Summary
Although the structural integrity of the hypopharynx can be readily restored in individuals
who have undergone laryngopharyngoesophagectomy by transferring a segment of the jejunum
by a microsurgical technique, rehabilitation is often hindered by voice loss. The
outcomes achievable with conventional approaches of artificial voice box reconstruction
have been, generally speaking, unsatisfactory. A new reconstructive technique was
devised to create a connection between the tracheal stump and the neo-hypopharynx
to shunt airflow for phonation. The technique consisted of modifying one of two jejunal
segments nourished by a single vascular pedicle to make a side mucosal tube resembling
an elephant's trunk. With the larger end of one segment connected to the tracheal
stump, the side arm having a smaller calibre was connected to the neo-oesophagus which
was reconstructed with the second jejunal segment. Upon recovery from the surgery,
the patient was trained for phonation by shunting the airflow into the neo-pharyngoesophagus.
A total of 39 individuals underwent the elephant trunk shunt procedure for voice restoration
at our hospital during the past 10 years. Although phonation was restored in 28 patients
who had survived the original disease, the speech was assessed in 11. The mean duration
of follow up was 5.6 years. The quality of speech was considered to be adequate in
all. The rehabilitation of individuals who had undergone laryngopharyngoesophageal
resection was enhanced and the quality of life was improved by voice restoration.
That objective is attainable by incorporating a jejunal segment that shunts airflow
to the jejunal pouch, thereby enabling phonation.
Keywords
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Article info
Publication history
Published online: January 20, 2007
Accepted:
October 28,
2006
Received:
May 10,
2006
Identification
Copyright
© 2006 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
