Objective: To examine the effect of a new surgical intervention, consisting of cricopharyngeal myotomy and tracheal cartilaginous implantation on the anterior wall of the esophagus, for tracheoesophageal shunt and esophageal phonation. Design: We examined the vibration of the neoglottis of tracheoesophageal shunt and esophageal speakers after total laryngectomy using a high-speed video camera (frame rate, 1000 per second). Patients: Twenty-one alaryngeal patients were involved: 13 who had undergone the present procedure and 8 who had not. Results: The regularity of neoglottal vibration and the degree of neoglottal closure were significantly (P&lt
.01) better in patients who had undergone the procedure than in those who had not. These effects on neoglottal vibration induced easier phonation. Conclusions: Cricopharyngeal myotomy was useful for avoiding reconstructed esophageal spasm, and tracheal cartilaginous implantation was effective for maintaining a wide subneoglottal space. This combination of procedures is useful for obtaining optimal vibration of the neoglottis in tracheoesophageal shunt and esophageal speakers.