Managing problems with tracheoesophageal puncture for alaryngeal voice rehabilitation

2006 ◽  
Vol 120 (6) ◽  
pp. 470-477 ◽  
Author(s):  
O A Albirmawy ◽  
M N Elsheikh ◽  
M E Saafan ◽  
E Elsheikh
Keyword(s):  
Adverse Events ◽  
Success Rate ◽  
Medical Records ◽  
Multidisciplinary Approach ◽  
Clinical Analysis ◽  
Voice Rehabilitation ◽  
Voice Restoration ◽  
Early Results ◽  
Tracheoesophageal Puncture

Objectives: The tracheoesophageal puncture (TEP) technique and the insertion of its associated voice prostheses may give rise to adverse events. We present our experience with this technique, paying special attention to the incidence and management of these adverse events.Study design: A retrospective clinical analysis was undertaken.Methods: Seventy-five laryngectomized patients underwent TEP for voice restoration. They were divided into two groups: group one, 43 patients with secondary TEP; and group two, 32 patients with primary TEP. Patient medical records were reviewed for data on the incidence, management and outcome of adverse events encountered during patients' follow up.Results: Problems that arose in the patients were itemized as either early or late. The same patient could develop one or more problems in either group. The management of these problems, concerning the creation and maintenance of the TEP and associated prostheses, was noted. In group one, results were initially favourable in 91 per cent of patients and still positive in 81.4 per cent after three years. In group two, early results were favourable in all patients, and only two patients asked for late elective closure of the TEP (with a success rate of 93.7 per cent).Conclusions: Via an intensive and multidisciplinary approach to problems, most of the inevitable adverse events could be solved adequately, minimizing the discomfort of patients who had undergone laryngectomy and indwelling voice prosthesis insertion.

Primary versus Secondary Tracheoesophageal Puncture for Speech Rehabilitation in Total Laryngectomy: Long-Term Results with Indwelling Voice Prosthesis

2005 ◽  
Vol 133 (1) ◽  
pp. 89-93 ◽  
Author(s):  
Carlos T. Chone ◽  
Flávio M. Gripp ◽  
Ana L. Spina ◽  
Agricio N. Crespo
Keyword(s):  
Success Rate ◽  
Total Laryngectomy ◽  
Voice Prosthesis ◽  
Long Term Results ◽  
Voice Rehabilitation ◽  
Patient Age ◽  
Patient Âgé ◽  
Tracheoesophageal Puncture

OBJECTIVE: To evaluate the long-term use of indwelling Blom-Singer voice prosthesis (VP) for vocal rehabilitation of patients submitted to total laryngectomy (TL). The influence of the timing (primary or secondary) of tracheoesophageal puncture (TEP), use of radiotherapy (xRT), patient age, and length of follow-up were studied to evaluate the success rate of VP use. STUDY DESIGN AND SETTING: Prospective clinical study in a tertiary referral center. Seventy-one patients were submitted to TL and rehabilitated with indwelling VP. All patients were evaluated for vocal functional issues by an otolaryngologist and a speech pathologist at 1 month, then at every 3 months up to 1 year, and then at every 6 months after 1 year of follow-up. The relative data on time of placement of VP, time of VP use, xRT, age, length of follow-up, and life span of each VP were recorded during the follow-up. RESULTS: Eighty-seven percent of the patients underwent primary and 13%, secondary TEP. The follow-up varied from 12 to 87 months, with an average of 38 months for primary and 51 months for secondary TEP. Fifty-nine percent of the patients were submitted to xRT. The general rate of success was 94%, with 97% for primary and 78% ( P = 0.07) for secondary TEP; after 2 years, the success rate was 96% for primary and 75% for secondary ( P = 0.07) TEP. The use of xRT and patient age had no influence on the success of VP use for primary and secondary TEP, independently of the length of follow-up. CONCLUSIONS: The success rate of voice rehabilitation with VP was 94%. In primary TEP, the success rate was 97%, whereas in secondary TEP it was 78%; 2 years later, it was 96% and 75%, respectively. A tendency for a higher success rate in voice rehabilitation after TL was observed in primary TEP. The use of xRT and age of patient had no influence on the success rate.

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.

Microcannula Utilization for Injectable Facial Fillers: Standard of Care?

2018 ◽  
Vol 35 (4) ◽  
pp. 189-197 ◽  
Author(s):  
Kian Karimi ◽  
Chester F. Griffiths ◽  
Alex Reivitis ◽  
Austin Davis-Hunter ◽  
Elizabeth Zhang ◽  
...  
Keyword(s):  
Adverse Events ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Standard Of Care ◽  
Dermal Filler ◽  
Popular Method ◽  
Patient Reported ◽  
Clinical Series ◽  
Filler Injections

The microcannula technique has become an increasingly popular method for injecting cosmetic fillers. Previous studies have illustrated that the microcannula technique allows filler to be injected with less pain, swelling, and essentially no bruising. This study is a retrospective clinical series examining 247 patients who have undergone dermal filler injections using the microcannula technique from 2011 to 2016 with a single injector, Kian Karimi. The purpose of this study is to assess the frequency of adverse events associated with injections such as bruising and swelling. All 666 recorded patient visits from 2011 to 2016 were analyzed using electronic medical records based on the criteria that the patients had cosmetic filler using the microcannula technique by the surgeon investigator. Of the 666 filler treatments using the microcannula technique, 3 treatments (0.5%) produced adverse events on the day of service, and 32 treatments (4.8%) produced adverse events at 2-week follow-up. In total, 5.4% of treatments produced adverse events. At the 2-week follow-up, 5.7% of treatments using the 25-gauge microcannula produced adverse events ( P = .830); 3.9% of treatments using the 27-gauge microcannula produced adverse events ( P = .612]). Only 3 patients were treated with the 30-gauge microcannula, and 1 patient reported adverse events on the day of service. None of the treatments using the 30-gauge microcannula produced adverse events at the 2-week follow-up ( P = .160). The data support that the microcannula technique is a safe and effective alternative to hypodermic needles for the injection of dermal filler to minimize common adverse events.

scholarly journals Surgical outcomes of acute acquired comitant esotropia of adulthood

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dae Hyun Kim ◽  
Ha Jeong Noh
Keyword(s):  
Success Rate ◽  
Surgical Outcomes ◽  
Medical Records ◽  
Large Angle ◽  
Sudden Onset ◽  
Prism Diopter ◽  
Factors Affecting ◽  
The Mean ◽  
Motor Outcomes

Abstract Background Acute acquired comitant esotropia (AACE) is a type of strabismus characterized by a sudden onset of large angle esotropia with diplopia, which often occurs in children after infancy, teenagers, and young adolescents. However, studies on the surgical outcomes of only adults are rare. The purpose of this article is to analyze the surgical outcomes for adult patients diagnosed with AACE. Methods Medical records of 24 patients who had undergone surgery for AACE were retrospectively analyzed. The main outcome measures were the final motor and sensory success rate after surgery and factors affecting motor and sensory outcomes. Motor success was considered alignment within 8 prism diopter (PD) at both near and distance and sensory success was stereoacuity ≥ 60 sec/arc. Results The preoperative mean esodeviation angles were 33.1 ± 10.4 PD at distance and 33.3 ± 11.2 PD at near. The mean period of postoperative follow up was 7.5 ± 4.5 months (range 1–8 months). The postoperative mean esodeviation angles at final follow-up time were 3.4 ± 6.1 PD at distance and 3.8 ± 6.7 PD at near. The surgical motor success rate at final follow-up was 79.2% (19/24). The sensory success rate at final follow-up was 50.0% (12/24). The factor affecting the motor outcome was the type of surgery (p < 0.05). The factor affecting sensory outcome was postoperative follow-up time (p < 0.05). Conclusions Surgery type appears to affect surgical motor outcomes in adults with AACE. Although the sensory outcome was favorable, it seems that regaining bifoveal fixation takes time.

Voice Rehabilitation after Laryngectomy

2010 ◽  
Vol 2 (3) ◽  
pp. 231-236 ◽  
Author(s):  
Audrey B Erman ◽  
Daniel G Deschler
Keyword(s):  
Turning Point ◽  
Voice Rehabilitation ◽  
Past Century ◽  
Voice Restoration ◽  
Surgical Success ◽  
The Past ◽  
Surgical Options ◽  
Tracheoesophageal Puncture

Abstract Improvements in voice rehabilitation over the past century have paralleled the surgical success of laryngectomy. The establishment of the tracheoesophageal puncture marked a turning point in the development of successful and dependable voice rehabilitation. Surgical options include both primary and secondary placement of a tracheoesophageal puncture. Though complications, such as pharyngoesophageal spasm or prosthesis leakage may occur, patients should expect functional voice restoration after laryngectomy.

scholarly journals Primary versus secondary tracheoesophageal puncture: systematic review and meta-analysis

2017 ◽  
Vol 132 (1) ◽  
pp. 14-21 ◽  
Author(s):  
P D Chakravarty ◽  
A E L McMurran ◽  
A Banigo ◽  
M Shakeel ◽  
K W Ah-See
Keyword(s):  
Systematic Review ◽  
Complication Rate ◽  
Meta Analysis ◽  
Case Series ◽  
Current Evidence ◽  
Voice Rehabilitation ◽  
Pharyngocutaneous Fistula ◽  
Voice Restoration ◽  
Increased Risk ◽  
Tracheoesophageal Puncture

AbstractBackground:Tracheoesophageal puncture represents the ‘gold standard’ for voice restoration following laryngectomy. Tracheoesophageal puncture can be undertaken primarily during laryngectomy or in a separate secondary procedure. There is no current consensus on which approach is superior. The current evidence comparing primary and secondary tracheoesophageal puncture was assessed.Methods:A systematic review and meta-analysis of articles comparing outcomes for primary and secondary tracheoesophageal puncture after laryngectomy were conducted. Outcome measures were: voice success, overall complication rate and pharyngocutaneous fistula rate.Results:Eleven case series met the inclusion criteria, two prospective and nine retrospective. Meta-analysis did not demonstrate statistically significant differences in overall complication rate or voice outcomes, though it suggested a significantly increased risk of pharyngocutaneous fistula in primary compared to secondary tracheoesophageal puncture.Conclusion:Primary tracheoesophageal puncture is a safe and efficient approach for voice rehabilitation. However, secondary tracheoesophageal puncture should be preferred where there is a higher risk of pharyngocutaneous fistula.

Voice Rehabilitation After Total Laryngectomy and Postoperative Radiation Therapy

2002 ◽  
Vol 20 (10) ◽  
pp. 2500-2505 ◽  
Author(s):  
William M. Mendenhall ◽  
Christopher G. Morris ◽  
Scott P. Stringer ◽  
Robert J. Amdur ◽  
Russell W. Hinerman ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Total Laryngectomy ◽  
Voice Rehabilitation ◽  
Postoperative Radiation ◽  
Postoperative Radiation Therapy ◽  
Artificial Larynx ◽  
Postoperative Irradiation ◽  
Tracheoesophageal Puncture

PURPOSE: The purpose of this study was to evaluate voice rehabilitation after laryngectomy and postoperative irradiation for patients with squamous cell carcinoma of the larynx and hypopharynx. PATIENTS AND METHODS: Between December 1983 and December 1998, 173 patients underwent a total laryngectomy and postoperative irradiation and had follow-up from 3 to 188 months (median, 38 months). Three patients were lost to follow-up at 63, 39, and 4 months after treatment. All other living patients had follow-up for 2 years or longer. Twelve (7%) patients had incomplete data pertaining to voice rehabilitation. RESULTS: Data pertaining to voice rehabilitation were available at 2 to 3 years and longer and 5 years and longer after treatment for 118 and 69 patients, respectively. The methods of voice rehabilitation at 2 to 3 years and longer and 5 years and longer were as follows: tracheoesophageal, 27% and 19%; artificial larynx, 50% and 57%; esophageal, 1% and 3%; nonvocal, 17% and 14%; and no data, 5% and 7%, respectively. CONCLUSION: The most common form of voice rehabilitation after total laryngectomy and postoperative radiation therapy is the artificial larynx. Although the tracheoesophageal puncture is a technique frequently promoted by clinicians as a superior method, a relatively small subset of patients are successfully rehabilitated long-term. However, of those who undergo a tracheoesophageal puncture, approximately half will use this method of voice rehabilitation long term.

scholarly journals Assessment of the success rate of specialised female surgical clinic in tertiary care hospital

2019 ◽  
Vol 7 (1) ◽  
pp. 271
Author(s):  
Anand Gupta ◽  
Anshuman Sharma
Keyword(s):  
Success Rate ◽  
Multidisciplinary Approach ◽  
Tertiary Care ◽  
General Medicine ◽  
Care Hospital ◽  
Surgical Department ◽  
Female Patients ◽  
One Year ◽  
Surgical Clinic

Background: Specialized female surgical clinics are the basic requirement in surgical department which should be addressed routinely. The management of surgical problems in female patients requires multidisciplinary approach mainly general surgery, obstetrics and gynaecology, general medicine, paediatrics, dermatology and psychiatry. If proper care is provided then this will uplift the follow up of same patients in such clinics. The objective of the study was to assess the success rate of female surgical clinics and to determine the follow up visits done by female patients once visited the female surgical clinics.Methods: Prospective educational interventional study was conducted. A total of 952 patients visiting the clinic were studied. Statistical analysis was done.Results: Out of 952 cases 944 (99.2%) cases were willing to continue visit to the clinic, while 809 (84.9%) cases revisited for follow up treatment in female surgical clinics within one year duration.Conclusions: It can be concluded that there is a requirement and need of a fully functional specialized female surgical clinic in our hospital. As the success rate for follow up visit by patients in this clinic was high.

scholarly journals A Clinical Analysis of the Treatment of Chronic Coronary Artery Occlusion With Antegrade Dissection Reentry

2021 ◽  
Vol 8 ◽  
Author(s):  
Xiangjun Wu ◽  
Dan Zhang ◽  
Haitao Liu ◽  
Shuai Li ◽  
Chao Fu ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Treatment Group ◽  
Success Rate ◽  
Operation Time ◽  
Coronary Artery Occlusion ◽  
Clinical Analysis ◽  
Control Group ◽  
Cardiac Events ◽  
Total Occlusion

Objective: This study aimed to investigate the efficacy and safety of antegrade dissection re-entry (ADR) technique in the percutaneous coronary intervention (PCI) to open chronic total occlusion (CTO) lesions.Methods: The baseline, angiographic results, PCI success rate, and major adverse cardiac events (MACE) during the 12 months of follow-up were compared between 48 patients who did not use ADR in the treatment of CTO lesions (control group) and 50 patients who used ADR (treatment group).Results: The control group comprised 48 patients who had 52 CTO lesions, and the treatment group comprised 50 patients who had 58 CTO lesions. The success rate of PCI in the treatment group (89.7 vs. 71.2%, P = 0.047) was significantly higher than in the control group, where six patients had in-stent restenosis (ISR, ISR-CTO) that were all recanalized. The mean PCI time (71 ± 25 min vs. 95 ± 33 min, P = 0.041), X-ray exposure time (42 ± 17 min vs. 71 ± 22 min, P = 0.032), contrast agent dosage (98 ± 26 ml vs. 178 ± 63 ml, P = 0.029), MACE incidence during the 12 months of follow-up (22.0 vs. 41.7%, P = 0.046) and recurrent myocardial infarction incidence (10.0 vs. 27.1%, P = 0.047) were significantly lower in the treatment group than in the control group. The differences were all statistically significant.Conclusion: It is safe and effective to use the ADR technique in PCI for coronary artery CTO lesions. The technique shortens the operation time, reduces the radiation dose of doctors and patients and the use dose of contrast agents, and improves patients' prognoses.

scholarly journals Endoscopic ultrasound-based transluminal cholecystolithotomy: the retrievable anchor assisted procedure

2019 ◽  
Author(s):  
Nan Ge ◽  
Jinlong Hu ◽  
Fei Yang ◽  
Fan Yang ◽  
Kai Zhang ◽  
...  
Keyword(s):  
Adverse Events ◽  
Success Rate ◽  
Outcome Measures ◽  
Clinical Success ◽  
Safe Procedure ◽  
Drainage Procedure ◽  
Indwelling Time ◽  
Per Oral

Abstract Background EUS guided gallbladder drainage has gradually emerging as an option among patients with cholecystitis. Stent bridged endoscope intervention in the gallbladder was further introduced. The aim of this study was to assess the effectiveness and safety of the ECE-LAMS and this newly designed retrievable puncture anchor applied in the transmural Cholecystolithotomy. Method We retrospectively reviewed consecutive patients undergoing EUS-guided transmural cholecystoscopic therapy. The main outcome measures for the EUS-GBD procedure were techniques success and adverse events, which were also compared between guided assisted group and retrievable anchor assisted group. The main outcome measures for the transmural cholecystoscopy after EUS-GBD were the stent indwelling time, clinical success and adverse events. Results A total of 24 (15 female) patients with gallstones were received the transluminal Cholecystolithotomy. Mean age is 36.08±13.69 years old. The successful rate of the anchor assisted group was high than the guidewire assisted group (92.9% Vs 70%, P=0.07). On the average of 12.25±2.77 (range 8-17) days after the initial BD drainage procedure, 20 patients received the per-oral cholecystoscopy via the fistula. Fistula broken was found in 2 patients in which the per-oral cholecystoscopy was applied on the ninth day after the EUS-GBD. During the follow-up period (mean 314.2± 213.7 days) no GB stones recurrence or other long term complications reported. Conclusion In conclusion, we have demonstrated that EUS-assisted per-oral cholecystoscopy technique with ECE-LMAS is an efficient and safe procedure. For the EUS-GBD procedure, retrievable anchor could significantly increase the success rate compared with the guidewire.

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