Further experience with the myomucosal tracheoesophageal shunt.

A follow-up study to the initial work of Strome and colleagues in advancing the concept of the myomucosal flap for voicing following total laryngectomy is described. Data are evaluated from 30 patients. Seven of the eight original patients have functioning shunts with excellent voicing and six remain tumor free at more than two years. In the Laennec Hospital (Paris) series of 22 patients, seven shunts are functioning independently. Eleven of 20 inferiorly based flaps stenosed, and all stenoses occurred at the posterior tracheal wall. Technique refinements improved the patency percentage with the seven successes occurring in the last 13 procedures. Four patients in the series had flap necrosis, two of whom had diabetes mellitus and two others extensive paratracheal resections. The technique continues to merit consideration, recognizing that there is a learning curve before success can be anticipated.