Implantation of an Artificial Larynx after Total Laryngectomy
Organ loss due to late-stage cancer is a heavy burden on both the patient and the health care system. Total laryngectomy in patients with advanced laryngeal or hypopharyngeal carcinoma is lifesaving,1 but it entails a substantial loss of quality of life because of altered physiological functions and a sense of mutilation. We designed an artificial larynx that can replace lost laryngeal functions. We first implanted an artificial larynx in a patient in 2012. Here we present the case of a patient who received an ENTegral artificial larynx in 2015 after total laryngectomy and underwent 16 months of follow-up.
The artificial larynx consists of two parts that are implanted in a two-phase procedure. The device contains a permanent titanium tracheal prosthesis with a porous distal end to improve soft-tissue integration3 and a removable titanium open-ventilation cap with a conformation that allows the continuous passage of air while protecting the patient’s airway from aspiration. This cap allows the patient to breathe and drink fluids. When the patient coughs, the upper flap can open transiently to allow the expulsion of bronchopulmonary secretions.
Our patient was a 56-year-old man who underwent total laryngectomy and bilateral cervical lymphadenectomy. The patient provided written informed consent, and in phase 1 of the procedure, the permanent tracheal prosthesis was implanted with a temporary closed cap. The patient was able to receive oral nutrition at 3 weeks and then received scheduled radiotherapy. Four months after phase 1, in phase 2 of the procedure, the temporary cap was removed and replaced with a removable open-ventilation cap.
After phase 2 of the procedure, the patient was able to speak at an intelligible whisper, with a score of 28 on the Voice Handicap Index (on a scale of 0 to 120, with higher scores indicating more severe impairment) . The patient continued to use a fenestrated tracheostomy cannula, although he was able to close it for 6 or more hours per day to breathe through the upper airways . He was not observed to have either dyspnea or symptomatic aspiration of saliva. However, videofluoroscopic imaging with contrast enhancement sometimes showed material inside the prosthesis after swallowing .
During the 16-month follow-up period, stenosis did not develop at the trachea–prosthesis anastomosis, the device did not interfere with planned radiotherapy, and the tracheostomy cannula could be closed at will. The patient could breathe and expectorate through the upper airways and maintained adequate arterial blood hemoglobin saturation while breathing ambient air. In addition, he was able to swallow saliva during the day and at night, although occasional aspiration of food occurred. The patient’s olfaction, which had been compromised, was completely restored.
Christian Debry, M.D., Ph.D.
Hôpitaux Universitaires de Strasbourg, Strasbourg, France
N. Engin Vrana, Ph.D.
INSERM Unité 1121, Strasbourg, France
Agnès Dupret-Bories, M.D., Ph.D.
Institut Claudius Regaud, Toulouse, France