Background/Objectives: Total laryngectomy (TL) remains a key treatment option for advanced laryngeal cancer. Primary tracheoesophageal puncture (TEP) with voice prosthesis (VP) enables early speech restoration and is increasingly adopted, even in patients with conditions traditionally considered contraindications, such as prior/adjuvant radiotherapy, extended resections, and immediate reconstructive procedures. This study evaluates complication rates and long-term outcomes associated with primary TEP in these settings. Methods: A retrospective cohort of 101 patients undergoing TL for laryngeal or hypopharyngeal squamous cell carcinoma at the University Hospital of Sassari (August 2017–December 2024) was analyzed. Demographic, clinical, surgical, and oncological data were collected, with a particular focus on postoperative early complications and late sequelae and oncological outcomes. Results: Primary TEP was performed in 78 patients (77.2%). Overall, pharyngocutaneous fistula occurred in 6/101 patients (5.9%), postoperative bleeding in 5/101 (5.0%), and dysphagia in 11/101 (10.9%), with only 2/11 (2.0%) requiring intervention. Mean follow-up was 44.6 ± 3.2 months (median 41, range 4–93). No significant association was found between primary TEP and complication rates, including in patients undergoing enlarged TL with pectoralis major reconstruction. Conclusions: Primary TEP appears safe and effective, even in cases requiring extended resections and reconstructive procedures. It should be considered to enhance functional recovery and postoperative quality of life for all motivated patients undergoing total laryngectomy without patient-related contraindications. Our findings may constitute a step towards personalized medicine in laryngeal oncology as they support priortizing patient-specific factors, such as pneumological and neurological clinical conditions and level of cooperation, over purely surgical considerations.

Objective: This study aims to critically review and synthesize the existing literature on the use of voice analysis in assessing nasal obstruction, with a particular focus on acoustic parameters. Data sources: PubMed, Scopus, Web of Science, Ovid Medline, and Science Direct. Review methods: A comprehensive literature search was conducted without any restrictions on publication year, employing Boolean search techniques. The selection and review process of the studies followed PRISMA guidelines. The inclusion criteria comprised studies with participants aged 18 years and older who had nasal obstruction evaluated using acoustic voice analysis parameters, along with objective and/or subjective methods for assessing nasal obstruction. Results: Of the 174 abstracts identified, 118 were screened after the removal of duplicates. The full texts of 37 articles were reviewed. Only 10 studies met inclusion criteria. The majority of these studies found no significant correlations between voice parameters and nasal obstruction. Among the various acoustic parameters examined, shimmer was the most consistently affected, with statistically significant changes identified in three independent studies. A smaller number of studies reported notable findings for fundamental frequency (F0) and noise-related measures such as NHR/HNR. Conclusion: This systematic review critically evaluates existing studies on the use of voice analysis for assessing and monitoring nasal obstruction and hyponasality. The current evidence remains limited, as most investigations predominantly focus on glottic sound and dysphonia, with insufficient attention to the influence of the vocal tract, particularly the nasal cavities, on voice production. A notable gap exists in the integration of advanced analytical approaches, such as machine learning, in this field. Future research should focus on the use of advanced analytical approaches to specifically extrapolate the contribution of nasal resonance to voice thus defining the specific parameters in the voice spectrogram that can give precise information on nasal obstruction.