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To study voice prosthesis survival, complications, efficacy and impact on quality of life. A single-center observational study was performed in patients treated for squamous cell carcinoma of the larynx or hypopharynx by total (pharyngo)-laryngectomy between 2010 and 2015. Study data comprised: maximum phonation time (sec), number of and reasons for prosthesis exchanges (leakage through or around the prosthesis, expulsion or inclusion of the prosthesis), plus 2 quality of life questionnaires (QLQ-C30, QLQ-H&N35) and the Voice Handicap Inventory (VHI 30). Forty-nine patients were included. The most common causes of prosthesis exchange were leakage through (73.2%) or around the prosthesis (18.5%). The median time between exchanges was 4 months. Global quality of life status on the QLQ-C30 was 63.5. Mean maximum phonation time was 7.4 sec. Mean VHI was 46/120; 10 patients had a mild voice handicap, 12 moderate and 10 severe. No relation emerged between the number of prosthesis exchanges per year and quality of life. Voice handicap significantly decreased quality of life, with QLQ-C30 72.3 for the 22 patients with mild to moderate voice handicap and 44.2 for the 10 patients with severe voice handicap (P = 0.001). Voice restoration by tracheoesophageal prosthesis after total (pharyngo)-laryngectomy is a reliable technique that decreases voice handicap and, despite potentially serious complications, has little negative impact on quality of life. [ABSTRACT FROM AUTHOR]

Summary: 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. [Copyright &y& Elsevier]