scholarly journals Management of periprosthetic leakage of tracheoesophageal fistula after total laryngectomy

2021 ◽  
Author(s):  
T Steffen ◽  
W Pethe ◽  
Jörg Langer
Keyword(s):  
Total Laryngectomy ◽  
Tracheoesophageal Fistula ◽  
Periprosthetic Leakage

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.

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.

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