Our Summary

This research paper reviews the latest methods used to rebuild the larynx (the part of the throat that holds the vocal cords) after it has been removed or partially removed due to diseases like cancer. The study reveals that a particular type of surgery, which uses skin and tissue from other parts of the body (known as fasciocutaneous free flaps), can lead to better results in terms of speech and swallowing compared to other methods. This type of surgery often uses skin and tissue from the forearm or the front of the thigh. The paper suggests that when there is enough of a certain type of tissue (pharyngeal mucosa) left in the throat after surgery, another method (myofascial onlay) can produce similar results. The evidence points to the fact that using these skin and tissue flaps not only reduces complications after surgery but also improves the patient’s ability to speak and swallow in the long term.

FAQs

  1. What are the most commonly used types of fasciocutaneous free flaps in laryngectomy reconstruction?
  2. How do fasciocutaneous free flaps and myofascial onlay compare in terms of speech and swallow outcomes after laryngectomy?
  3. What are the benefits of using a fasciocutaneous free flap in reconstructing a laryngectomy defect?

Doctor’s Tip

A doctor may advise a patient undergoing a laryngectomy to consider reconstruction with a fasciocutaneous free flap, such as a radial forearm or anterolateral thigh flap, to potentially improve speech and swallow outcomes in the long term. It is important to discuss with your healthcare provider the best reconstruction option based on your specific case and needs.

Suitable For

Patients who have undergone total laryngectomy, partial laryngopharyngectomy, or total laryngopharyngectomy may be recommended for reconstruction techniques to improve speech and swallow outcomes. Specifically, patients with mucosal deficiency or pharyngeal volume loss following surgery may benefit from fasciocutaneous free flaps or myofascial onlay techniques for reconstruction. These techniques have been shown to lead to improved long-term speech and swallow outcomes compared to other reconstruction methods. Patients who have experienced complications such as fistula formation following laryngectomy may also benefit from these reconstruction techniques.

Timeline

Before laryngectomy:

  1. Patient may experience symptoms such as hoarseness, difficulty breathing or swallowing, and a persistent cough.
  2. Patient undergoes diagnostic tests such as laryngoscopy, CT scans, and biopsies to confirm the presence of laryngeal cancer.
  3. Treatment options such as radiation therapy, chemotherapy, or surgery are discussed with the patient.
  4. If surgery is recommended, the patient undergoes a pre-operative evaluation to assess their overall health and fitness for surgery.

After laryngectomy:

  1. Patient undergoes total laryngectomy, partial laryngopharyngectomy, or total laryngopharyngectomy surgery to remove the affected portion of the larynx.
  2. Reconstruction techniques such as fasciocutaneous free flaps or myofascial flap onlay may be used to restore function and appearance.
  3. Patient undergoes post-operative care and rehabilitation, including speech therapy and swallow therapy to adapt to changes in speech and swallowing function.
  4. Long-term follow-up care is provided to monitor for complications such as fistula formation and to assess speech and swallow outcomes.
  5. Patient may need to use alternative methods of communication such as speech generating devices or esophageal speech if vocal cords are removed.
  6. Patient may experience emotional and psychological challenges following laryngectomy and may benefit from counseling and support groups.

What to Ask Your Doctor

Some questions a patient should ask their doctor about laryngectomy include:

  1. What type of reconstruction technique will be used following my laryngectomy?
  2. What are the potential long-term speech and swallow outcomes associated with the reconstruction technique being considered?
  3. Are there any specific factors that may affect my ability to speak or swallow after the procedure?
  4. How long is the recovery process expected to be, and what kind of support will be available during this time?
  5. Are there any potential complications or risks associated with the reconstruction procedure?
  6. Will I need any additional therapy or rehabilitation to help with speech and swallow function after the surgery?
  7. How often will I need follow-up appointments to monitor my progress and address any concerns?
  8. Are there any lifestyle changes or modifications I should consider following the laryngectomy and reconstruction procedure?

Reference

Authors: Elson NC, Martinez DC, Cervenka BP. Journal: Curr Opin Otolaryngol Head Neck Surg. 2020 Oct;28(5):355-364. doi: 10.1097/MOO.0000000000000645. PMID: 32796266