scholarly journals Clinical Localization of the Spasmodic Segment in Voice Limiting Pharyngoesophageal Spasm

2010 ◽  
Vol 1 (3) ◽  
pp. 189-192
Author(s):  
Rao Vishal ◽  
Anil K D'Cruz ◽  
Mandar Deshpande ◽  
Devendra Chaukar ◽  
Prathamesh Pai
Keyword(s):  
Total Laryngectomy ◽  
Speech Therapy ◽  
Postoperative Radiotherapy ◽  
Cervical Region ◽  
Clinical Tool ◽  
Pharyngoesophageal Segment ◽  
Speech Rehabilitation ◽  
The Mean ◽  
Tracheoesophageal Puncture ◽  
Carotid Vessels

Abstract Background Primary tracheoesophageal prosthetic speech is the gold standard for speech rehabilitation in patients undergoing total laryngectomy. However, despite a high success rate, the speech outcome can be suboptimal in 5-15% of these patients. The most frequent cause being hypertonicity of the pharyngoesophageal segment. We elaborate a simple clinical technique that can be performed in an outpatient clinic to identify the hypertonic pharyngoesophageal segment in patients with PES. Methods All these patients (13 males and 1 female) had undergone total laryngectomy and primary tracheoesophageal puncture followed by postoperative radiotherapy. Even after rigorous speech therapy, these patients had failed to develop fluent speech. The mean duration following surgery was 8 months (range 4-20 months). A simple clinical technique is elaborated utilizing the dermal ballooning effect observed in the cervical region to ascertain the site of pharyngo esophageal spasmodic segment. Results Using this technique we have been able to identify the hypertonic segment successfully in 13 of the 14 patients with PES. In these patients the trial lignocaine block was injected specifically at these points medial to the carotid vessels. Improvement in speech following the block was observed, and was further confirming using a videofluroscopy. Conclusion This technique serves as a simple and useful clinical tool to map the spasmodic segment and to guide the injection site for trial lignocaine block and as well for botulinum a toxin. In addition, it also prevents inadvertent injection to the normal segments.

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.

Long-Term Follow-up of Tracheoesophageal Puncture Results

1996 ◽  
Vol 105 (7) ◽  
pp. 501-503 ◽  
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.

scholarly journals Tyrosine Kinase Inhibitor Use and Wound Healing in Tracheoesophageal Punctures

2019 ◽  
Vol 98 (8) ◽  
pp. 510-512 ◽  
Author(s):  
Christopher J. Britt ◽  
Jonathon O. Russell
Keyword(s):  
Wound Healing ◽  
Tyrosine Kinase ◽  
Total Laryngectomy ◽  
Kinase Inhibitors ◽  
Kinase Inhibitor ◽  
Thyroid Malignancy ◽  
Speech Rehabilitation ◽  
Local Disease Control ◽  
Tracheoesophageal Puncture ◽  
Tki Treatment

Tyrosine kinase inhibitors (TKIs) aid in prolonging life in patients with advanced locoregional thyroid malignancy. Such patients may undergo total laryngectomy for local disease control and tracheoesophageal puncture (TEP) for speech rehabilitation. Enlargement of TEP fistulas is usually attributed to wound healing issues and leads to major complications. Four laryngectomies with TEP were performed between 2015 and 2016 and subsequently placed on a TKI. Three patients developed a complication after TKI treatment, and 2 patients had a tracheoesophageal fistula. Patients should be counseled about possible wound healing risks associated with TKIs.

Applications of the Voice Prosthesis during Laryngectomy

1989 ◽  
Vol 98 (12) ◽  
pp. 921-925 ◽  
Author(s):  
Mark I. Singer ◽  
Eric D. Blom ◽  
Ronald C. Hamaker ◽  
Glen Y. Yoshida
Keyword(s):  
Total Laryngectomy ◽  
Voice Prosthesis ◽  
Alaryngeal Speech ◽  
Recent Introduction ◽  
Speech Rehabilitation ◽  
Tracheoesophageal Puncture ◽  
The Voice

With the recent introduction of the voice prosthesis for alaryngeal speech rehabilitation, its application in the early postlaryngectomy period is gaining acceptance. One hundred twenty-eight patients received a tracheoesophageal puncture and adjunctive pharyngeal constrictor relaxation during laryngectomy. The voice prosthesis was applied as early as 10 days after surgery, and the results of a 9-year experience are presented. Eighty percent of the population achieved a durable voice, and the complications were infrequent. The results support the primary use of tracheoesophageal phonation as a relatively safe and reliable alternative to total laryngectomy alone.

Current Trends in Laryngectomy Rehabilitation: A Survey of Speech-Language Pathologists

1998 ◽  
Vol 118 (4) ◽  
pp. 458-463 ◽  
Author(s):  
Gerald L. Culton ◽  
John M. Gerwin
Keyword(s):  
Speech Production ◽  
Speech Therapy ◽  
Voice Prosthesis ◽  
Sample Population ◽  
Speech Language Pathologists ◽  
Speech Rehabilitation ◽  
Current Trends ◽  
Tracheoesophageal Puncture ◽  
Therapy Sessions ◽  
Production Problems

This study determined the perceptions of experienced speech-language pathologists regarding current practices in the speech rehabilitation of laryngectomy patients since the introduction of the tracheoesophageal puncture-voice prosthesis technique in 1980. The sample population consisted of 151 experienced speech-language pathologists, or 43% of those who were sent questionnaires. The speech-language pathologists ranked tracheoe-sophageal puncture-voice prosthesis as their most preferred speech rehabilitation method and the electrolarynx as their least preferred, even though the electrolarynx continues to be the most frequently used method. Variable use of the tracheoesophageal puncture procedure by otolaryngologists was reported, with only a small portion perceived as using it routinely. About 65% of the speech-language pathologists reported that more than half of the laryngectomy patients were being given choices among speech rehabilitation methods. Nearly 50% of the speech-language pathologists reported that fewer than six speech therapy sessions were necessary with tracheoesophageal puncture patients, whereas more than 20% reported the need for 10 sessions or more. Use of manual closure of the tracheostoma by tracheoesophageal puncture patients far outweighed their use of automatic speaking valves. Most speech-language pathologists reported that they were involved in teams with otolaryngologists to determine patient suitability for tracheoesophageal puncture and to troubleshoot problems. Eighteen different categories of medical and speech production problems were reported.

Location of the Vibratory Segment in Tracheoesophageal Speakers

1985 ◽  
Vol 93 (3) ◽  
pp. 355-361 ◽  
Author(s):  
Stephen J. Wetmore ◽  
Stephenie P. Ryan ◽  
James C. Montague ◽  
Kathleen Krueger ◽  
Kathleen Wesson ◽  
...  
Keyword(s):  
Alimentary Tract ◽  
Cervical Vertebrae ◽  
Cervical Esophagus ◽  
Viable Option ◽  
Voice Restoration ◽  
Alaryngeal Speech ◽  
Pharyngoesophageal Segment ◽  
Speech Rehabilitation ◽  
Esophageal Speech ◽  
Tracheoesophageal Puncture

The Singer-Blom tracheoesophageal puncture procedure for surgical-prosthetic voice restoration has proved to be a viable option for alaryngeal speech rehabilitation. Following tracheoesophageal puncture, occlusion of the tracheostoma shunts pulmonary air through the Blom-Singer prosthesis into the cervical esophagus. The pulmonary air passing through the cervical esophagus and into the hypopharynx causes a portion of the upper alimentary tract to vibrate in a manner similar to that of the pharyngoesophageal segment during the production of esophageal speech. To study the location and shape of the vibratory segment in tracheoesophageal speakers, videofluoroscopy and simultaneous voice recording were performed with 16 patients. To analyze the vibratory segment(s), photographs were made of the videotaped image white it was stopped during the patients' production of the /a/ sound. The most frequent location of the vibratory segment was in the lower third of the neck, which corresponds to cervical vertebrae C5 through C7. Five of the subjects had two separate vibratory segments and two other subjects had long vibratory segments. The vibratory segment(s) in tracheoesophageal speakers was found to be similar to the vibratory segment(s) in esophageal speakers.

Primary Vocal Rehabilitation Using the Blom-Singer and Panje Voice Prostheses

1982 ◽  
Vol 91 (4) ◽  
pp. 458-460 ◽  
Author(s):  
Michael D. Maves ◽  
Raleigh E. Lingeman
Keyword(s):  
Speech Production ◽  
Standard Method ◽  
Total Laryngectomy ◽  
Medical Center ◽  
Postoperative Radiotherapy ◽  
Neck Surgery ◽  
Indiana University ◽  
Vocal Rehabilitation ◽  
Tracheoesophageal Puncture ◽  
Second Procedure

Vocal rehabilitation by means of tracheoesophageal puncture and placement of either the Blom-Singer or Panje silicone prosthesis has become a standard method of speech production following total laryngectomy. The same technique has been employed primarily at the time of the laryngectomy by the Department of Otolaryngology-Head and Neck Surgery, Indiana University Medical Center, and our experience with 11 patients undergoing this technique forms the basis for this report. Of the ten patients available for evaluation, all have developed satisfactory prosthetic speech 2–12 weeks following total laryngectomy. Advantages of this technique include the utilization of standard laryngectomy without compromise of oncologic principles, elimination of a second procedure to place the tracheoesophageal puncture, elimination of the nasogastric tube, care in the pharyngeal closure to afford the maximum success of prosthetic speech production, and finally, the psychological boost. Limitations of the technique have been few but relate to limited voicing with postoperative radiotherapy and unrealistic patient expectations.

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.

Transverse Lag Screw Fixation in Midline Mandibulotomy

2000 ◽  
Vol 109 (3) ◽  
pp. 334-339 ◽  
Author(s):  
Joseph M. Serletti ◽  
John U. Coniglio ◽  
Salvatore J. Pacella ◽  
John D. Norante
Keyword(s):  
Reliable Method ◽  
Screw Fixation ◽  
Postoperative Radiotherapy ◽  
Major Complication ◽  
Recurrent Tumor ◽  
Minor Complication ◽  
Anterior Cortex ◽  
Lag Screw ◽  
The Mean

Vertical midline mandibulotomy has provided a relatively simple and efficient means of obtaining access to intraoral tumors that are too large or too posterior to be removed transorally. Midline mandibulotomy has had the advantage of nerve and muscle preservation and places the osteotomy outside the typical field of radiotherapy, in contrast to lateral and paramedian osteotomies. Plate and screw fixation has been the usual means of osteosynthesis for these mandibulotomies; however, plate contouring over the symphyseal surface has been a time-consuming process. Unless the plate was contoured exactly, mandibular malalignment and malocclusion in dentulous patients has occurred. Use of parallel transverse lag screws has become a popular method of osteosynthesis for parasymphyseal fractures, and we have extended their use for mandibulotomy fixation. This paper reports our clinical experience with transverse lag screw fixation of midline mandibulotomies in 9 patients from 1994 to 1997. There were 7 men and 2 women with a mean age of 56 (range 35 to 71 years). The pathological diagnosis in all patients was squamous cell carcinoma; 8 cases were primary, and 1 patient presented with recurrent tumor. No tumors involved the mandibular periosteum. One patient had had previous radiotherapy, and 3 patients underwent postoperative radiotherapy. The mean follow-up has been 17 months (range 9 to 27). There was 1 minor complication and 1 major complication related to our technique. The major complication was a delayed nonunion of the mandibulotomy. This occurred because the 2 parallel screws were placed too close to one another, and this placement resulted in a delayed sagittal fracture of the anterior cortex and subsequent nonunion. Transverse lag screw fixation has not affected occlusion in our dentulous patients. Speech and diet were normal in the majority of our patients. Transverse lag screw fixation of the midline mandibulotomy has been a relatively safe, rapid, and reliable method for tumor access and postextirpation mandibular stabilization and has significant advantages over other current methods of mandibulotomy and fixation.

Influence of Age, Sex, and Anthropometric Determinants on the Foot Posture Index in a Pediatric Population

2017 ◽  
Vol 107 (2) ◽  
pp. 124-129 ◽  
Author(s):  
Ana María Jimenez-Cebrian ◽  
María Francisca Morente-Bernal ◽  
Pedro Daniel Román-Bravo ◽  
Juan Francisco Saucedo-Badía ◽  
Juan Antonio Alonso-Ríos ◽  
...  
Keyword(s):  
Pediatric Population ◽  
Quantitative Result ◽  
Total Sample ◽  
Clinical Tool ◽  
Foot Posture Index ◽  
Posture Index ◽  
Asymptomatic Children ◽  
Foot Posture ◽  
The Mean ◽  
Foot Position

Background: The Foot Posture Index (FPI) is a clinical tool for diagnosis that aims to quantify the grade of a foot position as neutral, pronated, or supinated. Its purpose is to develop a simple six-factor method for rating foot posture with an easy and quantitative result. We evaluated possible differences in the FPI by sex and the influences of age, weight, height, foot size, and body mass index (BMI) on foot posture. Methods: In 150 asymptomatic children (79 boys and 71 girls) aged 8 to 13 years, we determined weight, height, BMI, and FPI in the bipedal, static, and relaxed position. The FPI was obtained as the sum of the scores (–2, –1, 0, 1, 2) given to each of the six criteria. Results: The mean ± SD FPI value for the total sample was 5.1 ± 2.1 (boys: 5.1 ± 2.2; girls: 5.2 ± 2.0), so there were no significant differences between the sexes (P = .636). Of the 150 feet examined, none had FPI values of very supinated or highly pronated, two were supinated (1.3%), 76 neutral (50.7%), and 72 pronated (48.0%). Of the total FPI values, 7.7% can be explained by anthropometric variables: height, weight, and foot size (r2 = 0.077; P < .010). Conclusions: The most frequent foot postures in the sample were neutral and pronated. Neither age nor BMI explained variations in the FPI.

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