Comparative Analysis of Tracheoesophageal Voice Outcomes after Primary Puncture during Total Laryngectomy with and without Pectoralis Major Flap Reconstruction

Objective: Total laryngectomy (TL) is still considered the gold standard treatment for advanced laryngeal cancer. Despite its oncological efficacy, the procedure is invasive and leads to permanent voice loss, profoundly affecting patients' quality of life. While communicative and functional outcomes following standard TL have been widely studied, limited evidence is available regarding extended procedures that require reconstructive techniques. In particular, the potential impact of a pectoralis major flap on subsequent vocal rehabilitation remains unclear. The present study aimed to retrospectively evaluate and compare vocal outcomes in patients who underwent TL with primary tracheoesophageal puncture (TEP) and voice prosthesis (VP) placement, either with pectoralis major flap reconstruction (Pec Maj reconstruction group) or without reconstruction (Primary closure group). Methods: Vocal assessments were performed during scheduled follow-up visits by a speech and language therapist. The evaluation included both subjective and objective measures. Acceptance and adaptation to tracheoesophageal (TE) speech were assessed using the Italian version of the Self-Evaluation of Communication Experiences after Laryngeal Cancer. Perceptual voice quality was analyzed through the Impression, Noise, Fluency, Voicing scale, while acoustic parameters were obtained using Praat software. Aerodynamic performance was measured with maximum phonation time. Group comparisons were carried out to identify possible differences and correlations among outcomes. Results: The statistical analysis showed no significant differences between the two groups. Comparable levels of acceptance and adaptation to TE speech were observed, along with similar perceptual, acoustic, and aerodynamic results. Conclusions: These findings suggest that pectoralis major flap reconstruction does not negatively influence vocal rehabilitation when primary TEP with VP placement is performed. TE speech, therefore, remains a reliable and effective method of voice restoration, regardless of reconstructive requirements. Patient-related factors, rather than surgical variables, appear to be the main determinants influencing candidacy for primary TEP and successful VP rehabilitation.