Vocal Rehabilitation with microvascularized phonatory fistula

Abstract

Introduction: Vocal rehabilitation after a total laryngectomy procedure is one of the greatest challenges a Head and Neck Surgery Unit must face. It includes vocal reconstruction without jeopardizing the airway during swallowing. Amongst the methods that achieve this double goal, tracheoesophageal puncture is the most widely used, albeit several drawbacks associated: the need for a high initial phonatory pressure, granulation tissue formation around the shunt, the risk of blocking or dislodging the device, difficulty in changing the prosthesis and the need for a proper and frequent clean up. Permanent care with this devices represent a significant kind of morbidity for the laryngectomized patient, therefore other alternatives must be taken into consideration. One of these is the reconstruction using a microvascularized flap. We present a case report with a functionally satisfactory result.

Material and methods: Case report of a microvascularized phonatory fistula using a forearm flap and literature review. Results: The post surgical follow up of the patient was favorable, achieving a good functional rehabilitation, both subjective and objectively. Vocal quality is quite satisfactory and aspiration during swallowing minimal and free from complications. Flap design allowed a relatively easy construction of the vocal neo- conduct.

Conclusions: Phonatory reconstruction after total laryngectomy with microvascular flap leads to a good vocal quality, no higher risks for aspiration during swallowing and need for minimal long term care, leading to an improvement in the quality of life of the patient. Therefore it should be an option in the absence of contraindications to this technique.