Understandable Speech Is Possible After Removal of Tongue and Voice Box

A surgical incision between the trachea and esophagus (tracheo-esophageal puncture) following removal of the tongue and voice box provides effective speech communication for select head and neck cancer patients who otherwise would not be able to speak.

Most treatments for tongue and voice box cancer allow patients to retain those organs and maintain speech communication. For those few patients whose cancers do not respond to organ-sparing techniques, surgical removal of the tongue (glossectomy) and voice box (laryngectomy) may be necessary. When the tongue and voice box are both removed, understandable speech communication becomes impossible, leading to a decline in the quality of life for the patient.

Now, researchers have developed an option that can restore understandable speech to this select patient group. After the total laryngectomy and glossectomy, a tracheoesophageal puncture (TEP), an incision between the trachea and esophagus that is fitted with a small plastic or silicone valve, is performed. With the help of post operative speech rehabilitation therapy, this procedure can provide understandable speech communication and improve quality of life. The authors of “Communication Rehabilitation for Patients with Head and Neck Cancer Following Total Laryngectomy with Total Glossectomy” are Daniel W. Karakla, MD, Ann Cyptar, MS, CCC-SLP, Nicole McIntyre, MD, and J. Trad Wadsworth, MD, all from the Department of Otolaryngology – Head & Neck Surgery, Eastern Virginia Medical School, Norfolk, VA. They will present their findings at the 6th International Conference on Head and Neck Cancer being held August 7-11, 2004, at the Wardman Park Marriott in Washington, DC.

Methodology: The retrospective study was conducted at two tertiary care referral centers for head and neck cancer and included two groups of patients. The first group consisted of four head and neck cancer patients who received a secondary TEP after being screened from a larger population of patients who underwent total laryngectomy (removal of voice box) and total glossectomy (removal of the tongue). Screening was done through counseling by the oncologic surgeon and speech and language pathologist to determine which patients would be most suitable for a TEP. The second group included five patients who received a TEP primarily (at the time of laryngectomy and glossectomy) and were retrospectively reviewed.

Both the patients and their families were surveyed to determine their level of satisfaction in speech intelligibility and swallowing after TEP and rehabilitation and at six month follow-up. Patients were also assessed by audiovisual tape during rehabilitation. All patients received post-operative speech rehabilitation therapy.

Results: All patients in the first group (secondary TEP) were satisfied with their speech intelligibility results. The range of achievable speech is demonstrated through review of the audiovisual tapes. The second group of patients (primary TEP) did not develop functional speech despite intensive speech therapy.

Conclusion: The results of this study indicate that secondary TEP can be a viable and important procedure following total laryngectomy with total glossectomy in carefully selected patients. In this subgroup of patients, secondary TEP can provide understandable speech, allowing improved quality of life for patients and their families.

Head and neck cancer remains a significant threat to the thousands of Americans of all ages who continue to use tobacco products and consume alcohol. New surgical and oncological treatments may successfully address the cancer; this study reminds us that new procedures are necessary to counter the negative consequences of any surgical treatment.