Selective myotomy for voice restoration after total laryngectomy.

Reconstruction of the pharyngoesophagus after total laryngectomy avoids the development of salivary fistulae and restores satisfactory swallowing. Successful techniques for closure include multiple layers of tissue, selected suture materials, the application of postoperative radiation therapy, and modified neck dissection. In addition, vocal rehabilitation has been traditionally associated with the formation of a pharyngoesophageal segment capable of producing sound after air insufflation. A three-year experience with 129 patients after they underwent a total laryngectomy and tracheoesophageal shunt showed that 16 patients (12%) failed to achieve satisfactory speech after tracheoesophageal puncture because of pharyngoesophageal spasm. Response to percutaneous block of the pharyngeal plexus and subsequent myotomy of the cricopharyngeus and pharyngeal constrictor muscles was assessed in 14 patients. Increased pharyngoesophageal tone after total laryngectomy seems to be an important factor in the failure to acquire esophageal voice.