Surgical voice rehabilitation after laryngopharyngectomy. Functional results of tracheo-hypopharyngeal shunts by jejunal transplantation

[Total laryngopharyngectomy and reconstruction with a jejunum speech siphon : A case report]

Advanced laryngeal and hypopharyngeal carcinomas are associated with a poor prognosis and a pronounced loss of quality of life due to impairment of the swallowing and voice function. The fundamental therapeutic challenge is successful tumor control with concomitant rehabilitation of swallowing and voice functions. Further objectives are a low complications rate (fistula, aspiration) and prompt transfer to the adjuvant radio-oncologic therapy. With these factors in mind, the microvascular anastomosed jejunum speech siphon with a biventer rein has proven to be an effective method of reconstruction following extensive circular laryngopharyngeal resections. In this case report, a typical operative and postoperative course is presented, as are the functional results.

Autotransplanted jejunum in head and neck cancer

Today, the free transplantation of jejunum is a reliable and attractive method for a single stage reconstruction of huge defects in the upper aerodigestive tract following the resection of advanced carcinomas, even in preoperatively irradiated patients. While being accepted for pharyngo-esophageal reconstruction, there is still controversy about its application in the reconstruction of the oral cavity and/or naso-/oropharynx, due to the possibility of using the other flaps, especially the radial forearm flap. As a consequence to the development of microvascular surgical technique and to the decrease of complications (mortality, graft necrosis, fistulas, strictures and abdominal complications) the free jejunal autograft provides now the shortest hospitalisation time and the most rapid interval leading to successful oral alimentation, when compared with other techniques. In order to estimate the usefulness of jejunal grafts either for surgical voice rehabilitation or the possible influence of these transplants in prolongation of survival, further investigations are necessary. In addition, jejunal autografts tolerate postoperative radiotherapy, necessary to reduce the incidence of local and neck recurrences. Therefore jejunal autografts increase the likelihood of returning the patient to a functional state in a time period commensurate with the natural history of the disease.