The developments of tracheoesophageal puncture and voice prosthesis for alaryngeal speech rehabilitation directed attention to the anatomy and physiology of the pharyngoesophageal segment. A reproducible tracheoesophageal shunt in a large number of patients permitted the largest study population for alaryngeal speech acquisition to date. The sustained tracheoesophageal airflow led to important observations on speech acquisition after laryngectomy. Surgical techniques to reduce the tension in the pharyngoesophageal segment have evolved and include pharyngeal constrictor myotomies or pharyngeal plexus neurectomies. These adjunctive procedures to total laryngectorny are key aspects for consistent and effective voice acquisition after laryngectorny. HEAD & NECK SURGERY 1O:S118-
Sl23,1988
Contemporary efforts to restore voice after laryngectomy have been directed toward the development of a valve to protect the airway during deglutition and to permit exhaled air to enter the pharynx for sound production. A number of shunt techniques have been proposed that rely on passive tissue collapse to close the passageway during swallowing. An alternative approach has been to interpose a mechanical valve in the shunt to provide for the necessary airway protection.