Head and Neck
Article first published online: 3 MAY 2011
Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.
Volume 121, Issue 7, pages 1436–1440, July 2011
How to Cite
Sinclair, C. F., Rosenthal, E. L., McColloch, N. L., Magnuson, J. S., Desmond, R. A., Peters, G. E. and Carroll, W. R. (2011), Primary versus delayed tracheoesophageal puncture for laryngopharyngectomy with free flap reconstruction. The Laryngoscope, 121: 1436–1440. doi: 10.1002/lary.21836
This study was presented as a poster at the 2011 Combined Sections Meeting January 27–29, 2011, at the Westin Kierland Resort, Scottsdale, AZ.
The authors have no financial disclosures for this article. The authors did not receive any funds in support of this study
The author have no conflicts of interest to declare.
- Issue published online: 16 JUN 2011
- Article first published online: 3 MAY 2011
- Manuscript Accepted: 15 MAR 2011
- free tissue flaps;
- speech rehabilitation;
- quality of life;
- Level of Evidence: 4 (Case Series)
To determine whether postoperative complication rates and speech outcomes differ between patients undergoing primary versus secondary tracheoesophageal puncture following total laryngectomy with free flap reconstruction.
Retrospective clinical study in a tertiary academic center.
Between November 2004 and June 2010, 137 patients underwent total laryngectomy or laryngopharyngectomy with pharyngeal free flap reconstruction for malignant disease. Data was collected on patient and operative demographics, early postoperative complications, speech outcomes, and predictive factors for tracheoesophageal puncture failure.
Thirty patients (22%) had a primary tracheoesophageal puncture performed at the time of laryngectomy, 27 patients (20%) received secondary punctures (>3 months postlaryngectomy), and 80 patients (58%) never received a puncture. Patient and operative demographics were similar between groups (P < .05), apart from proportionately more hypopharyngeal tumors in the “no puncture” group (P < .002). Similar numbers of patients in primary and secondary puncture groups achieved intelligible speech (67% vs. 71%, P = .82) and both groups reported good patient-perceived voice-related quality of life. Salvage surgery and nonpatch radial forearm free flap reconstruction both trended toward increased early postoperative complication rates (P = .09).
There is no difference in the early postoperative complication rate for primary versus secondary tracheoesophageal puncture following total laryngectomy with concurrent free flap reconstruction. Radial forearm patch free flap reconstruction achieves good speech outcomes.