Document Detail


Use of an 'elephant trunk' shunt for voice restoration: a decade of experience in voice restoration using a free jejunal graft in patients who have undergone laryngopharyngoesophagectomy.
MedLine Citation:
PMID:  17293276     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Although the structural integrity of the hypopharynx can be readily restored in individuals who have undergone laryngopharyngoesophagectomy by transferring a segment of the jejunum by a microsurgical technique, rehabilitation is often hindered by voice loss. The outcomes achievable with conventional approaches of artificial voice box reconstruction have been, generally speaking, unsatisfactory. A new reconstructive technique was devised to create a connection between the tracheal stump and the neo-hypopharynx to shunt airflow for phonation. The technique consisted of modifying one of two jejunal segments nourished by a single vascular pedicle to make a side mucosal tube resembling an elephant's trunk. With the larger end of one segment connected to the tracheal stump, the side arm having a smaller calibre was connected to the neo-oesophagus which was reconstructed with the second jejunal segment. Upon recovery from the surgery, the patient was trained for phonation by shunting the airflow into the neo-pharyngoesophagus. A total of 39 individuals underwent the elephant trunk shunt procedure for voice restoration at our hospital during the past 10 years. Although phonation was restored in 28 patients who had survived the original disease, the speech was assessed in 11. The mean duration of follow up was 5.6 years. The quality of speech was considered to be adequate in all. The rehabilitation of individuals who had undergone laryngopharyngoesophageal resection was enhanced and the quality of life was improved by voice restoration. That objective is attainable by incorporating a jejunal segment that shunts airflow to the jejunal pouch, thereby enabling phonation.
Authors:
Motohiro Nozaki; Hiroyuki Sakurai; Masaki Takeuchi; Hiroaki Nakazawa; Kenji Sasaki
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Publication Detail:
Type:  Evaluation Studies; Journal Article     Date:  2007-01-17
Journal Detail:
Title:  Journal of plastic, reconstructive & aesthetic surgery : JPRAS     Volume:  60     ISSN:  1748-6815     ISO Abbreviation:  -     Publication Date:  2007  
Date Detail:
Created Date:  2007-02-12     Completed Date:  2007-04-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101264239     Medline TA:  J Plast Reconstr Aesthet Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  217-22     Citation Subset:  IM    
Affiliation:
Department of Plastic Surgery, Tokyo Women's Medical University, Tokyo 162-8111, Japan. mnozaki@prs.twmu.ac.jp <mnozaki@prs.twmu.ac.jp>
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MeSH Terms
Descriptor/Qualifier:
Aged
Esophagectomy / rehabilitation
Female
Humans
Hypopharynx / surgery
Jejunum / transplantation*
Laryngeal Neoplasms / surgery
Laryngectomy / rehabilitation*
Male
Microsurgery / methods
Middle Aged
Pharyngectomy / rehabilitation
Phonation
Postoperative Care / methods
Postoperative Complications
Speech Intelligibility
Speech, Alaryngeal / methods*
Trachea / surgery
Voice Quality

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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