How comparatively effective are the total laryngopharyngectomy jejunal (TLP-Jej) flap and TLP radial forearm flap (TLP-RFF) in TLP for tracheoesophageal (TE) voice restoration after reconstruction?
Background: The reconstruction of the TLP defect is a significant challenge in head and neck surgery, and voice restoration is a reconstructive priority. Numerous studies have shown the qualitative success and functional utility of the TE prosthesis voice restoration techniques. Despite an absence of studies specifically comparing TLP-RFF and TLP-Jej, there is an impression that voice after TLP-Jej is inferior to voice after TLP-RFF.
Explore this issue:December 2015
Study design: Retrospective cohort study of 40 patients after total laryngectomy (18 primary closure [STL], 10 TLP-Jej, and 12 TLP-RFF).
Setting: Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston; the Otolaryngology–Head and Neck Surgery Service, Brooke Army Medical Center, San Antonio, Texas; Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio.
Synopsis: Five of the STL participants had a pharyngeal myotomy; two TLP-RFF participants and no TLP-Jej participants underwent myotomy. STL participants had a conversational fundamental frequency equivalent to TLP-RFF participants, and both groups were higher than TLP-Jej participants. Conversational intensity levels were essentially equivalent for all three groups. Subjective analysis by groups of listeners demonstrated a statistically significant superior function in nearly all parameters for STL speakers compared with reconstructed participants. Naïve listeners noted differences of varying degrees of statistical significance among STL, TLP-RFF, and TLP-Jej speakers for all parameters assessed except words correct on the word list. For all parameters, naïve listeners gave all three study groups statistically significantly lower scores when compared with the trained listeners. TLP-Jej participants received statistically significantly poorer voice survey scores on overall voice quality, limitations in normal conversation, limitations in telephone conversation, and interference with normal activity/work compared with STL participants. TLP-RFF participants had poorer voice survey scores on limitations in a noisy area compared to STL participants. Limitations included the use of all accomplished TE speakers, small sample groups, small numbers of testable participants in busy cancer centers, and the increase of multimodality therapy.
Bottom line: TE voice restoration in TLP-Jej and TLP-RFF subjects was equivalent but inferior to STL subjects, but reconstructed subjects had no differences in general, disease-specific, and voice-specific quality of life.
Citation: Deschler DG, Herr MW, Kmiecik JR, Sethi R, Bunting G. Tracheoesophageal voice after total laryngopharyngectomy reconstruction: jejunum versus radial forearm free flap. Laryngoscope. 2015;125:2715-2721.