From the Guidelines
After a jejunal pharyngolaryngectomy, patients should expect significant and permanent changes in their speech, necessitating speech rehabilitation to achieve functional communication. The removal of the larynx (voice box) during this procedure results in the loss of natural voice, and thus, alternative methods of communication must be employed 1.
Speech Rehabilitation Approaches
- The use of a tracheoesophageal puncture (TEP) with a voice prosthesis is a common approach, allowing air from the lungs to be directed into the esophagus to create sound.
- An electrolarynx, a handheld device placed against the neck, can also be used to create vibrations that produce speech.
- Some patients may develop esophageal speech, where air is swallowed and then released in a controlled manner to create sound.
Impact on Speech Quality
The reconstructed pharynx using jejunal tissue can affect articulation and resonance, often resulting in speech that sounds wet or gurgled due to saliva pooling and the altered anatomy 1. Preoperative education regarding the potential impact of surgery on voice, as well as voice rehabilitation for voice change or abnormal vocal fold mobility, is crucial for managing these changes 1.
Rehabilitation Process
Speech therapy is essential in the rehabilitation process, typically beginning 2-4 weeks post-surgery and continuing for several months. Regular maintenance, including prosthesis changes every 3-6 months for those using a TEP, is necessary to ensure optimal communication outcomes. Despite these interventions, patients should expect permanent changes in voice quality, pitch, and loudness compared to their pre-surgical voice.
From the Research
Impact on Speech after Jejunal Pharyngolaryngectomy
The impact of jejunal pharyngolaryngectomy on speech is a significant concern for patients undergoing this procedure. Several studies have investigated the effects of this surgery on speech restoration and the effectiveness of various voice restoration methods.
- Voice Restoration Methods: Studies have shown that voice restoration after circumferential pharyngolaryngectomy with free jejunum repair is possible through the use of voice prostheses, such as the Provox 2 type prosthesis 2 and the Provox® prosthesis 3.
- Speech Outcomes: Research has demonstrated that patients who undergo voice restoration after jejunal pharyngolaryngectomy can achieve satisfactory speech outcomes, with some studies reporting excellent speech intelligibility in up to 75% of patients 4.
- Complications: However, complications such as leakage through or around the prosthesis, local infection, and graft failure can occur, highlighting the need for careful patient selection and management 3, 5.
- Reconstruction Techniques: The use of free jejunal interposition reconstruction after pharyngolaryngectomy has been shown to provide excellent reconstruction with potential for lower immediate complications and better long-term results than other procedures 6.
- Radiation Therapy: Studies have also investigated the impact of radiation therapy on voice restoration after jejunal pharyngolaryngectomy, with some findings suggesting that radiation therapy does not significantly affect the quality of functional results in the long term 5.
Key Findings
- Voice restoration after jejunal pharyngolaryngectomy is possible through the use of voice prostheses.
- Satisfactory speech outcomes can be achieved in a significant proportion of patients.
- Complications can occur, but careful patient selection and management can minimize these risks.
- Free jejunal interposition reconstruction provides excellent reconstruction with potential for lower immediate complications and better long-term results.
- Radiation therapy does not significantly affect the quality of functional results in the long term. 2, 3, 6, 5, 4