Clin Exp Otorhinolaryngol.  2024 Nov;17(4):346-354. 10.21053/ceo.2024.00109.

Long-Term Assessment of Speech and Swallowing Function in Laryngopharyngeal Cancer Patients After J-Flap Reconstruction

• Lu YA
• Tsao CK
• Hsin LJ
• Chuang HF
• Fang TJ

• KMID: 2561368
• DOI: http://doi.org/10.21053/ceo.2024.00109

Abstract

Objectives
. A novel J-shaped anterolateral thigh (ALT) flap reconstruction technique was developed to simultaneously restore swallowing and speech functions in patients following total laryngopharyngectomy. This study aimed to assess the outcomes and surgical complications in patients who underwent J-flap reconstruction over time.
Methods
. Patients who underwent J-shaped ALT flap phonatory tube reconstruction were enrolled. Surgical morbidities and outcomes were evaluated every 3 months post-surgery for a period of 12 months or until death.
Results
. Of the 36 patients, 13 underwent circumferential pharyngeal wall resection (circumferential defect [CD] group), and 23 underwent partial resection (partial defect [PD] group). After 12 months, 97% of the patients were able to resume oral intake without the need for a nasogastric tube, and 50% achieved fluent speech using the reconstructed phonatory tube. The CD group experienced a higher rate of delayed healing than the PD group (30.8% vs. 0%, p=0.012). Additionally, the PD group showed significantly higher percentages of individuals consuming solid food at both the 3- and 12-month intervals than the CD group (81.0% vs. 23.1% and 78.9% vs. 40%, respectively).
Conclusions
. This study investigated the progression of speech and swallowing functions over time after reconstruction of the voice tube with a J-flap. Using a J-shaped ALT flap phonatory tube effectively restored both speech and swallowing functions, providing long-term benefits, regardless of whether the defect was circumferential or partial.

Keyword

Laryngopharyngeal Neoplasms; Surgical Flaps; Speech Disorders; Swallowing Disorders; Quality of Life; Laryngectomy; Reconstructive Surgical Procedures

Figure

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  Fig. 1. (A) The J-designed anterolateral thigh (ALT) flap comprises two parts: a trapezoidal section (TS) for pharyngeal reconstruction and a phonatory tube section (PS) distally for phonatory tube (PT) creation. (B) The PS is longitudinally tubularized to form the PT, and a catheter is inserted to maintain the tract’s patency during the healing process. (C, D) In cases of partial resection of the pharyngeal wall, the TS flap was anastomosed side-to-side with the residual pharyngeal wall.

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  Fig. 2. (A) The design of the trapezoidal section (TS) for esophageal reconstruction is based on defects in the pharyngeal wall. In the circumferential defect group, the TS flap was rolled into a tube and joined to both the distal and proximal stumps. (B) In the partial defect group, the TS flap was sutured in two places, with each edge of the TS flap being separately attached to the remaining pharyngeal wall. PT, phonatory tube.

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  Fig. 3. Post-surgical view of the patient’s stoma, showing the opening of the phonatory tube positioned on the left side of the stoma (arrow).

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  Fig. 4. (A) The proportion of fluent speakers who use phonatory tube speech between two groups over a period of up to 2 years. (B) Comparison of postoperative morbidity between the circumferential defect (CD) and partial defect (PD) groups. The incidence of delayed healing and esophageal fistula is higher in patients with a circumferential defect. (C) The proportion of patients consuming a regular oral diet without limitations or the need for special preparation, among all patients and within the PD and CD groups, up to 2 years. a)Delayed healing: delayed healing at the neopharynx anastomosis, as indicated by an esophagogram conducted two weeks after surgery that revealed barium leakage. b)Esophageal fistula: leakage from the esophagus requiring surgical repair within 1 year after surgery. *P<0.05.

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