Voice Reconstruction with Bowel Transfer

ABSTRACT

At this time, voice reconstruction with a voice prosthesis can achieve a fair result; however, this type of reconstruction has many drawbacks. Another direction in voice reconstruction has been the development of methods to restore voice using segments of bowel. This type of reconstruction, in which autogenous tissue, particularly bowel, is used to reconstruct a voice tube, continues to be a challenge. Even though techniques of microsurgical transfer of bowel for reconstructing the esophagus have become fairly routine, the use of these same methods for voice reconstruction poses a unique set of obstacles that are currently being overcome. Autogenous tissue such as jejunum, ileocolon, appendix, and skin flaps have all been applied to create voice tubes at the same time as esophageal reconstruction or as a separate procedure. Among these methods, jejunum and ileum are the most commonly used. Simultaneous reconstruction of the esophagus and voice tube using bowel segments has the following advantages: lack of complications that might be associated with the long-term use of voice prostheses, and improved function as compared with voice prostheses. In general, the jejunum provides the best deglutition function; however, it has a higher rate of food regurgitation into the airway when used to create a voice tube. At present, we prefer the use of an ileocolon flap for the reconstruction of both the esophagus and voice tube in one setting. Whereas using ileocolon might yield slightly inferior results with swallowing as compared with jejunum, results with voice function and prevention of regurgitation are superior. Although laryngeal allo-transplantation has potential applications, its use will be limited by the level of sophistication of immune-suppressant medication. Future trends in voice reconstruction might use a combination of both autogenous tissue and tissue engineered constructs to produce high-quality voice with little to no side effects.

KEYWORDS

Voice reconstruction - voice prosthesis - jejunum - ileocolon - appendix

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