Abstract
It has been well known, since the first laryngectomy was performed by Billroth in 1873, that air communication between the trachea and the gullet could produce phonation following total laryngectomy. In this article, following a brief historical review regarding postlaryngectomy voice rehabilitation mainly by surgical methods and its classification, the author's tracheo-esophageal shunt operation for postlaryngectomy speech and its results are described.
The essential part of the author's technique consists of the construction of a tracheo-esophageal shunt using the posterior wall of the trachea which is exposed at the time of the laryngectomy.
Fifty-four out of ninty laryngectomies were operated by using this technique during the past four years. Forty out of fifty-four patients could use the shunt for daily conversation.
Fourteen out of fifty-four patients failed in speaking with the shunt. The most frequent and significant cause of failure was obstruction of the esophageal orifice of the shunt.
Irradiation before and after the operation seemed to be not contraindicated for performing the procedure.
Slight leakage of fluid from the esophagus into the trachea was recognized in sixteen (40%) out of forty patients, which was effectively blocked by slight digital pressure. This technique could not be applied to thirty-six out of ninety laryngectomy cases. Ths causes were analysed and discussed.
