Squamous cell carcinoma is by far the commonest malignancy of the larynx and I would confine my present paper mainly to this along with the management and post-operative rehabilitation after total laryngectomy. High survival rate in majority of the cases, if diagnosed and treated early and adequately, provokes and encourages the interested laryngologist to consider not only about performing effective surgery, including on those cases where radiotherapy is inadequate or has failed, but also resorting to rehabilitative surgical procedures after total laryngectomy with or without neck dissection, offering to the laryngectomee a ‘Biologic’ Neo-Larynx, created from the patients own tissues, for tracheo-oesopharyngeal phonation.
I am of the opinion that if a Neo-Larynx is constructed from the upper parts of the patient’s own trachea and oesophagus without using any extraneous synthetic material, the patient would be happy to learn that the new voice box has been created out of his own tissues and no extraneous foreign material has been implanted and left in his body and he can effortlessly phonate ‘tracheo-oesophageally’ instaneously after removal of the silastic sheet from the Neoglottis five weeks after the operation without any rigorous training and the voice is better than the conventional alaryngeal ‘pharyngo-oesophageal’ one after total laryngectomy. Moreover, the complications associated with the prostheses viz. fungal and bacterial invasion with subsequent leakage around it and its displacement, and the tedious maintenance and replacement problems can be obviated by providing the patient with a ‘biologic’ Neo-Larynx of viable tissues.
Therefore, my present paper will deal with the construction of Neo-Larynx after conducting experiments on animals. In the Neo-Larynx, a Neo-Epiglottis (hitherto not reported in the literature to my knowledge) and a Neo-Glottis are ingeniously constructed in order to enable the laryngectomee to phonate tracheooesophageally (c.f. pharyngoesophageally). The Neo-Glottis is transversely disposed since it offers better protection against aspiration than the vertically disposed one. The Neo-Epiglottis is constructed from the posterior tracheal wall, inferiorly based, or from the superiorly based tongue-shaped flap, raised from the full-thickness membranous posterior tracheal wall, or from the anterior tracheal wall, folded posteriorly (as in ‘Duck-Bill’ Neo-Larynx), for preventing aspiration through the Neo-Glottis into the tracheaobronchial tree during deglutition. In addition, a statico-dynamic sphincter or sling, reminiscent of the original primitive one, has been constructed around the Neo-Larynx, utilizing the strap muscles of the neck, in order to bring about competency of the Neo-Larynx for preventing aspiration through the Neo-Glottis. By this operation the problems of aspiration and stenosis of the Neo-Glottis have been largely solved. The Neo-Glottis is constructed in a transverse slit in the anterior oesophageal wall in a protective gutter in the anterior wall of the oesophageal lumen and the inferior lip of the slit is reinforced with a small cartilage bar in order to make it a stiff neo-vocal cord for producing stronger and better voice than pharyngo-oesophageal one which (i.e. tracheo-oesophageal one) is akin to normal voice. Presumably, the sphincter influences the voice quality by its continuously changing tension. The upper end of the trachea is closed to form a cul-de-sac and the phonetic stream is stopped here and channelised through the only available outlet i.e. the tracheooesophageal fistula (Neo-Glottis) into the oesophagus and pharynx for articulation.
The latest proposed procedure is easier than the previous ones in which a biologic ‘Duck-Bill’ Neo-larynx is constructed from the upper parts of the trachea and oesophagus. Neo-Epiglottis and Neo-Vocal cords are incorporated in this. The Neo-Glottis is situated in the trachea anterior to the tracheo-oesophageal fistula. In this there are two additional phonatory mechanisms through which the phonetic stream passes :
The two tracheal flaps, projecting into the oesophageal lumen, vibrate during phonation.
Pseudoglottis at cricopharyngeus level.
It is presumed that these, by producing harmonics, enrich the voice produced by the Neo-Glottis. Voice would be good with inflectional patterns and aspiration and stenosis problems would be significantly minimized.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Amatsu M, Matsui T, Maki T, Kanagawa K, (1977): Vocal reconstruction after toal laryngectomy : A new one-stage surgical technique. J. Otolaryngology 80 : 779.
Arslan M, Serafini I (1972): Restoration of laryngeal function after total laryngectomy, report on first 25 cases. Laryngoscope 82:1349.
Asai R (1972): Laryngoplasty after total laryngectomy. Arch. Otolaryngol 95:114.
Bell Laboratories (1959):New artificial larynx. Trans Am Acad Ophthalmol Otolaryngol 63:548.
Blom E.D., Singer M.L., Hamaker R.C (1982): Tracheostoma valve for post laryngectomy vocie rehabilitation., Ann Otol Rhinol Laryngol 91: 57b.
Calcaterra T.C, Jafek B. W (1971): Tracheo-oesophageal shunt for speech rehabilitation after total laryngectomy. Arch. Otolaryngol 94; 124.
Conley J. J, De Amesti F, Pierce J. K (1958): A new surgical technique for the vocal rehabilitation of the laryngectomized patient. Ann Otol Rhinol Laryngol 67:655.
Conley J. J. (1959):Vocal rehabilitation by autogenous vein graft. Ann Otol Rhinol Laryngol 58: 990.
Czermak J (1959): Ueber die Sprache bei luftdichter versch liessung des Kehlkopfes. Sitzungsb K Akad D Wissensch Math Nature C1. 35:65.
Czerny V (1870): Versuche Ueber Kehlkopiexstirpation. Wein Med Wochenschr 24:557.
Deka Ramesh C, Subimal Roy, S. K. Kacker, P. Ghosh, U. Sharma (1974): Evaluation of biological potential of laryngeal carcinoma by whole organ serial section - a preliminary report. Indian J. Otolaryngol 26:11.
Deka Ramesh C, S. K. Kacker, P. Ghosh (1974): Some inferences from the study of whole organ laryngeal serial section in cancer of larynx and laryngopharynx. J. Otolaryngological Soc. Australia 3:633.
Deka R.C., Kacker S. K., Roy Subimal, Ghosh P (1976): Glandular theory of cancer spread in the larynx, Ind. J. Otolaryngol 28:115.
Deka R. C., Ghosh P, Kacker S. K (1977): Supraglottic horizontal partial laryngectomy. Ind. J. Otolaryngol 29:58.
Deka Rames C, Santosh K. Kacker, Patit P. Ghosh, Subimal Roy (1979): Whole organ sections of the larynx and hypopharynx. Ear, Nose & Throat Journal 58:53.
Delhaunty J.E, Nassar V. H (1969): Application of total organ laryngeal section. Arch Otolaryngol 90:342.
Ghosh P (1974): Asai Laryngoplasty. Indian J. Otolaryng 26:35.
Ghosh P (1976): Vertical tracheo-oesophagoplasty. Ind. J. Otolaryng 28:164.
Ghosh P (1977): Transverse tracheo-oesophagoplasty. Journal of Laryngol & Otol 91:1077
Ghosh P (1980): Phonosurgery (Tracheo-oesophagoplasty). Bihar J. Otolaryngol 1:29.
Ghosh P (1980): Phonosurgery (Combined Approach Palato-pharyngo plasty ‘CAP’). J. Laryngol & Otol, 94:1165.
Ghosh P (1984): Modification of Transverse Tracheo-oeso-phagoplasty (Construction of a Neo-Larynx). Ind. J. Otolaryngol 36:103.
Ghosh P (1986): A new operation for construction of Neo-Larynx. Ind. J. Otolaryngol. 38:64.
Goldstein J. C. (1961): Update on voice restoration following total laryngectomy. Trans Am Laryngol Assoc. 102:129.
Gussenbauer C (1874): Ueber die erste durch Th. Billrotham Menschen ausgefuehrte Kehlkopf-Extirpation und die Anwendung eines Kuentstlichen Kehlkopfes. Arch K Chri 17:343.
Guttman M.R (1932): Rehabilitation of voice in laryngectomized patients. Arch. Otolaryngol 15:478.
Kirschner J. A (1969): One hundred laryngeal cancers studied by serial section. Ann. Otol. Rhinol. Laryngol 78:689.
Kirschner J.A (1977): Two hundred laryngeal cancers: Patterns of growth and spread as seen in serial section. Laryngoscope 87:474.29.
Kitamura T, Kaneko T, Togawa K, Unno T (1970): Supracricoid Laryngectomy. Ann Otol Rhinol Laryngol 79:1027.
Mackenty J.E (1926): Cancer of the larynx. Arch Otolaryngol 3:205.
Mackenty J.E (1929): Laryngeal Cancer, early diagnosis and treatment. Arch. Otolaryngol 9:237.
Miller A.H (1967): First experience with Asai technique for vocal rehabilitation after total laryngectomy. Ann. Otol. Rhinol Laryngol. 76:829.
Montgomery W.W, Toohill R. J (1968): Voice rehabilitation after laryngectomy. AMA Arch. Otolaryngol 88:499.
Norris M, Tucker G, Kuo B.F & Pitser W.F (1970): A correlation of clinical staging, pathological findings and five year end results in surgically treated cancer of larynx. Ann. Otol. Rhinol. Laryngol. 79:1033.
Panje W.R. (1981): Prosthetic vocal rehabilitation following laryngectomy, the voice button. Ann. Otolaryngol 90:116.
Panje W.R. (1983): Experience with the voice button results presented at the University of Iowa surgical prosthetic voice rehabilitation course, Copper Mountain, Colorado March.
Pearson B. W. (1980) Extended hemilaryngectomy for T3 glottic carcinoma with preservation of speech and swallowing, Laryngoscope 90:1950.
Seeman M (1926): Phoniatrische Bemerkungenzur Laryngectomy. Arch K Chir 140:285.
Shapiro M.J, Ramanathan V.R. (1982): Trachea stomavent voice prosthesis. Laryngoscope 92:1126.
Singer M.I., Blom E.D (1979): Tracheo-oesophageal puncture : A surgical prosthetic method for postlaryngeclomy speech restoration. Third International Symposium on Plastic and Reconstructive Surgery of the Head and Neck, New Orleans, LA.
Singer M.I, Blom E.D (1981): Selective myotomy for vocie restoration after total laryngectomy. Arch Otolaryngol 107:670.
Staffieri M (1970): Laryngectomia totalie conreconstru-zione di glottide fonatona. J. Boll Soc Med Chir Brescina 24:406.
Taub S, Spiro R. H (1972): Vocal rehabilitation of laryngectomees: Preliminary report of a new technic. Am. J. Surg. 124:87.
Tiwari R.M, Snow G.B, Le Cluse FLE et al (1982): Observation on surgical rehabilitation of the voice after laryngectomy with Staffieri’s method. J. Laryngol Otol 96:24.
Vega M.F (1975): Larynx reconstructive surgery - a study of three-year findings a modified surgical technique. Laryngoscope 85:866.
Wind J (1976): Phylogeny of the human vocal tract. Annals of the New York Academy of Sciences, 280:612.
About this article
Cite this article
Ghosh, P. Malignancy of the larynx. IJO & HNS 49, 209–227 (1997). https://doi.org/10.1007/BF02991283
- Vocal Rehabilitation
- Total Laryngectomy
- Tracheal Wall
- Strap Muscle
- Voice Prosthesis