Prosthetic voice rehabilitation after laryngectomy

Background. Indwelling voice prostheses are state of the art for postlaryngectomy voice rehabilitation. The aim of this study was to identify the impact of radiation prior to tracheoesophageal puncture on success rate and complications. Patients and methods. We undertook a retrospective study of 145 patients who had undergone prosthetic voice restoration between 1990 and 2002 (Provo((R)) and Provox2((R))). Risks of functional failure and complications in 17 patients with previous radiation therapy were compared to those of 128 patients without such therapy. Results. Previous radiation increased not only the risk of functional failure by 2.9 (P=0.023), but also the risk of shunt-related complications such as aspiration around the prosthesis (1.51; P=0.046), widening of the shunt (2.32; P=0.014), esophageal (2.51; P=0.013) or tracheal (3.29; P=0.0023) dislocation of the prosthesis and spontaneous (2.51; P=0.047) or surgical closure (3.76; P=0.037) of the shunt. Conclusion. Primary tracheoesophageal puncture during laryngectomy is recommended in cases without previous radiation therapy, especially when postlaryngectomy radiation is likely. In patients with previous radiation therapy, generally good success rates decrease, however, without absolute contraindication of tracheoesophageal puncture. These results may affect salvage surgery concepts.