Background – Following pharyngolaryngectmy for malignant disease many patients are suitable for speech and swallowing rehabilitation, including those who have had complex reconstructive surgery. Many techniques have been used for speech production but primary puncture and insertion of a voice rehabilitation prosthesis is considered the gold standard. Not all head and neck teams however would attempt a primary puncture following a complex free flap reconstruction. Aims of Investigation - We report our experience of rehabilitation of speech and swallowing following pharyngolaryngectmy for malignant disease in patients who had free tissue transfer reconstruction of their pharynx. Subjects - 15 patients underwent pharyngolaryngectmy with microvascular reconstruction utilising a free jejunal transfer or a tubed radial forearm flap. Thirteen had a voice prosthesis, Blom Singer or Provox, inserted as a primary puncture. Design - Each subject was assessed prospectively by a multidisciplinary team for quality of speech and ability to swallow following surgery. Main outcome measures – Quality of speech was assessed by a dedicated speech therapist and rated as poor, fair or good. A dedicated dietician made a full dietary assessment. Methods – The project was an observational study. Results - Overall ten out of thirteen patients (77%) who had a voice restoration prosthesis following pharyngolaryngectomy developed good quality speech as assessed by a dedicated speech therapist. All fifteen patients were rehabilitated to swallow with five taking a normal diet, eight taking a soft diet and two taking fluids only. There was one flap loss and no deaths in this series. Conclusions - Many patients can expect a substantial disease free period following pharyngolaryngectomy and quality of life is important, with the capacity to speak and swallow key factors in this. Microvascular reconstruction is demanding and time consuming but when combined with primary puncture and a voice prosthesis the majority of patients will regain speech and swallowing and we would recommend this technique.
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