Section: 
Science articles
Science articlesRestoration of the upper part of gastrointestinal tract and vocal function in patients after laryngectomy
A. P. Polyakov (1), I. V. Reshetov (2), M. V. Ratushnyi (1), O. V. Matorin (1), I. V. Rebrikova (1), M. M. Filyushin (1)
(1) Р. Hertsen Moscow Research Institute – Branch of the National Medical Research Radiological Centre of the Ministry of Healthcare of the Russian Federation
(2) Scientific Research and Educational Center of Plastic Surgery of I. M. Sechenov First Moscow State Medical University, Moscow, Russia
UDK: 616.321-089.844:616.22-089.87
DOI: https://doi.org/10.18692/1810-4800-2017-2-64-71
ABSTRACT
Objective: To improve the outcomes of patients rehabilitation after surgical treatment of local larynx tumors with restoration of the upper part of gastrointestinal tract and vocal function.
Materials and methods: Voice prostheses were installed in 243 patients after laryngectomy. Pharyngoplasty with displaced pre-fabricated pectoris flap was performed in 16 patients, voice prosthesis was installed in 9 of them. Reconstruction of pharynx and cervical part of esophagus with visceral flaps was performed in 94 cases, voice prosthesis was installed in 19 of them. Autotransplantation of ilea-colon flap was performed in 1 case, thus providing restoration of digestive and vocal without any prosthesis.
This article presents clinical cases of delayed pharyngoplasty with pre-fabricated pectoris flap and visceral flap with installation of voice prosthesis and a case of ilea-colon flap reconstruction.
Results: In the group of patients after laryngectomy and voice prosthesis installation, 85% of voice rehabilitation cases were successful, 15% of patients had a spasm of pharynx constrictor muscle, and this required myotomy to be performed. Mouth nutrition after pharyngoplasty with pectoris flap was restored in 94% of patients. 77% of patients had satisfactory speech function after the prosthesis installation. Salivary fistula were observed in 19% of the cases, neck wound maturation – in 6%, flap necrosis – in 6% of the cases. Mouth nutrition after pharyngoplasty with visceral flaps was restored in 94.6% of patients. 84% of patients have good speech generation after prosthesis installation. Salivary fistulas were observed in 8.7% of cases, neck wound maturation – in 6.5% of cases, flap necrosis – in 5.4% of cases.
Conclusion: Voice prosthesis installation is possible in patients after all types of pharyngoplasty, except for gastroepiploic flap. The choice of flap for the reconstruction of the upper digestive tract depends on the general condition of the patient, on concomitant pathology, on the state of the donor organs and tissues, on previous surgical intervention on the abdominal organs, and the capabilities of the department.
Publication date:
06.05.2017
Keywords:
voice rehabilitation, pharyngoplasty, pre-fabricated pectoris flap, visceral flap. For citation:
Polyakov A. P., Reshetov I. V., Ratushnyi M. V., Matorin O. V., Rebrikova I. V., Filyushin M. M. Restoration of the upper part of gastrointestinal tract and vocal function in patients after laryngectomy. Rossiiskaya otorinolaringologiya. 2017;2:64–71. https://doi.org/10.18692/1810-4800-2017-2-64-71