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With the advancements in the medical field, many innovations in medical devices have happened. Using a surgical stapler to close the laryngectomy defect without opening the pharynx is particularly advantageous in a total laryngectomy (TL). However, performing the tracheoesophageal puncture (TEP) during stapler closure of the larynx has not been widely advocated, due to the fear of complications related to the procedure.We treated two male patients with advanced glottic malignancy who underwent a TL. To restore their ability to speak, we performed a primary TEP and immediate voice prosthesis placement. After the TEP, we closed the larynx using a stapler. The surgical technique used in this procedure has been thoroughly explained.The use of a surgical stapler for pharyngeal closure during a TL has several advantages, particularly with regard to the duration of surgery. The current techniques appear to be promising in reducing TEP-related complications during stapler-assisted laryngeal closure., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Most patients perceive total laryngectomy as a mutilation carrying with it a loss of physical and psychological integrity. Thus, an artificial larynx system that can replace the laryngeal functions would significantly improve the quality of life for the afflicted patients., Methods: This report, with accompanying video, presents the first case in an ongoing clinical trial of laryngeal rehabilitation using an artificial larynx after total laryngectomy for squamous cell carcinoma, for an 8-month follow-up period. We depict the prosthesis' features, our 2-step surgical procedure, and the outcome. The prosthesis is formed of 2 parts: (1) a tracheal prosthesis with a porous titanium junction with trachea, which was implanted in the first step to ensure its colonization, and (2) a removable part composed of concentric valves that enable inhalation and exhalation. The second part was implanted endoscopically. The implant was monitored with a retrograde nasofibroscopy of the tracheal prosthesis lumen and CT scans over a course of 8 months., Results: The patient's functioning in the relevant postoperative problem areas, such as swallowing, breathing, and smelling, has significantly improved. The patient was able to talk in a whispering fashion while the tracheostomy was temporarily closed. The implant's porous part was in the process of being colonized by the surrounding tissue and no fistulas were observed as evidenced by barium swallow., Conclusion: As the current case shows, tracheotomy closure can be performed, and laryngeal functions are restored, by means of an implant. With further improvements, this system can alleviate the need for a permanent tracheostomy after total laryngectomy, while maintaining important larynx functions intact., (© 2014 Wiley Periodicals, Inc.)

Objective: We aimed to determine patterns of alaryngeal voice acquisition and predictive factors of vocal rehabilitation (VR) failure following total laryngectomy (TL) at a large Canadian tertiary care center. Methods: All consecutive patients having undergone a TL between January 1st, 2011 and December 31st, 2019, at the Centre Hospitalier de l'Université de Montréal were included. Results: One hundred and ninety‐seven laryngectomized patients were identified. Successful VR was achieved in 86 (59.0%) patients, while 59 (41.0%) failed to use a method of alaryngeal voice as their principal means of communication at 1 year postoperatively. The use of tracheoesophageal puncture (TEP) was associated with higher VR success rates (70.6%) when compared with the artificial larynx (48.6%), and esophageal voice (18.8%). The only independent predictor of VR failure on multivariate analysis at all time points was a low socioeconomic status. Conclusion: Failure to adopt an alaryngeal voice following TL is highly prevalent, despite comprehensive and free speech language pathologist services being offered at our center. A low resort to TEP at our institution and a poor acceptability and accessibility of alternative VR methods may contribute to this trend. The challenges of VR may be further exacerbated by the barriers linked to a lower socioeconomic status, which in turn may contribute to reduced candidacy for TEP. [ABSTRACT FROM AUTHOR]

Herein, we report the first study to create a three‐dimensional (3D) bioprinted artificial larynx for whole‐laryngeal replacement. Our 3D bio‐printed larynx was generated using extrusion‐based 3D bioprinter with rabbit's chondrocyte‐laden gelatin methacryloyl (GelMA)/glycidyl‐methacrylated hyaluronic acid (GMHA) hybrid bioink. We used a polycaprolactone (PCL) outer framework incorporated with pores to achieve the structural strength of printed constructs, as well as to provide a suitable microenvironment to support printed cells. Notably, we established a novel fluidics supply (FS) system that simultaneously supplies basal medium together with a 3D bioprinting process, thereby improving cell survival during the printing process. Our results showed that the FS system enhanced post‐printing cell viability, which enabled the generation of a large‐scale cell‐laden artificial laryngeal framework. Additionally, the incorporation of the PCL outer framework with pores and inner hydrogel provides structural stability and sufficient nutrient/oxygen transport. An animal study confirmed that the transplanted 3D bio‐larynx successfully maintained the airway. With further development, our new strategy holds great potential for fabricating human‐scale larynxes with in vivo‐like biological functions for laryngectomy patients. [ABSTRACT FROM AUTHOR]

The aim of this historical vignette is to delve into the description and use of the first artificial larynx, developed by Carl Gussenbauer, and used after Theodor Billroth's first total laryngectomy, performed on December 31, 1873. [ABSTRACT FROM AUTHOR]

This article documents experiments performed in ewes to design an artificial larynx. The artificial larynx is composed of a hollow, porous tube that elongates the trachea and is capped with a valve that acts as a laryngeal sphincter. Through an industrial collaboration, our team developed a porous biomaterial that can be colonized by cervical tissues. This biomaterial has been used in animals to replace part of the trachea, but it is meant to eventually substitute for laryngeal cartilage. The tracheal prosthesis is a hollow cylindrical tube composed of titanium microbeads. We performed a study in large animals to establish an optimal surgical protocol for tracheal replacement in humans. The study included 11 sheep (n = 11) and compared5 methods of implantation. We successfully established an optimalthree-step surgical protocol to make the porous-titanium tracheal prosthesis functional: (1) large lumen endoprosthetics, (2) colonization by the peripheral tissues, and (3) endoprosthetic epithelialization. This study is the first step in developing an artificial larynx because it successfully identifies a biomaterial capable of extending the trachea to allow it to open at the junction of the upper aerodigestive tracts. [ABSTRACT FROM AUTHOR]

Background. A newly developed artificial voice source was clinically evaluated in laryngectomized women for voice quality improvements. The prosthesis was placed in a commercially available, tracheoesophageal shunt valve. Methods. In 17 subjects, voice-producing element (VPE) prototypes were compared with the subject's regular tracheo-esophageal shunt voice in a randomized cross-over trial. The evaluation was based on aeroacoustic measurements and perceptual analysis. Results. Considerably higher fundamental frequencies were attained with the use of the VPE. The sound pressure level also increased for most subjects. The required driving pressures of the lung and air flow rates were altered, allowing significantly longer phonation times in 1 breath. Accumulation of mucus did not interfere with the proper functioning of the device during these tests. Conclusion. A VPE with sound-generating membranes is suitable for providing a substitute voice source for laryngectomized patients, especially patients suggestive of a severely hypotonic or atonic pharyngoesophageal segment who can benefit from a more melodious and louder voice. © 2008 Wiley Periodicals, Inc. Head Neck 2008 [ABSTRACT FROM AUTHOR]

Purpose: The electrolarynx (EL) is a widely used device for alaryngeal speech, but it requires manual operation and produces voice that typically has a constant fundamental frequency. An electromyographically controlled EL (EMG-EL) was designed and implemented to provide hands-free control with dynamic pitch modulation. Method: Three participants who underwent total laryngectomy surgery and 4 participants with normal voice were trained to produce EMG-EL speech through a multiple-baseline, successive-stage protocol. Baseline performance was established through 3 testing probes, followed by multiple hour-long training sessions. Results: At the end of the training, all participants learned to initiate, sustain, and terminate EMG-EL activation in correspondence with articulation, and most were able to modulate the pitch to produce intonational contrasts. After completing the testing/ training protocol, 1 of the 3 participants who underwent total laryngectomy was encouraged to independently use the EMG-EL at his residence. This participant sustained his performance for an additional 6 weeks and also used the EMG-EL successfully to communicate over the phone. Conclusions: Our findings suggest that some participants with laryngectomies and vocally normal individuals can learn to produce hands-free speech using the EMG-EL device within a few hours and that significant additional gains in device control (particularly pitch modulation) are attainable through subsequent training sessions. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To analyze the effectiveness of the Provox2 voice prosthesis for voice rehabilitation following total laryngectomy. Methods: From September 2000 to December 2004, the Provox2 voice prosthesis was used for voice rehabilitation in 32 patients following total laryngectomy. The quality of speech with the Provox2 voice prosthesis was analyzed using the HRS rating scale, the maximum phonation time (MPT), incidence of complications and the in situ lifetime. The rate of speech restoration was further analyzed in 129 patients with total laryngectomy from 1996 to 2004. Result: Twenty-nine of 32 patients were able to restore speech using the Provox2 voice prosthesis, a speech restoration rate of 90.6%. The maximum phonation time (MPT) was measured in 18 patients using the Provox2 voice prosthesis. The mean MPT was 15.1s, with a range of 8–28s. MPT was not influenced by age, concurrent radiotherapy treatment, the location of the primary tumor or use of reconstructive surgery. The average lifetime of the Provox2 in patients with laryngeal carcinoma (12 patients) and hypopharyngeal carcinoma (17 patients) was 27.2 and 16.6 weeks, respectively, which was significantly different (P =0.024, non-parametric Mann–Whitney''s U-test). The rate of speech restoration by the use of esophageal speech, and insertion of an artificial larynx was 62.7% for laryngeal carcinoma (59 cases) and 38.6% for hypopharyngeal carcinoma (70 cases), which was also significantly different (P <0.01, chi-square test). Conclusion: Provox2 voice prosthesis speech was very useful due to the higher rate of speech restoration, longer phonatory time, and better intelligibility. It was also thought that voice prosthesis speech was useful in conjunction with esophageal speech and an artificial larynx depending on the patient''s condition or wishes. [Copyright &y& Elsevier]

Background. A pneumatic artificial sound source incorporated in a regular tracheoesophageal shunt valve may improve alaryngeal voice quality. Methods. In 20 laryngectomees categorized for sex and pharyngoesophageal segment tonicity, a prototype sound-producing voice prosthesis (SPVP) is evaluated for a brief period and compared with their regular tracheoesophageal shunt speech. Results. Perceptual voice evaluation by an expert listener and acoustical analysis demonstrate a uniform rise of vocal pitch when using the SPVP. Female laryngectomees with an atonic pharyngoesophageal segment gain vocal strength with the SPVP. Exerted tracheal pressure and airflow rate are equivalent to those required for regular tracheoesophageal shunt valves. However, communicative suitability and speech intelligibility deteriorate by the SPVP for most patients. Tracheal phlegm clogging the SPVP is a hindrance for most patients. Conclusions. The SPVP raises vocal pitch. Female laryngectomees with an atonic or severely hypotonic pharyngoesophageal segment can benefit from a stronger voice with the SPVP. © 2005 Wiley Periodicals, Inc. Head Neck28: 400–412, 2006 [ABSTRACT FROM AUTHOR]

After total laryngectomy the normal voice can be replaced by an electronic artificial larynx (AL). However, the results of the surrogate voice are not overall satisfying due to a robotic clattered sound of that prosthesis. In this paper the outcome of a sound investigation for an AL is presented. This work is part of our AL research project on laryngectomee speech enhancement. As a result, an autoregressive model of the hearing process is derived that can directly be used for a novel speech-enhancement procedure. The model is derived in the framework of linear prediction theory based on the fact that speech can be modelled as the output of a linear filter excited by a periodic pulse train and random noise. Additionally, we developed an innovative training unit for novice laryngectomees measuring the relative inter-line energy of the speech. [ABSTRACT FROM AUTHOR]

Hands-free triggering and pitch control would improve electrolarynx devices, which are inconvenient to use and sound unnatural. The present study tested the strategy of salvaging voice-related neural signals for hands-free electrolarynx control either by transferring cut recurrent laryngeal nerves (RLNs) to denervated neck strap muscles or by preserving strap muscles with their normal innervation. An RLN nerve transfer was performed at the time of total laryngectomy in 8 individuals, and in 5 of these subjects, strap muscles with intact ansa cervicalis innervation were also preserved for comparison. Neck surface electromyography performed over the strap muscles was used periodically for more than 1 year on phonatory and nonphonatory tasks. Signals were eventually obtained in all subjects from both RLN-innervated and ansa-innervated strap muscles that correlated with speech production. After 1 year, RLN-driven signals were larger than ansa-driven signals in magnitude, and their timing appeared better correlated with intended phonation. The results show that neck surface electromyography is an effective control source for hands-free electrolarynx activation, and that RLN transfer may provide the best approach for obtaining phonation-related activity. [ABSTRACT FROM AUTHOR]

In order to improve voice quality in female laryngectomees and/or laryngectomees with a hypotonic pharyngo-oesophageal segment, a sound-producing voice prosthesis was designed. The new source of voice consists of either one or two bent silicone lips which perform an oscillatory movement driven by the expired pulmonary air that flows along the outward-striking lips through the tracheo-oesophageal shunt valve. Four different prototypes of this pneumatic sound source were evaluated in vitro and in two female laryngectomees, testing the feasibility and characteristics of this new mechanism for alternative alaryngeal voice production. In vivo evaluation included acoustic analyses of both sustained vowels and read-aloud prose, videofluoroscopy, speech rate, and registration of tracheal phonatory pressure and vocal intensity. The mechanism proved feasible and did not result in unacceptable airflow resistance. The average pitch of voice increased and clarity improved in female laryngectomees. Pitch regulation of this prosthetic voice is possible with sufficient modulation to avoid monotony. The quality of voice attained through the sound-producing voice prostheses depends on a patient’s ability to let pulmonary air flow easily through the pharyngo-oesophageal segment without evoking the low-frequency mucosal vibrations that form the regular tracheo-oesophageal shunt voice. These initial experimental and clinical results provide directions for the future development of sound-producing voice prostheses. A single relatively long lip in a container with a rectangular lumen that hardly protrudes from the voice prosthesis may have the most promising characteristics. [ABSTRACT FROM AUTHOR]

Objective To improve the voice quality of female laryngectomees and/or laryngectomees with a hypotonic pharyngoesophageal (PE) segment by means of a pneumatic artificial source of voice incorporated in a regular tracheoesophageal (TE) shunt valve. Study Design Experimental, randomized, crossover trial. Methods The new sound source consists of a single silicone lip, which performs an oscillatory movement driven by expired pulmonary air flowing along the outward-striking lip through the TE shunt valve. A prototype of this pneumatic sound source is evaluated in vitro and in six laryngectomees. In vivo evaluation includes speech rate, maximal phonation time, perceptual voice evaluation of read-aloud prose by an expert listener, speech intelligibility measurements with 12 listeners, and self-assessment by the patients. Moreover, extensive acoustical and aerodynamic in vivo registrations are performed using a newly developed data acquisition system. Results The current prototype seems beneficial in female laryngectomees with a hypotonic PE segment only. For them the sound-producing voice prosthesis improves voice quality and increases the average pitch of voice, without decreasing intelligibility or necessitating other pressure and airflow rates than regular TE shunt speech. Pitch regulation of this prosthetic voice is possible, yet limited. Conclusions The mechanism is feasible and does not result in unacceptable airflow resistance. For this new mechanism of alaryngeal voice to become an established technique for postlaryngectomy voice restoration, a voice suitably pitched for male laryngectomees has to be generated and a large part of the melodic and dynamic range of the sound source has to be attainable within physiological airflow rates. [ABSTRACT FROM AUTHOR]

Since the introduction and performance of total laryngectomy, voice restoration has become an important issue. Voice prostheses are widely used for this purpose. Based on experience with previous and current prostheses, the important characteristics for any voice prosthesis can be defined. These characteristics are: indwelling fixation, low resistance to airflow, less bothersome and easier insertion into the tracheoesophageal (TE) fistula. Also, predictable long device life span (resistance to Candida deterioration) and easy removal of the prosthesis to allow inspection or cleaning and consequent re-insertion are desirable. The VoiceMaster voice prosthesis was developed with these characteristics in mind. The VoiceMaster prosthesis is described in this paper. The first results from the preliminary study in which the currently available VoiceMaster was tested are very encouraging. [ABSTRACT FROM AUTHOR]