Abstract
BackgroundFunctional speech rehabilitation after total laryngectomy remains one of the most challenging issues in head and neck multidisciplinary care. Tracheoesophageal puncture for voice prosthesis insertion performed as a secondary procedure with a rigid esophagoscope and trocar can be technically difficult in certain patients due to post-treatment cervical abnormalities, such as reduced hyperextension, stenosis, and trismus.MethodsThis study presents an improved method of secondary tracheoesophageal prosthesis insertion using a flexible endoscope in association with a plastic pliable overtube to keep the virtual esophageal lumen open. By this method, the puncture can be performed easily and safely with the avoidance of unexpected lesions.ResultsFrom 2005 to 2015, 12 (16,9%) out of 71 patients who underwent secondary voice prosthesis placement at our institution required this alternative technique due to anatomical alterations that hindered the execution of the procedure following the standard technique.ConclusionThe procedure was successfully performed in all patients with no related complications.
Highlights
Functional speech rehabilitation after total laryngectomy remains one of the most challenging issues in head and neck multidisciplinary care
With the flexible endoscope introduced through the plastic overtube, we could observe the portion of the needle exposed in the esophageal lumen after it had perforated the posterior wall of the trachea and the anterior wall of the esophagus and had transfixed the overtube itself
The set is pulled up until it Results From Jan. 2005 to Dec. 2015, 71 secondary tracheoesophageal puncture (TEP) procedures were performed at AC Camargo Cancer Center, São Paulo, Brazil
Summary
Functional speech rehabilitation after total laryngectomy remains one of the most challenging issues in head and neck multidisciplinary care. Tracheoesophageal puncture for voice prosthesis insertion performed as a secondary procedure with a rigid esophagoscope and trocar can be technically difficult in certain patients due to post-treatment cervical abnormalities, such as reduced hyperextension, stenosis, and trismus. Methods: This study presents an improved method of secondary tracheoesophageal prosthesis insertion using a flexible endoscope in association with a plastic pliable overtube to keep the virtual esophageal lumen open. By this method, the puncture can be performed and safely with the avoidance of unexpected lesions. When the conventional procedure is technically difficult or even impossible due to posttreatment abnormalities, such as reduced neck extension, pharyngoesophageal stenosis, and trismus, performing tracheoesophageal puncture (TEP) with a
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