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Explores clinical issues of the 20-year-old tracheoesophageal puncture technique which allows for esophageal speech with pulmonic air. After a brief overview of the history of the technique, topics discussed include preoperative assessment methods, patient selection considerations, surgical techniques of primary and secondary puncture, surgical approaches to laryngopharyngectomy, surgical complications, postoperative therapeutic issues, the preservation of tracheoesophogeal prostheses, and the use of botulinum neurotoxin to nonsurgically optimize the pharynx muscles for alaryngeal phonation. Annotation c. by Book News, Inc., Portland, Or.