Use of Ultrasound for Sizing Tracheoesophageal Puncture Prostheses

2017 ◽  
Vol 157 (6) ◽  
pp. 1075-1078
Author(s):  
Aaron Smith ◽  
Vikrum Thimmappa ◽  
Julia Jones ◽  
Courtney Shires ◽  
Merry Sebelik
Keyword(s):  
Wall Thickness ◽  
Gold Standard ◽  
Total Laryngectomy ◽  
Primary Closure ◽  
Ultrasound Measurement ◽  
Voice Rehabilitation ◽  
Flap Reconstruction ◽  
Tracheoesophageal Puncture ◽  
Party Wall ◽  
Posterior Tracheal Wall

Tracheoesophageal puncture (TEP) with voice prosthesis placement is the gold standard voice rehabilitation following total laryngectomy. Ultrasound may be useful to determine tracheoesophageal wall thickness, guiding prosthesis choice. Therefore, 14 patients undergoing total laryngectomy and TEP or prosthesis change with 16-mHz ultrasound measurement of the posterior tracheal wall were included. Seven patients underwent secondary TEP, 3 primary TEP, and 4 TEP changes. Six patients underwent flap reconstruction, while 8 patients were closed primarily. Average party wall thickness was 9.6 ± 1.7 mm, without a difference ( P = .08) between primary closure (10.3 ± 1.7 mm) and flap reconstruction (8.6 ± 1.4 mm). Change from the hypothesized sizing was noted in 11 patients (79%). Prosthesis size did not correlate with age (–0.19, P = .51), height (–0.12, P = .69), weight (0.26, P = .38), body mass index (0.22, P = .46), or flap status (–0.48, P = .079). These data suggest that ultrasound is beneficial in patients with distorted or less predictable anatomy (eg, flap reconstruction) but also important for those patients undergoing primary closure.

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.

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.

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 Insertion of a tracheoesophageal speech valve: a novel approach in a difficult situation

2016 ◽  
Vol 131 (1) ◽  
pp. 88-89
Author(s):  
C P Yiannakis ◽  
R B Townsley ◽  
I G Smillie ◽  
G L Picozzi
Keyword(s):  
Gold Standard ◽  
Total Laryngectomy ◽  
Cost Effective ◽  
Voice Rehabilitation ◽  
Patient Factors ◽  
Shunt Valve ◽  
Difficult Situation ◽  
Novel Approach ◽  
Tracheoesophageal Speech ◽  
Functional Voice Rehabilitation

AbstractBackground:Functional voice rehabilitation is becoming increasingly important following total laryngectomy and pharyngolaryngectomy. Tracheoesophageal voice via a shunt valve is currently regarded as the ‘gold standard’ for voice rehabilitation. Traditional techniques usually allow for the replacement of valves in the out-patient setting; however, patient factors such as altered anatomy may occasionally prevent this.Objective:This paper describes a novel approach for speech valve insertion that is safe, quick and cost-effective, and which uses equipment commonly available in ENT wards and the operating theatre.

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.

scholarly journals Tracheoesophageal Voice Rehabilitation after Total laryngectomy: Primary Versus Secondary Tracheoesophageal Puncture

2021 ◽  
Vol 84 (1) ◽  
pp. 1980-1983
Author(s):  
Ibrahim Ahmed Khaled ◽  
Alaa El-Din Mohammed El-Feky ◽  
Tarek Abd-Elmoaty Omran ◽  
Khaled Abd-Elshakour Mohammed ◽  
Amal Said Quriba ◽  
...  
Keyword(s):  
Total Laryngectomy ◽  
Voice Rehabilitation ◽  
Tracheoesophageal Puncture

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.

Long-term results of voice rehabilitation after total laryngectomy using primary tracheoesophageal puncture in Chinese patients

1997 ◽  
Vol 18 (2) ◽  
pp. 94-98 ◽  
Author(s):  
Simon Hon Wai Wong ◽  
Anthony Po Wing Yuen ◽  
Catherine Cheung ◽  
William Ignace Wei ◽  
Lai Kun Lam
Keyword(s):  
Total Laryngectomy ◽  
Chinese Patients ◽  
Long Term Results ◽  
Voice Rehabilitation ◽  
Tracheoesophageal Puncture

Functional results of pharyngo-laryngectomy and total laryngectomy: a comparison

2011 ◽  
Vol 126 (1) ◽  
pp. 52-57 ◽  
Author(s):  
C Gadepalli ◽  
C de Casso ◽  
S Silva ◽  
S Loughran ◽  
J J Homer
Keyword(s):  
Enteral Feeding ◽  
Total Laryngectomy ◽  
Functional Results ◽  
Voice Rehabilitation ◽  
Wide Field ◽  
Flap Reconstruction ◽  
Soft Diet ◽  
Significant Difference ◽  
Voice Development

AbstractObjective:To compare the key functional results (regarding swallowing and voice rehabilitation) in patients treated by pharyngo-laryngectomy with flap reconstruction, versus standard, wide-field, total laryngectomy.Method:We studied 97 patients who had undergone total laryngectomy and pharyngo-laryngectomy with flap reconstruction. The main outcome measures were swallowing (i.e. solid food, soft diet, fluid or enteral feeding) and fluent voice development.Results:There were 79 men and 18 women, with follow up of one to 19 years. Voice (p = 0.037) and swallowing (p = 0.041) results were significantly worse after circumferential pharyngo-laryngectomy than after non-circumferential pharyngo-laryngectomy. There was no significant difference in voice (p = 0.23) or swallowing (p = 0.655) results, comparing total laryngectomy and non-circumferential pharyngo-laryngectomy. The presence of a post-operative fistula significantly influenced voice (p = 0.001) and swallowing (p = 0.009) outcomes.Conclusion:The additional measures involved in pharyngo-laryngectomy do not confer any functional disadvantage, compared with total laryngectomy, but only if the procedure is non-circumferential. Functional results of circumferential pharyngo-laryngectomy are worse than those of both non-circumferential pharyngo-laryngectomy and total laryngectomy. If oncologically possible and safe, it is better to keep a pharyngo-laryngectomy non-circumferential.

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.

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