To the Editor.—Primary voice restoration after laryngectomy1 is gaining wider acceptance, and it is currently the method of choice at our services. Recently, one of our patients who underwent primary voice restoration returned with delayed dysphonia. When last seen, the patient had a fluent voice and was able to count from one to 20 in one breath. Four weeks later, the patient's voice fluency was gone, he had to stop several times to complete a sentence, and he was unable to count more than one to four in one breath.
We did not consider the possibility of cricopharyngeal spasm, as an adequate myotomy was done at the time of primary surgery. This patient had a history of pharyngocutaneous fistula in the immediate postoperative period, which healed spontaneously. On exploring the neck on the side with the fistula, we found extensive fibrosis and scar tissue with adhesions to the