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Myomucosal Tracheoesophageal Shunt

Marshall Strome, MD, MS; Thomas A. Mustoe, MD; James H. Kelly, MD

Arch Otolaryngol Head Neck Surg. 1986;112(11):1168-1171.

Abstract
• Surgical procedures for speech rehabilitation following laryngectomy lack wide support owing to tumor recurrence, aspiration, stenosis of the fistula, and multiple surgical stages of limited usefulness in irradiated patients. The recent prostheses and their modifications have approximately a 70% success rate but similarly remain limited by the requisite maintenance and soilage. A mucosa-lined tracheoesophageal fistula with a functioning proximal muscle sphincter, created in one stage at laryngectomy, is described. This myomucosal unit can function with or without a prosthesis and potentially eliminates aspiration. Evolution of the flap design in an animal model is delineated and the clinical trial in six patients highlighted. Five of the six have an excellent vocal quality without an associated air leak on phonation. Three function without a prosthesis.

(Arch Otolaryngol Head Neck Surg 1986;112:1168-1171)

Author Affiliations
From the Department of Otolaryngology, Harvard Medical School, Brigham and Women's Hospital, and Beth Israel Hospital, Boston (Dr Strome); the Department of Plastic Surgery, Washington University School of Medicine, St Louis (Dr Mustoe); and the Department of Otolaryngology, Johns Hopkins University, Baltimore, and Sinai Hospital of Baltimore (Dr Kelly).

Footnotes
Accepted for publication Aug 16, 1986.

Read before the American Society for Head and Neck Surgery, Palm Beach, Fla, May 7, 1986.

Reprint requests to 333 Longwood Ave, Boston, MA 02215 (Dr Strome).

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