Voice Rehabilitation After Laryngectomy

THE IDEA of constructing a communication between the trachea and the pharynx in order to reestablish speech following total laryngectomy has undoubtedly occurred, at one time or another, to most laryngeal surgeons. Two complicating factors, however, have rendered any such procedure impractical—leakage of saliva and food into the trachea and ultimate stenosis of the tracheopharyngeal communication. In 1870 Professor Billroth performed a series of experimental laryngectomies on dogs.1He was successful in restoring a coarse bark by constructing a communication between the trachea and the pharynx. In 1874 Dr. Billroth performed the first recorded laryngectomy. Dr. Gussenbauer, a resident training with Dr. Billroth, designed and constructed an apparatus (Fig 1) for restoration of speech by way of a pharyngostoma above the tracheostoma.2 In 1874 Czerny reported a series of dog experiments with restoration of bark, using a technique similar to that of Billroth's.3 Scuri, in 1928, reported