Tracheoesophageal Speaking Fistula with Sphincter Mechanism

During the past three decades, several authors reported various surgical techniques for voice res toration after total laryngectomy. The principle behind these procedures is to divert pulmonary air into the pharynx or esophagus to achieve intelligible voice. The resultant speech compared satisfactorily with esophageal speech, which had been the most frequently used method of vocal re habilitation. However, tracts made between the trachea and the esophagus for phonatory purposes risk possible aspiration, unless a protective mechanism provides a sphincter or valve during deglutition. Surgical procedures for voice restoration after total laryngectomy previously reported rely on passive shunt closure or the use of a prosthetic one-way valve. To achieve surgical voice restoration, voice production must be compatible with normal deglutition. During the past 12 years we have been performing the tracheoesophageal speaking fistula operation. We had used the membranous part of the trachea for the purpose of primary voice restoration at laryngectomy (original technique without sphincter mechanism). This paper presents further additional technique designed to eliminate aspiration, using bilateral esophageal constrictor muscle flaps(BECMF).