gms | German Medical Science

Background: Dysphonia after partial laryngectomy due to laryngeal malignancies is determined by the extent of the resection and the resulting defect. After such a procedure the inner larynx is lined by rigid scars.

Methods and Material: In general, the vocal cord is reconstructed by medialisation of tissue on the operated side. Basically two methods are available: Laryngoplasty (thyroplasty) via an extralaryngeal approach and endolaryngeal, microsurgical augmentation via laryngoscope. Indications for such procedures are: large glottal gap, persisting dysphonia despite speech therapy and discontentment of the patient. Provided that there are no pathological findings in the operated area (e. g. leukoplakia, inflammation, granulation), reconstruction surgery can be performed 6-12 months after tumour surgery. Functional deficits are an aphonic voice, running out of air when speaking, increased effort, and dysphagia. Five patients have been operated on by medialisation of the lateral scarred laryngeal wall by thyroplasty and injection of fat, collagen, or silicone as well as implantation of septal cartilage into the augmented “neocord”.

Results: These surgical techniques have been applied in different combinations to the patients. Each patient underwent two or more procedures. The dysphonia could be improved by one degree. This is documented by objective measures forming the Dysphonia Severity Index which goes up from -3,92 (severe dysphonia, DSI class 3) to 0,67 (moderate dysphonia, DSI class 2). In one case the dysphonia increased. But, generally, the air consumption is reduced, the speech passages are prolonged and the subjective assessment of speech is improved. The post surgical tumour control is not affected.

Conclusions: Surgical speech rehabilitation after tumour surgery has only limited success in terms of voice quality. Nevertheless, it should be offered to patients with the appropriate indications.