Abstract
Since 1988 we have been performing tracheojejunal (TJ) fistulization for voice reconstruction at the time of operation with free jejunal transplantation to improve QOL of patients after pharyngolaryngoesophagectomy for hypopharyngeal cancer. Ten TJ speakers were subjected to manometry to determine their vibratory source and an aerodynamic investigation to clarify the phonatory mechanism in TJ phonation.
Intraluminal pressure waveforms with manometry demonstrated the vibratory source since the baseline of the pressure waveforms showed vibration. The location of the vibratory source was basically the same in nine speakers except for one subject, although it varied slightly depending from speaker to speaker. Even for the easy phonation, patients phonated at several different fundamental frequencies. In TJ phonation averages of intensity of voice, mean airflow rate, the pressure below the vibratory source, and the resistance of the vibratory source were 75.8 dBSPL, 129.6 ml/s, 18.6 mmHg, and 300.2 dyne s/cm5, respectively.
The above findings indicate that the vibratory source in TJ phonation is located at the stenosed portion of the transplanted jejunum regardless of peristalsis. The vibration on the jejunal membrane in TJ phonation can occur more easily than on the neoglottis in tracheoesophageal (TE) phonation. TJ speakers don't have a mechanism for the adjustment of the vibratory source which TE speakers have. This necessitates a lower resistance of the vibratory source in TJ phonation compared with that in TE phonation. Lower pressure below the vibratory source in TJ phonation than in the subneoglottis of TE phonation results from the low resistance in TJ phonation. The varieties of the fundamental frequency of voice are produced by peristalsis, which changes the stiffness of the vibratory source in TJ phonation.
