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.

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.

Effect of primary neopharyngeal repair on acoustic characteristics of tracheoesophageal voice after total laryngectomy

2008 ◽  
Vol 123 (4) ◽  
pp. 426-433 ◽  
Author(s):  
O A Albirmawy ◽  
A S El-Guindy ◽  
M N Elsheikh ◽  
M E Saafan ◽  
M E Darwish
Keyword(s):  
Total Laryngectomy ◽  
Speaking Rate ◽  
Voice Rehabilitation ◽  
Muscle Repair ◽  
Mean Values ◽  
Voice Restoration ◽  
Pharyngeal Plexus ◽  
Significant Difference ◽  
Tracheoesophageal Puncture ◽  
Repair Group

AbstractObjectives:The tracheoesophageal puncture technique of voice restoration enables successful voice rehabilitation after total laryngectomy. Because post-operative voice quality can vary significantly, depending on which type of hypopharyngeal repair is chosen, the aim of this study was to evaluate the effect of such repair on tracheoesophageal puncture voice after total laryngectomy.Study design:Prospective, clinical study.Setting:Otolaryngology department, Tanta University, Egypt.Methods:Tracheoesophageal puncture voice was quantitatively and qualitatively evaluated in 40 patients using a Provox 2TM prosthesis after standard total laryngectomy. The patients were divided, according to the type of hypopharyngeal repair, into four groups of 10 cases each, as follows: group one, pharyngoesophageal myotomy; group two, pharyngeal plexus neurectomy; group three, non-muscle vertical repair; and group four, transverse repair. These surgical groups were compared with each other with respect to different voice parameters.Results:Patient profiles were almost equivalent in all surgical groups. The mean values of most of the parameters of quantitative tracheoesophageal puncture voice did not differ significantly, comparing the four surgical groups; however, a slightly significant difference was observed regarding loud intensity in the non-muscle repair group, and soft and loud jitter in the transverse repair group. Mean values for qualitative measures of intelligibility and communicative effectiveness did not show significant difference. However, a slightly significant difference was observed regarding fluency, word correctness, speaking rate and wetness, with higher values for all these parameters except wetness in the myotomy group, and higher values for wetness in the non-muscle repair group.Conclusion:The four hypopharyngeal repair types – primary pharyngoesophageal myotomy, pharyngeal plexus neurectomy, non-muscle vertical repair and transverse hypopharyngeal repair – were almost equivalent in prevention of pharyngoesophageal spasm in total laryngectomy patients who had undergone primary tracheoesophageal puncture for voice restoration.

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.

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 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 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.

Tracheoesophageal Puncture for Voice Restoration: Modification of the Blom-Singer Technique

1984 ◽  
Vol 92 (4) ◽  
pp. 418-423 ◽  
Author(s):  
Robert H. Ossoff ◽  
Cathy L. Lazarus ◽  
George A. Sisson
Keyword(s):  
Postoperative Period ◽  
Modified Technique ◽  
Puncture Site ◽  
Voice Restoration ◽  
Polyester Suture ◽  
Tracheoesophageal Puncture

We have used a modification of the Blom-Singer technique in our last 24 tracheoesophageal punctures, performed on 20 patients. At the time of puncture a surgical stent with an indwelling Dacron polyester suture is placed to form the fistula. Forty-eight to 72 hours later the stent is backed out of the puncture site but the suture is allowed to remain. The Blom-Singer duckbill prosthesis is fitted and taped in the routine fashion. The suture is left to traverse the tracheoesophageal tract until the time of discharge, when it is removed. At discharge the patient is given a Silastic dilator, to be used if the puncture site becomes too small to allow for insertion of the duckbill prosthesis. Seventeen of the 20 patients in this group obtained good voice. Six operations would have been failures because of the loss of the patient's prosthesis in the immediate postoperative period if the modified technique had not been used.

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.

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