Page 47 - Prosthetic voice rehabilitation-5th edition

The esophageal opening is closed with inverting vicryl sutures (figure below). A second muscular layer is sutured to reinforce the esophageal wall. If needed, the sternal head of the sternocleidomastoid muscle can be dissected from the sternum to create a superiorly based tendon/muscle flap, which can be easily interposed between the esophagus and the trachea. Even if this additional layer is not needed, it is advisable to take this opportunity to cut the sternal heads of the sternocleidomastoid muscles, if this has not been done at the time of laryngectomy. This has the advantage that the stoma area will be flatter after this procedure, which makes the use of stoma appliances, such as an HME or automatic stoma valve, easier, as already described earlier in the chapters on total laryngectomy and tracheostoma construction. Next the tracheal wall is sutured in one layer (figures below). 47