Complications of Primary Tracheoesophageal Fistula Following Total Laryngectomy

1989 ◽  
Vol 115 (8) ◽  
pp. 906-906
Author(s):  
--P. A. LEVINE
Keyword(s):  
Total Laryngectomy ◽  
Tracheoesophageal Fistula

Surgical Closure of Tracheoesophageal Puncture Without a Flap Interposition

2020 ◽  
Vol 163 (3) ◽  
pp. 618-620
Author(s):  
João Fonseca Neves ◽  
Ana Rita Nobre ◽  
Edite Portugal ◽  
Francisco Branquinho
Keyword(s):  
Surgical Technique ◽  
Total Laryngectomy ◽  
Tracheoesophageal Fistula ◽  
Skin Flap ◽  
Anterior Segment ◽  
Continuous Suture ◽  
Vocal Rehabilitation ◽  
Surgical Closure ◽  
Tracheoesophageal Puncture ◽  
Suture Closure

Tracheoesophageal puncture for voice prosthesis placement is often used in vocal rehabilitation of patients undergoing total laryngectomy. Although its closure can occur spontaneously, some patients require a surgical procedure. We propose a surgical technique, without flap interposition, that begins with careful separation of the esophagus and trachea and identification of the site of tracheoesophageal fistula. After continuous suture closure of the esophagus, the anterior segment of the first tracheal rings is vertically incised to facilitate tracheal closure in a suture without tension. Finally, a small pectoral skin flap is made and mobilized to suture to the free edges of the sectioned tracheal rings, thus reducing the risk of tracheal stenosis. Four patients underwent this procedure with uneventful postoperative evolution and permanent closure of the fistula.

scholarly journals Tracheoesophageal puncture site closure with sternocleidomastoid musculocutaneous transposition flap

2015 ◽  
Vol 48 (03) ◽  
pp. 278-282 ◽  
Author(s):  
Dushyant Jaiswal ◽  
Prabha Yadav ◽  
Vinay Kant Shankhdhar ◽  
Rajendra Suresh Gujjalanavar ◽  
Prashant Puranik
Keyword(s):  
Total Laryngectomy ◽  
Tracheoesophageal Fistula ◽  
Leading Edge ◽  
Puncture Site ◽  
Transposition Flap ◽  
Oesophageal Mucosa ◽  
Surgical Methods ◽  
Post Radiation ◽  
Tracheoesophageal Puncture ◽  
Second Procedure

ABSTRACT Introduction: Tracheoesophageal voice prosthesis is highly effective in providing speech after total laryngectomy. Although it is a safe method, in certain cases dilatation or leakage occurs around the prosthesis that needs closure of tracheoesophageal fistula. Both non-surgical and surgical methods for closure have been described. Surgical methods are used when non-surgical methods fail. We present the use of the sternocleidomastoid musculocutaneous (SCMMC) transposition flap for the closure of tracheoesophageal fistula. Materials and Methods: An incision is made at the mucocutaneous junction circumferentially around the tracheostoma. Tracheoesophageal space is dissected down to and beyond the fistula. The tracheoesophageal tract is divided. The oesophageal mucosa is closed with simple sutures. Then SCMMC transposition flap is raised and transposed to cover sutured oesophagus and the defect between the oesophagus and the trachea. Results: This study was done prospectively over a period of 1 year from June 2012 to May 2013. This technique was used in patients with pliable neck skin. In nine patients, this procedure was done (inferior based flap in nine cases) and it was successful in eight patients. In one case, there was dehiscence at the leading edge of flap with oesophageal dehiscence, which required a second procedure. In two cases, there was marginal necrosis of flap, which healed without any intervention. Nine patients in this series were post-radiation. Conclusion: This method of closure is simple and effective for patients with pliable neck skin, who require permanent closure of the tracheoesophageal fistula.

scholarly journals Videostroboscopic Evaluation of Neoglottis in Alaryngeal Patients after Tracheoesophageal Voice Reconstruction without Prosthesis

2009 ◽  
Vol 24 (2) ◽  
pp. 14-18
Author(s):  
Jeanne O. Madrid ◽  
Celso V. Ureta
Keyword(s):  
Total Laryngectomy ◽  
Tracheoesophageal Fistula ◽  
Public Hospital ◽  
Sound Production ◽  
Myocutaneous Flap ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Voice Production ◽  
Alaryngeal Speech

Objective:  To investigate by means of videostoboscopy the characteristics of the neoglottis after total laryngectomy with primary or secondary voice reconstruction using a non-prosthetic tracheoesophageal fistula technique Methods:        Design: Cross-Sectional Study Setting: Tertiary Public Hospital        Subjects: Twenty alaryngeal patients Results:  Videostroboscopy enabled evaluation of the neoglottis in all but two patients with a pectoralis major myocutaneous flap reconstruction of the pharyngoesophageal segment. Pooling of saliva was present in the cranial neoglottic opening in all subjects, but obscured visualization in these two. A circular neoglottic shape was most commonly seen.  Vibration of the neoglottis was noted in 90% of all alaryngeal patients and was associated with a regular mucosal wave.  Pharyngoesophageal vibration was noted in two thirds of patients.  It was associated with a strong mucosal wave, regular vibration and a longer open phase. Conclusion: Videostroboscopy confirmed that neoglottic vibration accompanies sound production while pharyngoesophageal vibration may reinforce and enhance voice production in alaryngeal patients with non-prosthetic TE voice reconstruction.    Keywords:  larynx, total laryngectomy, voice reconstruction, tracheoesophageal (te) fistula speech, alaryngeal voice, alaryngeal speech, videostrobe    

A simple technique for closure of persistent tracheoesophageal fistula after total laryngectomy

2009 ◽  
Vol 140 (4) ◽  
pp. 601-603 ◽  
Author(s):  
Sandra Schmitz ◽  
Jean-Philippe Van Damme ◽  
Marc Hamoir
Keyword(s):  
Total Laryngectomy ◽  
Tracheoesophageal Fistula ◽  
Simple Technique

scholarly journals Aspiration of tracheoesophageal prosthesis in a laryngectomized patient

2012 ◽  
Vol 7 ◽  
Author(s):  
Sergio C. Conte ◽  
Elena De Nardi ◽  
Federico Conte ◽  
Stefano Nardini
Keyword(s):  
Total Laryngectomy ◽  
Tracheoesophageal Fistula ◽  
Definitive Diagnosis ◽  
Voice Prosthesis ◽  
Voice Rehabilitation ◽  
Case Presentation ◽  
Safe Management ◽  
Tracheal Stoma ◽  
Laryngectomized Patient ◽  
The Voice

Background: The voice prosthesis inserted into a tracheoesophageal fistula has become the most widely used device for voice rehabilitation in patients with total laryngectomy. Case presentation: We describe a case of tracheoesophageal prosthesis’ (TEP) aspiration in a laryngectomized patient, with permanent tracheal stoma, that appeared during standard cleaning procedure, despite a programme of training for the safe management of patients with voice prosthesis. Conclusions: The definitive diagnosis and treatment were performed by flexible bronchoscopy, that may be considered the procedure of choice in these cases, also on the basis of the literature.

Communication Status following Laryngectomy: The Iowa Experience 1984–1987

1992 ◽  
Vol 101 (6) ◽  
pp. 503-510 ◽  
Author(s):  
Hughlett L. Morris ◽  
Duane R. Van Demark ◽  
Alice E. Smith ◽  
Michael D. Maves
Keyword(s):  
Total Laryngectomy ◽  
Tracheoesophageal Fistula ◽  
Consecutive Series ◽  
Voice Change ◽  
Early Symptom ◽  
Communication Modality ◽  
Voice Restoration ◽  
Sphincter Spasm ◽  
Clinical Records

Data regarding treatment and outcome for a consecutive series of 73 total laryngectomy patients were collected from clinical records with a follow-up period of 30 to 78 months postoperatively. Notable findings were that 27% were women; 75% reported hoarseness or a voice change as an early symptom; and 22% reported combined heavy use of both cigarettes and alcohol. Of the 73 patients, 38 (52%) died during the follow-up period; 18 of the 38 died within 1 year postoperatively. Thirty-nine (53%) of the 73 had received a surgical tracheoesophageal fistula (TEF) for voice restoration, as either a primary or a secondary procedure. Of the 39, 75 % were using the TEF at last examination, with no failures attributed to sphincter spasm. Of the total group, the primary communication modality was reported to be use of a TEF by 44% and use of an electrolarynx by 50%. Limitations of the study and directions for future investigations are discussed.

Prevention of aspiration following recurrent dislodgement of voice prosthesis: a patient's innovation

2008 ◽  
Vol 123 (6) ◽  
pp. 680-682
Author(s):  
M Masaany ◽  
M B Marina ◽  
A Asma ◽  
A Sani
Keyword(s):  
Total Laryngectomy ◽  
World Literature ◽  
Tracheoesophageal Fistula ◽  
Voice Prosthesis ◽  
Voice Restoration ◽  
The World ◽  
Carcinoma Of The Larynx ◽  
Cheap Method ◽  
Tracheal Stoma ◽  
The Voice

AbstractObjective:To demonstrate a simple, practical, cheap method of preventing potentially fatal aspiration of a dislodged voice prosthesis; this method was developed by a laryngectomised patient.Case report:A patient diagnosed with squamous cell carcinoma of the larynx underwent total laryngectomy. Upon completion of radiotherapy, a tracheoesophageal fistula was created and a voice prosthesis inserted to enable voice restoration. Unfortunately, the patient presented subsequently with repeated episodes of dislodgement and an episode of potentially fatal aspiration of the voice prosthesis, despite various measures taken by the surgeons to overcome the problem. The patient subsequently developed a method enabling him to retrieve the voice prosthesis himself should it become dislodged. He attached a ring to the prosthesis, which was larger in diameter than the tracheal stoma, thus preventing ingestion or recurrence of aspiration.Conclusion:To our knowledge, this is the first report in the world literature of this form of innovation, created by a laryngectomised patient, to overcome the problem of aspiration or ingestion of a dislodged voice prosthesis.

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