Page 57 - Prosthetic voice rehabilitation-5th edition

The left figure below shows a Provox 2 voice prosthesis in situ in the lumen of a tubed stomach, and the right figure a Provox voice prosthesis in a full gastric pull-up. The much larger of the latter explains lower (amphoral) voice quality with the full gastric reconstruction The voice obtained with the tubed stomach clearly has a better intelligibility and loudness. Other advantages of a greater curvature tube over a complete gastric pull-up are: the transposition through the esophageal bed is less difficult, and there is less intra-thoracic cardio-pulmonary compression, and dumping. It is our experience that prosthetic vocal rehabilitation after extensive pharyngeal reconstruction is possible in virtually all patients and should be aimed for. It can be concluded that in pharyngeal reconstruction, besides oncological and technical arguments, the possibility of applying primary instead of secondary prosthetic voice rehabilitation and the quality of the resulting voice should also play a role in the choice of the reconstruction method. 3.6.1 References pharynx reconstruction: 60. Hilgers FJM, Hoorweg JJ, Kroon BBR, Schaeffer B, de Boer JB, Balm AJM. Prosthetic voice rehabilitation with the Provox system after extensive pharyngeal resection and reconstruction. In: Algaba J, ed. Proceedings of the 6th International Congress on Surgical and Prosthetic Voice Restoration after Total Laryngectomy. San Sebastian: Elsevier Science Publishers, Amsterdam, 1995:111-120. 61. Jacobi I, Timmermans AJ, Hilgers FJ, van den Brekel MW. Voice quality and surgical detail in post- laryngectomy tracheoesophageal speakers. Eur Arch Otorhinolaryngol 2015. 62. Kelly KE, Anthony JP, Singer M. Pharyngoesophageal reconstruction using the radial forearm fasciocutaneous free flap: Preliminary results. Otolaryngology - Head and Neck Surgery 1994; 111:16- 24. 63. Patel RS, Makitie AA, Goldstein DP et al. Morbidity and functional outcomes following gastro-omental free flap reconstruction of circumferential pharyngeal defects. Head Neck 2009; 31:655-663. 64. Patel RS, Goldstein DP, Brown D, Irish J, Gullane PJ, Gilbert RW. Circumferential pharyngeal reconstruction: history, critical analysis of techniques, and current therapeutic recommendations. Head Neck 2010; 32:109-120. 57