“How I Do It” Secondary tracheoesophageal puncture for voice reconstruction after total laryngectomy: The blind technique procedure with video

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.

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Voice Rehabilitation after Total Laryngectomy and Tracheoesophageal Puncture Using Nonmuscle Closure

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949310201010 ◽

1993 ◽

Vol 102 (10) ◽

pp. 792-796 ◽

Cited By ~ 20

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.

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S154 – Primary TEP and Patch Free-Flap Laryngectomy Reconstruction

Otolaryngology ◽

10.1016/j.otohns.2008.05.328 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P128-P128 ◽

Cited By ~ 1

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.

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Impact of Primary Tracheoesophageal Puncture on Outcomes after Total Laryngectomy

Otolaryngology ◽

10.1177/0194599817722938 ◽

2017 ◽

Vol 158 (1) ◽

pp. 103-109 ◽

Cited By ~ 2

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.

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Surgical Closure of Tracheoesophageal Puncture Without a Flap Interposition

Otolaryngology ◽

10.1177/0194599820931077 ◽

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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Speech and voice analysis after near-total laryngectomy and tracheoesophageal puncture with implantation of Provox 2 prosthesis

Logopedics Phoniatrics Vocology ◽

10.1080/14015430310021762 ◽

2004 ◽

Vol 29 (2) ◽

pp. 84-86 ◽

Cited By ~ 4

Author(s):

Dubravka Globlek ◽

Boris Simunjak ◽

Mirko Ivkic ◽

Mladen Hedjever

Keyword(s):

Total Laryngectomy ◽

Voice Analysis ◽

Tracheoesophageal Puncture

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Speech Restoration and Complications of Primary versus Secondary Tracheoesophageal Puncture Following Total Laryngectomy

The Laryngoscope ◽

10.1288/00005537-198905000-00004 ◽

1989 ◽

Vol 99 (5) ◽

pp. 489???491 ◽

Cited By ~ 28

Author(s):

Anthony J. Maniglia ◽

Donna S. Lundy ◽

Roy C. Casiano ◽

Scott C. Swim

Keyword(s):

Total Laryngectomy ◽

Tracheoesophageal Puncture ◽

Speech Restoration

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Long-Term Follow-up of Tracheoesophageal Puncture Results

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949610500701 ◽

1996 ◽

Vol 105 (7) ◽

pp. 501-503 ◽

Cited By ~ 21

Author(s):

James A. Geraghty ◽

Bonnie E. Smith ◽

Barry L. Wenig ◽

Louis G. Portugal

Keyword(s):

Low Socioeconomic Status ◽

Total Laryngectomy ◽

Success Rates ◽

Vocal Rehabilitation ◽

Speech Rehabilitation ◽

Long Term Follow Up ◽

Tracheoesophageal Speech ◽

Tracheoesophageal Puncture

Since its introduction by Blom and Singer in 1980, tracheoesophageal puncture with a voice prosthesis has become the most frequently recommended choice for speech rehabilitation of total laryngectomees. Many studies have reviewed the initial speech acquisition success rates following tracheoesophageal puncture; however, long-term follow-up in these initial successes has been lacking. In addition, factors predictive of long-term success with tracheoesophageal speech have not been defined. Over a 10-yearperiod, we retrospectively reviewed all total laryngectomy patients, including those who have undergone primary or secondary tracheoesophageal puncture, at the University of Illinois Hospital and Clinics and the Westside Veterans Administration Hospitals. Survival in the total laryngectomy cohort of 202 patients ranged from 35% to 50%. Forty of these patients underwent tracheoesophageal puncture, in whom survival was 75%. Short-term success with tracheoesophageal speech was approximately 70% for our patients, while long-term success was achieved in 66%. Despite low socioeconomic status and relatively high alcoholism rates, successful maintenance of tracheoesophageal speech was achieved in the majority of cases. Tracheoesophageal speech should therefore be considered as a primary method of vocal rehabilitation in all patients undergoing total laryngectomy.

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Primary Tracheoesophageal Puncture in Stapler-Assisted Total Laryngectomy

ORL ◽

10.1159/000278257 ◽

2010 ◽

Vol 72 (2) ◽

pp. 124-126 ◽

Cited By ~ 4

Author(s):

Kevin P. Leahy ◽

Ralph P. Tufano

Keyword(s):

Total Laryngectomy ◽

Tracheoesophageal Puncture

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Insertion of Provox®2 voice prosthesis using the anterograde technique immediately after the secondary tracheoesophageal puncture

The Journal of Laryngology & Otology ◽

10.1258/002221505775010850 ◽

2005 ◽

Vol 119 (12) ◽

pp. 988-990 ◽

Cited By ~ 6

Author(s):

Raymond W M Ng ◽

Paul Lam ◽

Birgitta Y H Wong

Keyword(s):

General Anaesthesia ◽

Local Anaesthesia ◽

Total Laryngectomy ◽

Second Generation ◽

Voice Prosthesis ◽

Neck Stiffness ◽

Neck Extension ◽

Second Stage ◽

Tracheoesophageal Puncture ◽

The Voice

Insertion of a voice prosthesis through the tracheoesophageal puncture (TEP) is one way to restore the voice after total laryngectomy. The second generation Provox® voice prosthesis is presently one of the most popular devices. Although TEP can be done primarily, there are many centres that prefer it to be done at a second stage for various reasons. However, secondary TEP for retrograde replacement of prosthesis can be difficult and general anaesthesia is very often necessary. Moreover, the presence of neck stiffness and fibrosis from the surgery or previous radiotherapy could affect the neck extension for proper positioning of the trocar. Similarly, it is difficult to insert the prosthesis if there is stenosis at the pharyngoesophageal segment. We describe a technique in which creation of secondary TEP and insertion of Provox®2 is done with local anaesthesia under the same setting. The procedure is well tolerated and can be safely performed on an out-patient basis.

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