Abstract
Loss of voice often results from combined removal of the larynx, hypopharynx and cervical esophagus in patients with cancer. The author devised a new voice reconstruction method (T. E. G. double shunt) for these patients, using an esophago-cardiac loop as a new glottis with a physiological, non-regurgitation mechanism.
A lower esophago-cardiac loop (6-7cm long) with a gastric tube was mobilized to the neck with good blood supply from the right gastric and gastro-epiploic artery. A stenosis (2cm long) was formed in the esophagus near the cardia. A double tracheo-esophago-gastric shunt was created by anastomosis between the trachea and the distal end of the esophagus. Patients were evaluated with certain criteria for capability of conversation determined by the Japan Society for Head and Neck Cancer and examined for regurgitation of milk and Barium swallowing.
This method resulted in a new voice without milk regurgitation for all patients to some degree. 60% of the patients had moderately to very successful conversation with high-quality and high-efficiency phonation. A physiological study of these voices revealed a normal intensity in spite of a low air-flow rate. Sound spectrography characteristically indicated intermittent sounds with little noise.
Some patients did not achieve any speech after the surgery due to a rapid cancer recurrence and/or the loss of a desire for conversation. The recovery of phonation using a esophago-cardiac loop as a new glottis, however, seems to hold promising prospects for the laryngo-pharyngo-esophagectomized patients with cancer.
