Sudden Onset Dysphonia: Accidental Aspiration of Tracheoesophageal Prosthesis

Abstract

SESSION TITLE: Bronchoscopy and Associated Procedures SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Achieving voice without a functional larynx has been described more than a century ago. Tracheoesophageal puncture allows patient to channel air from lungs through the puncture site in the back of traches, into the esophagus. Although 11% of patients report complications, aspiratin of prothesis is rare. CASE PRESENTATION: A 70 year-old male presented to emergency room with complaints of sudden onset of muffled voice. He was diagnosed with laryngeal cancer two years back and was treated with total laryngectomy. Later, he underwent secondary tracheoesophageal puncture and is able phonate well tracheoesophageal prosthesis(TEP). He was seen by speech pathologist and his 20Fr/6MM Blom-Singer® Dual Valve™ prosthesis was exchanged successfully. His clinical examination was normal except missing TEP from the puncture site. CT scan of the chest revealed the aspirated prosthesis in the left main bronchus extending to the secondary carina. There was no evidence of atelectasis of the distal lung(Image 1A-D). Flexible bronchoscopy through the tracheostomy stoma confirmed the prosthesis lodged in left main bronchus (Image 1E). The distal end of the prosthesis could not be visualized and scope could not be passed beyond left main bronchus. Lung biopsy forceps was passed through the working channel of the scope and the prosthesis tail was held, and removed en bloc with the bronchoscopy successfully (Image 1F). DISCUSSION: Aspiration of Blom-Singer prosthesis is a rare complication reported in approximately ten cases. As the size of TEP is smaller compared to the diameter of the trachea, most cases were non-asphxiating, but required rigid bronchoscopy for their extraction. . If the aspiration does not cause any significant hemodynamic abnormality, then CT of chest should be done to look for the distal extension and for any complication due to aspiration. CONCLUSIONS: Innovation and experience in flexible bronchoscope technique have enabled us for interventional procedure like foreign body removal, contrary to popular belief, as done in our patient. In an study, the success rate of foreign body extraction lodges in proximal airways using flexible was more than 90% in adults. In children, who are more prone for foreign body aspiration, we continue to support rigid bronchoscope for foreign body extraction due better control over airway with more options for intervention Reference #1: Leuin SC, Deschler DG. The missing tracheoesophageal puncture prosthesis: evaluation and management. Ear Nose Throat J. 2013;92:14-16. DISCLOSURE: The following authors have nothing to disclose: Mohan Rudrappa, Laxmi Kokatnur No Product/Research Disclosure Information