In reference to A Novel Approach for Dilation of Neopharyngeal Stricture Following Total Laryngectomy Using the Tracheoesophageal Puncture Site

2009 ◽  
Vol 119 (5) ◽  
pp. 1042-1042
Author(s):  
William J. Richtsmeier ◽  
James Bordley
Keyword(s):  
Total Laryngectomy ◽  
Puncture Site ◽  
Novel Approach ◽  
Tracheoesophageal Puncture

scholarly journals Aspirated Voice Prosthesis: A Unique Complication of Post Total Laryngectomy Voice Rehabilitation

2012 ◽  
Vol 2 (1) ◽  
pp. 41-45 ◽  
Author(s):  
Sudhir M Naik
Keyword(s):  
Case Report ◽  
Total Laryngectomy ◽  
Voice Prosthesis ◽  
Voice Rehabilitation ◽  
Wide Field ◽  
Wide Angle ◽  
Puncture Site ◽  
History Of ◽  
Tracheoesophageal Puncture ◽  
The Voice

ABSTRACT Background/objectives Prosthetic voice rehabilitation after total laryngectomy has proven to be successful in restoring proper speech function in over 90% of patients. The possibility of achieving effective speech using the voice prosthesis is superior to esophageal speech and electrolarynx. Setting Department of Head and Neck Oncosurgery, Kidwai Memorial Institute of Oncology, Bengaluru. Case report A 75-year-old female who had undergone wide field laryngectomy 14 months back came with history of lost voice prosthesis which was later found aspirated. It was removed by the bronchoscopic forceps under topical anesthesia by visualizing it by a nasal 0° wide angle endoscope. The puncture site was cleaned and allowed to cicatrize and narrow down. The fistula was closed by topical application of silver nitrate. Conclusion Tracheoesophageal puncture and prosthesis rehabilitation has emerged as the standard voice rehabilitation of laryngectomized patients. Patient education regarding maintenance of the prosthesis and the care for the tracheostoma is important in reducing the complications. How to cite this article Naik SM. Aspirated Voice Prosthesis: A Unique Complication of Post Total Laryngectomy Voice Rehabilitation. Int J Phonosurg Laryngol 2012;2(1):41-45.

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.

Transnasal oesophagoscopy-guided in-office secondary tracheoesophageal puncture

2007 ◽  
Vol 122 (3) ◽  
pp. 303-306 ◽  
Author(s):  
V S Doctor ◽  
D J Enepekides ◽  
D G Farwell ◽  
P C Belafsky
Keyword(s):  
Local Anaesthetic ◽  
Total Laryngectomy ◽  
Reliable Method ◽  
Voice Rehabilitation ◽  
Intravenous Sedation ◽  
Puncture Site ◽  
Endoscopic Techniques ◽  
Voice Restoration ◽  
Tracheoesophageal Puncture ◽  
Rigid Oesophagoscopy

AbstractObjective:Tracheoesophageal puncture is recognised as an effective and reliable method for voice restoration following total laryngectomy. Several techniques have been described, ranging from rigid oesophagoscopy under general anaesthesia to more recent endoscopic techniques utilising intravenous sedation or local anaesthetic. We describe our technique for secondary tracheoesophageal puncture utilising unsedated transnasal oesophagoscopy in an office setting.Method:Retrospective review of all total laryngectomy patients undergoing in-office transnasal oesophagoscopy-assisted tracheoesophageal puncture between October 1 2004 and December 31 2006.Results:Eleven patients undergoing transnasal oesophagoscopy-guided tracheoesophageal puncture were identified. Successful tracheoesophageal puncture placement was achieved in 10 of 11 patients (91 per cent). In one patient tracheoesophageal puncture could not be performed due to anatomic constraints. One patient had bleeding from the puncture site requiring silver nitrate cautery. All patients tolerated the procedure well. Voice results were satisfactory in all cases.Conclusions:Transnasal oesophagoscopy-guided tracheoesophageal puncture provides a simple, safe option for secondary voice rehabilitation in laryngectomy patients.

Periprosthetic Leakage in Tracheoesophageal Prosthesis: Proposal of a Standardized Therapeutic Algorithm

2021 ◽  
pp. 019459982098334
Author(s):  
Claudio Parrilla ◽  
Ylenia Longobardi ◽  
Jacopo Galli ◽  
Mario Rigante ◽  
Gaetano Paludetti ◽  
...  
Keyword(s):  
Total Laryngectomy ◽  
Retrospective Cohort ◽  
Voice Prosthesis ◽  
Management Algorithm ◽  
Therapeutic Algorithm ◽  
Periprosthetic Leakage ◽  
Tracheoesophageal Puncture ◽  
The University ◽  
The Voice

Objective Periprosthetic leakage represents the most demanding long-term complication in the voice prosthesis rehabilitation. The aim of this article is to discuss the various causes of periprosthetic leakage and to propose a systematic management algorithm. Study Design Retrospective cohort study. Setting Otolaryngology clinic of the University Polyclinic A. Gemelli–IRCCS Foundation. Methods The study included 115 patients with voice prosthesis who were treated from December 2014 to December 2019. All patients who experienced periprosthetic leakage were treated with the same step-by-step therapeutic approach until it was successful. Incidence, management, and success rate of every attempt are analyzed and discussed. Results Periprosthetic leakage was reported 330 times by 82 patients in 1374 clinic accesses. Radiotherapy, timing of tracheoesophageal puncture, and type of total laryngectomy (primary or salvage) did not influence the incidence of periprosthetic leakage. Salvage total laryngectomy increases the risk of more clinically relevant leakages. Conclusion By using a systematic algorithm with a step-by-step standardized approach, periprosthetic leakage management could become a less treacherous issue.

Voice Rehabilitation after Total Laryngectomy and Tracheoesophageal Puncture Using Nonmuscle Closure

1993 ◽  
Vol 102 (10) ◽  
pp. 792-796 ◽  
Author(s):  
Ross A. Clevens ◽  
Duane O. Hartshorn ◽  
Ramon M. Esclamado ◽  
Jan S. Lewin
Keyword(s):  
Total Laryngectomy ◽  
Voice Rehabilitation ◽  
Rehabilitation Outcomes ◽  
Pharyngoesophageal Segment ◽  
Pharyngeal Plexus ◽  
Neck Recurrence ◽  
Tracheoesophageal Puncture ◽  
Early Primary ◽  
Successful Production

The successful production of voice with a tracheoesophageal puncture (TEP) and voice prosthesis requires a compliant pharyngoesophageal segment. Speech failure is commonly attributed to spasm of the pharyngoesophageal segment. During total laryngectomy (TL), a 3-layer closure is typically performed. This prospective single-arm study examines the safety and efficacy of TL and TEP with nonclosure of the pharyngeal musculature to prevent pharyngoesophageal spasm as an alternative to 3-layer closure with pharyngeal plexus neurectomy and/or pharyngeal constrictor myotomy. Twenty-one consecutive patients were enrolled by a single surgeon. The mean duration of follow-up was 19.5 ± 7.9 months. Surgical complications and voice rehabilitation outcomes were examined. An overall complication rate of 28.5% was observed. Fluency was achieved in 75% of patients within a mean of 4.3 ± 5.1 months. Speech failure was attributable to early primary site and neck recurrence (5%), hypoglossal nerve palsy (5%), hypopharyngeal stricture and recurrence (5%), dementia (5%), and intransigent alcohol abuse (5%). Pharyngeosophageal spasm was not observed in any subjects. We conclude that primary TEP with nonclosure of the pharyngeal muscle during TL is relatively safe. Furthermore, it is preferable over 3-layer closure because it avoids pharyngeosophageal spasm, a factor limiting voice rehabilitation.

S154 – Primary TEP and Patch Free-Flap Laryngectomy Reconstruction

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P128-P128 ◽  
Author(s):  
Tamer Abdel-Halim Ghanem ◽  
Justin McLarty ◽  
Farhad Ardeshirpour ◽  
Christopher F Baranano ◽  
Eben L Rosenthal ◽  
...  
Keyword(s):  
Free Flap ◽  
Total Laryngectomy ◽  
Demographic Data ◽  
Free Flaps ◽  
Fistula Formation ◽  
Increased Risk ◽  
Radial Forearm ◽  
Speech Therapist ◽  
Fistula Rate ◽  
Tracheoesophageal Puncture

Objectives 1. Assess speech outcomes for patients undergoing primary tracheoesophageal puncture (TEP) following total laryngectomy (TL) with patch free flap reconstruction. 2. Evaluate risk of fistulization following primary TEP vs. no TEP in patch free flap TL reconstruction. Methods Patients undergoing reconstruction with patch free-flaps following TL were studied retrospectively. Demographic data, surgical procedures, speech outcomes, and postoperative complications were collected. Patients were divided in 2 groups depending on whether TEP was performed at the time of ablation (primary TEP). Voice outcomes were assessed by a speech therapist. Results 77 patients underwent TL, mean age of 63 years. Glottis (60%), followed by hypopharynx (18%), and supraglottis (17%) were the most common tumor sites. Most patients had T3 and T4 disease (71%) on initial presentation, and there were 57% undergoing salvage total laryngectomy. The radial forearm fascioucutaneous free flap was used in 90% of the cases. Primary TEP was performed in 44 patients (57%), and only 1 of 33 patients underwent a TEP procedure secondarily. Voice outcomes for the TEP group were good. The overall fistula rate was 39%, half of which healed spontaneously. The fistula rate in the primary TEP group was 41%, and in the group not receiving primary TEP it was 36.7% (p=0.87). Conclusions Primary TEP performed at the time of free-flap patch reconstruction after TL enhances speech outcomes for patients, and does not lead to an increased risk in fistula formation.

Impact of Primary Tracheoesophageal Puncture on Outcomes after Total Laryngectomy

2017 ◽  
Vol 158 (1) ◽  
pp. 103-109 ◽  
Author(s):  
Aru Panwar ◽  
Oleg Militsakh ◽  
Robert Lindau ◽  
Andrew Coughlin ◽  
Harlan Sayles ◽  
...  
Keyword(s):  
Total Laryngectomy ◽  
Attributable Risk ◽  
Wound Complications ◽  
Medical Complications ◽  
Improvement Program ◽  
Data Set ◽  
Surgical Quality ◽  
Postoperative Wound ◽  
Tracheoesophageal Puncture ◽  
Length Of Hospitalization

Objectives To identify differences in postoperative wound complications associated with a primary tracheoesophageal puncture (TEP) at the time of laryngectomy versus no TEP. Study Design Retrospective review of large national data set. Setting Academic and nonacademic health care facilities in United States, contributing de-identified, risk-adjusted clinical data to the American College of Surgeons National Surgical Quality Improvement Program. Subjects and Methods The National Surgical Quality Improvement Program data set for years 2006 to 2012 identified 430 patients who underwent total laryngectomy with or without a primary TEP. Patients who underwent a TEP at the time of laryngectomy (n = 68) were compared with patients who underwent laryngectomy without a TEP (n = 362). Postoperative wound complications and secondary outcomes, including medical complications and length of hospitalization, were compared between the groups. Results The incidence of “superficial” and “deep or organ space” surgical site infection, medical complications, return to the operating room, and length of hospitalization were similar between the groups. Patients in the TEP group had a higher overall wound complication rate (relative risk, 2.02; 95% CI = 1.06-3.84; attributable risk, 8.17%; number needed to harm, 12). Conclusions Performance of a primary TEP concurrent to total laryngectomy contributed to a small increase in attributable risk for overall wound complications but did not add substantial risk for “superficial” or “deep or organ space” surgical site infection, medical complications, or increased burden for resource utilization. These data may help inform patient choice and physician recommendations for primary alaryngeal speech rehabilitation.

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.

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