulties in oesophageal voice acquisition are directly related to adequacy of the pharyngo-oesophageal (P-E) segment, which is a direct result of the type of surgery used at the time of initial laryngectomy. This paper gives indications for intervention in each of the five groups described and emphasises the need for earlier objective evaluations in order to remedy these difficulties.

A modification of the Blom-Singer valve for restoration of voice after laryngectomy

The authors have been involved in developing a modification of the Blom-Singer valved prosthesis for restoration of voice after laryngectomy. This is a case report on the first patient who underwent this procedure in Britain. It was found essential that a different design of valved prosthesis be invented and this is described. Aspects for consideration when selecting a potential candidate for this procedure are outlined, and guidelines given for choosing suitable patients.