Speech Rehabilitation with Free Lateral Upper Arm Flap after Total or Subtotal Laryngectomy in Patients with Advanced Laryngeal Cancer.

Abstract

To investigate the feasibility of using free lateral upper arm flap (LUAF) to reconstruct a laryngeal phonatory tube for restoring the speech function in patients with advanced laryngeal cancer. The voice outcomes were evaluated in comparison with those of the patients using esophageal speech (ES) after total laryngectomy (TLG). The clinical data of 74 male patients diagnosed with advanced laryngeal cancer between 2019 and 2024 were reviewed. All patients underwent TLG or subtotal laryngectomy (sTLG). Among them, 23 patients received free LUAF to reconstruct a laryngeal phonatory tube connecting the stumps of the trachea and oropharynx, the remaining patients without phonatory tube reconstruction received ES training 20 days after surgery. The voice was assessed via subjective, objective evaluation, and voice-related quality of life assessment (VrQoL), which was performed 3 months after surgery. The follow-up period ranged from 1 to 4 years, with a mean of 2 years and 4 months. The flaps survived without complications in 20 patients (LUAF group), and transient pharyngeal fistulas developed in 3 patients. At the end of the follow-up period, all patients in the LUAF group were alive and had no signs of recurrence. All patients in the LUAF group restored voice after surgery. 26(26/51) patients in the ES group acquired esophageal phonation at 3 months postoperatively. Compared with the ES group, the LUAF group had a better fundamental frequency(F0) (p <0.05), sound pressure level (SPL) (p <0.05), maximum phonation time (MPT) (p <0.05), harmonics-to-noise ratio (HNR) (p <0.05), speech recognition rate (SRR), and reduced effort during speech but showed worse swallowing function (p <0.05). The two groups showed comparable daily communication satisfaction (DCS), and speech naturalness and intelligibility. The free LUAF can be used to reconstruct a phonatory tube after TLG or sTLG in patients with advanced laryngeal cancer, with minor damage to the donor site. Compared with ES, the speech reconstructed by the LUAF tube is easier to acquire, and the patients in the LUAF group have higher speech quality, indicating that this technology is a feasible alternative to restore the patients' speech after TLG or sTLG.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.