Several modifications of the tracheoesophageal shunt have been attempted in laryngectomized patients for voice rehabilitation, however, almost all have been beset by stenosis of the shunt, aspiration through the shunt, or both. Thus, the author proposed another modification of the tracheoesophageal shunt, using the inferiorly-based esophageal mucosal flap, and the flap design was developed through animal models(6 dogs). Clinical trials in 8 patients were evaluated for the quantitative and qualitative parameters of maximum phonation time, counting/breath, words/breath, speech intelligibility and maximum intensity. The results obtained were better than those of other tracheoesophageal to shunt modifications and are summarized as follows : 1) Six cases were rehabilitated to good voice(Leipzig criteria grade I or II), and the results were 14.1 seconds of maximum phonation time, 23.6 counts of counting/13.1 words of words/breath, 83.3% of speech intelligibility and 77.2dB of maximum intensity. The mean rehabilitation time was 3.7 weeks. 2) Two cases showed aspiration and 1 case had stenosis of the shunt, but there was no evidence of swallowing difficulty. 3) There was no evidence of radiation effects onto the shunt. 4) The suitable size of the mucosal flap was considered to be 3.0×1.5 cm, which was based on animal experiment and clinical application.