Secondary Tracheoesophageal Puncture Research Articles

Secondary voice prosthesis insertion in patients without direct access to the upper esophagus

After total laryngectomy, voice rehabilitation can be achieved by use of voice prosthesis insertion (e.g. Blom-Singer®, Inhealth Technologies, USA; Provox®, Atos Medical, Sweden; Tracoe®, Tracoe Medical, Germany), esophageal voice or assistive digital speech device (e.g. Servox®, Servox AG, Germany). Various studies have shown that insertion of a voice prosthesis leads to superior rehabilitation results compared to other voice methods 1,2 and has become standard of care in many countries. However, insertion of voice prosthesis requires tracheo-esophageal puncture (TEP) which normally is performed during laryngectomy procedure or secondarily as an elective procedure following adjuvant therapy. Primary TEP allows almost direct visualization of the proposed TEP site and protection of the posterior esophageal wall by a rigid pharyngoscope or by the therefore introduced pharynxprotector (e.g. Provox Pharynx Protector®, Atos Medical, Sweden) In case of secondary puncture, the use of rigid scopes to protect the posterior pharyngeal wall and verify correct position of the prosthesis requires sufficient head reclination and mouth opening to ascertain adequate exposure of the upper esophagus and correct placement of the trocar. However, due to degenerative changes of the cervical spine, trismus, pharyngeal reconstruction (e.g. microvascular free tissue transfer), scar tissue formation in postirradiated patients or most often a combination of these factors, the upper esophagus sometimes cannot directly be accessed by rigid instruments. Alternative techniques for secondary TEP comprehend a special wire-guided TEP using a flexible scope 3, transnasal esophagoscopy with air insufflation 4 and a fiberoptic laryngoscope inserted in the cuffed part of an endotracheal tube for visualizing the puncture site 5. Even though these fiberoptic guided methods allow access to the upper esophagus and the puncture site can be directly visualized, safe TEP is compromised by the lack of a rigid abutment protecting the posterior esophagus wall and in some cases, air insufflation can lead to pneumomediastinum and mediastinitis due to a created “via falsa”. In our experience sufficient protection of the posterior esophagus wall is one of the key factors in preventing from possible TEP-complications, such as mediastinitis and sepsis 6. With regard to these few patients, who don’t qualify for secondary TEP by using rigid optic control, we opted for a simple, cheap and safe method to insert voice prosthesis after laryngectomy.

Post laryngectomy speech rehabilitation outcome in elderly patients

The aim of our work has been to evaluate the different options of tracheoesophageal voice rehabilitation in over 70-year-old patients, who had undergone laryngectomy, assessing advantages and drawbacks of this method of vocal recovery. A retrospective study has been carried out. This has included 40 subjects, all aged more than 70 years old, who have been referred to tracheoesophageal voice rehabilitation. It has been realized a phonatory fistula between trachea and esophagus with prosthesis positioning by means of a primary puncture in 18 cases and it has been realized a secondary puncture in 22 cases. The results gathered in these patients were compared with data obtained from a group made of 39 patients, less than 70 years of age that therefore represented our control group. In primary tracheoesophageal puncture (TEP), the short-term success was 67 %, while in the 22 cases who underwent secondary TEP, the short-term success was 64 %. After 2 years from TEP, the long-term success was 82.5 %. In the control group, the short-term success was 65 % in primary TEP and 73 % in secondary TEP. After 2 years from TEP, the long-term success was 77 %. The evaluation of the results has shown the absence of a statistically significant difference both as regards complications incidence, during and after surgery (p > 0.9) and as regards overall success ratio of prosthesis implants between the two groups (p > 0.7). The possibilities of tracheoesophageal recovery of elderly patients do not show dissimilarities in comparison with the results in younger subjects.

Complications of tracheoesophageal puncture and speech valves: retrospective analysis of 47 patients

This study aims to evaluate the complications of tracheoesophageal puncture (TEP) for voice restoration and speech valves in patients undergoing total laryngectomy. Between January 2006 and June 2011, 47 male patients (mean age 62.8±1.2 years; range 41 to 80 years) who underwent TEP and speech valve for voice restoration after total laryngectomy were retrospectively analyzed. Secondary TEP was performed and Provox indwelling voice prosthesis were inserted in all patients. Demographic, disease and treatment characteristics of patients were recorded. Complications related to TEP and speech valves, the management of complications and clinical conditions of complete closure of TEP were also recorded. Tracheoesophageal puncture and speech valve related complications were observed in 20 patients. The majority of complications were minor complications including granulation tissue formation (n=2, 4.2%), deglutition of prosthesis (n=6, 12.7%) and TEP enlargement/leakage around prosthesis (n=9, 19.1%). Major complications were observed in three patients. Two of them were life-threatening complications; a mediastinitis (n=1, 3.1%) and paraesophageal abscess (n=1, 3.1%), and both appeared in the first month of the postoperative period. The overall complication rate was 42.6% during mean follow-up of 15.3 months. Tracheoesophageal fistula enlargement (n=9, 19.1%) was the most common minor complication and the most common cause of complete closure of TEP in this study. Tracheoesophageal puncture for voice restoration is not an entirely innocent procedure without any complications. Patients should be monitored for TEP-related complications in the early and late postoperative period.

Development and (pre-) clinical assessment of a novel surgical tool for primary and secondary tracheoesophageal puncture with immediate voice prosthesis insertion, the Provox Vega Puncture Set

Development and (pre-) clinical assessment were performed of a novel surgical tool for primary and secondary tracheoesophageal puncture (TEP) with immediate voice prosthesis (VP) insertion in laryngectomized patients, the Provox Vega Puncture Set (PVPS). After preclinical assessment in fresh frozen cadavers, a multicenter prospective clinical feasibility study in two stages was performed. Stage-1 included 20 patients, and stage-2 had 27. Based on observations in stage-1, the PVPS was re-designed (decrease in diameter of the dilator from 23.5 to 18 Fr.) and further used in stage-2. Primary outcome measure was immediate VP insertion without requiring additional instruments. Secondary outcome measures for comparison of the new with the traditional TEP procedure were: appreciation, ease of use, time consumption, estimated surgical risks and overall preference. A mini-max two-stage study design was used to establish the required sample size. In stage-1, dilatation forces were considered too high in patients with a fibrotic TE wall. With the final thinner version of the PVPS, VPs were successfully inserted into the TEP in ‘one-go’ in 24/27 (89%) of TEPs: 20 primary and 7 secondary. Participating surgeons rated appreciation, ease of use, time consumption and estimated surgical risks as better. Related adverse events were few and minor. The new PVPS appeared to be the preferred device by all participating surgeons. This study shows that the novel, disposable PVPS is a useful TEP instrument allowing quick and easy insertion of the VP in the vast majority of cases without requiring additional instruments.

Video laryngoscopy-assisted secondary tracheoesophageal puncture placement for the patient with severely limited neck extension

Secondary tracheoesophageal puncture (TEP) placement in patients with severe limitations in neck extension is challenging. Visualization of the hypopharynx with traditional rigid endoscopy may not be possible. We report using the C-MAC (Karl Storz, Tuttlingen, Germany) video laryngoscope to successfully place a secondary TEP in patient with severe radiation fibrosis at a tertiary referral center. A 59-year-old male with severe radiation fibrosis of the neck underwent total laryngectomy for a nonfunctioning larynx. His primary TEP dislodged in the early postoperative period and the patient requested secondary TEP and voice prosthesis. The result was a successful, properly positioned, placement of a secondary TEP. Videolaryngoscopy should be included in the surgeon's armamentarium of techniques to effectively and safely perform secondary TEP in anatomically difficult patients.

Secondary tracheoesophageal puncture and myotomy—A novel outpatient technique

The purpose of this study was to show a novel technique for secondary tracheoesophageal puncture (TEP) and myotomy in patients who previously underwent total laryngectomy. Fifteen patients underwent secondary TEP and 3 patients underwent myotomy. In 1 patient, both myotomy and TEP were done concurrently. A Foley catheter is nasally inserted into the esophagus with the patient under local anesthesia and the catheter balloon is inflated at the site of the planned procedure. The myotomy is performed over the inflated balloon for esophageal posterior wall protection and a voice prosthesis is inserted in a small incision made by the physician. When only myotomy is performed, the muscles over the mucosa are incised. A voice test is performed immediately. All patients exhibited good voice rehabilitation. One patient who had a myotomy had a penetration of the pharyngeal mucosa with immediate closure and no sequelae. Outpatient Foley catheter-guided myotomy and secondary TEP are simple, safe, time saving, and cost-effective procedures.

Simplified technique of tracheoesophageal prosthesis placement at the time of secondary tracheoesophageal puncture (TEP)

Secondary tracheoesophageal (TE) puncture standardly involves placement of a catheter at time of TE fistula creation. We explore the feasibility of placement of the prosthesis at the time of TE puncture (TEP) obviating the need for a subsequent procedure to place the prosthesis. We describe the technique and evaluate the success and potential advantages. Retrospective chart review of consecutive patients who underwent TE prosthesis placement at the time of secondary TEP from 3/2009 to 1/2011. Fourteen patients underwent the primary TE prosthesis placement at the time of secondary puncture and were evaluated. Assessed outcomes included patient demographics, success of prosthesis placement, need for repeat procedure, early or late prosthesis dislodgement, complications, and specific voice outcomes. Patient cohort included nine males, five females, with average age of 64 years. All TE prosthesis placements were successful. The 12-mm 20 F Blom-Singer Indwelling prosthesis was used in all cases. No complications occurred during prosthesis placement. Two perioperative complications occurred: one case of transient pulmonary edema from general anesthesia, one case of posterior tracheal wall swelling. The second was addressed with placement of a larger prosthesis. All patients successfully achieved good voice at an average of 4 days after the procedure (range: 1-9 days). This initial series of 14 consecutive patients demonstrates successful TE prosthesis placement at the time of secondary TE puncture. Functional voice was achieved in all patients with no significant immediate complications. No dislodgements occurred and no repeat procedures were required. Voice acquisition was achieved at an earlier time (4 days on average) than with traditional techniques and without the necessity of a subsequent procedure. Primary prosthesis placement at the time of secondary TE puncture is a successful option for surgical voice restoration with distinct advantages and minimal complications.

Primary versus delayed tracheoesophageal puncture for laryngopharyngectomy with free flap reconstruction

To determine whether postoperative complication rates and speech outcomes differ between patients undergoing primary versus secondary tracheoesophageal puncture following total laryngectomy with free flap reconstruction. Retrospective clinical study in a tertiary academic center. Between November 2004 and June 2010, 137 patients underwent total laryngectomy or laryngopharyngectomy with pharyngeal free flap reconstruction for malignant disease. Data was collected on patient and operative demographics, early postoperative complications, speech outcomes, and predictive factors for tracheoesophageal puncture failure. Thirty patients (22%) had a primary tracheoesophageal puncture performed at the time of laryngectomy, 27 patients (20%) received secondary punctures (>3 months postlaryngectomy), and 80 patients (58%) never received a puncture. Patient and operative demographics were similar between groups (P < .05), apart from proportionately more hypopharyngeal tumors in the "no puncture" group (P < .002). Similar numbers of patients in primary and secondary puncture groups achieved intelligible speech (67% vs. 71%, P = .82) and both groups reported good patient-perceived voice-related quality of life. Salvage surgery and nonpatch radial forearm free flap reconstruction both trended toward increased early postoperative complication rates (P = .09). There is no difference in the early postoperative complication rate for primary versus secondary tracheoesophageal puncture following total laryngectomy with concurrent free flap reconstruction. Radial forearm patch free flap reconstruction achieves good speech outcomes.

Simplified Technique of Tracheoesophageal Prosthesis Placement at the Time of Secondary Tracheoesophageal Puncture

Simplified Technique of Tracheoesophageal Prosthesis Placement at the Time of Secondary Tracheoesophageal Puncture

Reconstruction of Pharyngolaryngectomy Defects Using the Jejunal Free Flap: A 10-Year Experience from a Single Reconstructive Center

Reconstruction following pharyngolaryngectomy presents a complex reconstructive challenge, and a single-stage, reliable reconstruction allowing prompt discharge from the hospital and return of swallowing and speech function is required. The authors present their 10-year experience of 43 jejunal free flaps for pharyngolaryngectomy reconstruction by a single team and outline their operative algorithm to minimize postoperative morbidity. The data for patients who underwent jejunal free flap reconstruction of circumferential pharyngoesophageal defects between March of 2000 and September of 2009 were reviewed retrospectively. All cases were included for analysis. There were 31 male patients and 12 female patients, with 100 percent acute flap survival. The authors' overall benign pharyngocutaneous fistula rate was two of 43 (5 percent), with two of 29 (7 percent) occurring in the group without a prophylactic pectoralis muscle flap and zero of 14 occurring in the group that had a prophylactic pectoralis muscle flap. No fistulas occurred when the anastomosis was performed with the gastrointestinal stapler (zero of 48). The authors' overall benign stricture rate was six of 43 (14 percent). Thirty-six patients received either a primary or secondary tracheoesophageal puncture; of these, 28 of 36 (78 percent) used their tracheoesophageal puncture as their primary mode of communication. The authors' recommendations for minimizing fistulas and stricture rate, following free jejunal reconstruction, include the gastrointestinal stapler for bowel anastomosis whenever possible, and the use of a prophylactic pedicled pectoralis major muscle flap for patients exposed to previous radiotherapy.

Tracheo oesophageal puncture voice: an Indian perspective.

Author presents in this study 160 patients who underwent tracheoesophageal puncture (TEP) for voice rehabilitation after laryngectomy. This study represents authors experience in Indian perspective with regards to technique, timing of surgery, i.e., primary or secondary, effect of socioeconomic condition of the patients. Author also narrated complications secondary to the TEP voice and prosthesis, during long follow-up of 15years. The primary and secondary TEP were compared in patients having good socio-economical status with that of relatively poor status patients. As compared to the western literature, this Indian study showed significant differences in success rate of achieving good TEP voice production and also continuing use of TEP voice. Author observed that despite, entirely different socio economic condition and lack of proper follow-up, the secondary TEP done after complete evaluation of the patient yields much better sustained results for successful voice acquisition and continuation of the use of acquired voice. Author has described in details about the surgical procedures for secondary TEP; the prosthesis, care of prosthesis, problems due to TEP and prosthesis and the ways to rectify these problems.

Complications Following Tracheoesophageal Puncture: A Tertiary Hospital Experience

In laryngectomised patients, tracheoesophageal speech is the gold standard for voice rehabilitation. This study evaluated complications related to the tracheoesophageal puncture (TEP) and the success rate in voice prosthesis after total laryngectomy at our institution over a 10-year period. A retrospective review of 22 TEPs was performed between January 1998 and December 2008. The timing of TEP, type of voice prosthesis, surgical and prosthesis-related complications, and TEP closure were noted. Eighteen percent of the patients underwent primary and 82% secondary TEP. Our patients were predominantly males (95.4%) of Chinese descent with a mean age of 62.1 years. The types of voice prostheses used were ProvoxTM (n = 15), Voicemasters (n = 6), and Blom-Singer (n = 1). Prosthesis- related complications occurred in 77.3%. Notable complications were leakage (82.5%), prosthesis displacement (41.2%), intractable aspiration (29.4%), and aspiration of prosthesis (23.5%). The most common surgical-related complication was tracheostomal stenosis. An array of interventions comprising resizing or changing prosthesis type, nasogastric catheter insertion, stomaplasty, purse string suturing, and bronchoscopic removal of bronchial aspirated prosthesis were implemented to address encountered complications. In a mean follow-up of 34.8 months, 68.2% of patients achieved functional tracheoesophageal speech (75% of primary TEP and 67% of secondary TEP). There were 7 TEP closures indicated by persistent leakage, recurrent dislodgement, phonatory failure and, in 1 patient, persistent pain. TEP has become an integral part in the rehabilitation of a laryngectomee. However, management of the frequent complications related to TEP requires specific efforts and specialistic commitments in order to treat them.

Pharyngoesophageal reconstruction with the anterolateral thigh flap after total laryngopharyngectomy

: Pharyngoesophageal defects traditionally have been reconstructed using a jejunal or radial forearm flap. In 2002, the authors began using the anterolateral thigh flap for pharyngoesophageal reconstruction, and it has become our preferred method. The purpose of this study was to analyze the clinical and functional outcomes achieved using this technique. : The medical records of 91 male and 23 female patients who underwent pharyngoesophageal reconstruction using an anterolateral thigh flap were retrospectively reviewed. Outcomes analyzed included length of hospital and intensive care unit stay, fistula and anastomotic stricture formation and other complications, swallowing and tracheoesophageal speech function, and survival. Most patients had primary (27%) or recurrent (42%) squamous cell carcinoma. Before reconstruction, 71% of patients had undergone surgery, radiotherapy, or both. There were 67 circumferential and 47 near-circumferential defects. : Mean intensive care unit stay was 1.9 +/- 2.2 days, and mean hospital stay was 9.0 +/- 4.7 days. Two patients experienced total flap loss, and 1 patient had partial flap necrosis. Pharyngocutaneous fistulas and strictures occurred in 9% and 6% of patients, respectively. Ninety-one percent of patients tolerated an oral diet without the need for tube feeding. Tracheoesophageal puncture was performed for speech rehabilitation in 51 patients. Eight-one percent of patients with a secondary tracheoesophageal puncture achieved fluent speech versus 41% of patients with a primary tracheoesophageal puncture. : This series demonstrates that excellent clinical and functional outcomes, with minimal donor site morbidity and quick recovery, are possible with pharyngoesophageal reconstruction using an anterolateral thigh flap. Cancer 2010. (c) 2010 American Cancer Society.

Improved Tracheoesophageal Prosthesis Sizing in Office-Based Tracheoesophageal Puncture

Tracheoesophageal puncture (TEP) for postlaryngectomy speech is increasingly being performed as an office-based procedure. We review our experience with office-based TEP and compare outcomes with those of operating room-based TEP. Our hypothesis was that office-based TEP results in improved prosthesis sizing, reducing the number of visits dedicated to prosthesis resizing. A retrospective chart review was performed of all patients who underwent secondary TEP at our institution from 2001 to 2008. The primary dependent measure was the change in the length of the voice prosthesis. We also evaluated the number of visits made to the speech-language pathologist for resizing before a stable prosthesis length was achieved, and the number of days between voice prosthesis placement and the date a stable prosthesis length was observed. Thirty-one patients were included in this study. There was a significant difference in prosthesis length change between patients who had office-based TEP and patients who had operating room-based TEP (p < 0.001). In addition, the office-based cohort required fewer visits to the speech-language pathologist for TEP adjustments before a stable TEP length was achieved (p < 0.001). Voice prosthesis sizing was better in patients who had office-based TEP than in patients who had operating room-based TEP. This outcome is likely due to the lesser degree of swelling of the tracheoesophageal party wall in the office-based procedure.

Secondary Tracheoesophageal Puncture With In-Office Transnasal Esophagoscopy

To evaluate the outcomes of voice restoration using office-based transnasal esophagoscopy (TNE) to guide placement of the secondary tracheoesophageal puncture (TEP). Retrospective chart review. Two tertiary care medical centers. The study included 39 patients who underwent the TNE-TEP procedure from January 2004 to December 2008. Clinical, demographic, and TE speech-related data were recorded to examine the ease, efficiency, complications, and speech-related outcomes. Among 39 patients identified, the average age was 65 years (age range, 47-83 years), with 32 male (82%) and 7 female (16%) patients. Twenty-five patients (64%) underwent total laryngectomy; 8 (21%) underwent total laryngectomy with partial pharyngectomy; and 14 (36%) underwent microvascular flap reconstruction. The overall success rate of secondary TNE-assisted TEP placement was 97% (n = 38), with 1 unsuccessful attempt. There was no statistically significant correlation found between patients having undergone radiation therapy (either before or after oncologic resection) or a cricopharyngeal myotomy and successful TEP placement, type of reconstruction used to close the pharyngeal defect when compared with the difficulty in the placement of the TEP, development of complications associated with TEP placement, use of the TEP prosthesis, or speech intelligibility at the last follow-up visit. Thirty-one patients (79%) were still using their TEP prosthesis for speech at the last follow-up visit. Of the patients reviewed, 28 (72%) had understandable TE speech. In-office TNE-assisted TEP placement can safely be performed, with excellent speech outcomes. Reconstruction with musculocutaneous or microvascular free-tissue transfer did not limit our ability to place secondary TEPs with TNE.

Results of vocal rehabilitation using tracheoesophageal voice prosthesis after total laryngectomy and their predictive factors

The aims of this retrospective study were to evaluate prosthetic voice restoration by tracheoesophageal puncture (TEP) in laryngectomized patients and to identify clinical factors correlated with functional outcomes. Between 2000 and 2008, 103 patients who underwent total laryngectomy or pharyngolaryngectomy (TPL) were included in our study. Functional outcomes were recorded 6 months postoperatively, and results were scored from 0 to 2 for oral diet and speech intelligibility. Lifetime of voice prosthesis and early and late complications were recorded. The impact of several clinical factors on functional outcomes, prosthetic valve lifetime and complications was assessed in univariate analysis. A total of 87 patients (84%) underwent TEP and speech valve placement (79 primary and 8 secondary punctures). Hypopharyngeal tumors (P = 0.005), circular TPL (P = 0.003) and use of a pectoralis major myocutaneous flap (P = 0.0003) were significantly associated with secondary TEP. Successful voice rehabilitation was obtained by 77 of 82 evaluable patients (82%). A high level of comorbidity (ASA score > or = 3; P = 0.003) was correlated to speech rehabilitation failure. The median device lifetimes were 7.6 and 3.7 months for Provox I and II speech valves, respectively. Minor leakage around the valve occurred in 26% of the patients. Late complications occurred in 14 patients (16%) including: severe enlargement of the fistula (n = 3), prosthesis displacement (n = 7) and granulation tissue-formation (n = 4). In conclusion the use of voice prosthesis showed a high success rate of vocal rehabilitation with an acceptable complication rate.

Secondary tracheoesophageal puncture: Blind technique with a rigid hysterometer

The use of a rigid esophagoscope during tracheoesophageal puncture for speaking valve insertion in laryngectomized patients may be hindered by stenosis of the esophagus, or arthritic deformation of the spine, limiting extension of the neck. To prevent complications we currently perform a blind technique in these patients with the use of a rigid hysterometer instead of the esophagoscope. Ten patients underwent secondary tracheoesophageal puncture using a rigid hysterometer. This was inserted through the mouth and gently advanced along the cervical esophagus to the level of the tracheostomy. A transverse incision was made on the posterior membranaceous wall of the trachea to enable the hysterometer to enter the tracheal lumen. The curved cannula of a Provox trocar was retrogradely inserted into the fistula following the hysterometer as a guide. After withdrawing the hysterometer, a Provox flexible guidewire was introduced into the cannula and advanced up to the oral cavity to anchor a Blom-Singer prosthesis. Withdrawal of the guidewire enabled the prosthesis to be housed in the fistula. All patients had a successful surgical outcome without any intra- or postoperative complications. The resulting fistula was adequate and enabled patients to wear their prostheses without trouble and to quickly acquire an intelligible voice. The limited thickness allows easy advance of the hysterometer beyond esophageal stenotic tracts, and its particular curved conformation permits progression toward the level of the tracheostomy in patients who cannot assume a relaxed, extended supine position on the operating table.

Primary versus secondary tracheoesophageal puncture in salvage total laryngectomy following chemoradiation

To compare the rate of postoperative wound-healing complications and voice fluency in primary vs secondary tracheoesophageal puncture (TEP) following chemoradiation. Between 1998 and 2005, 30 patients underwent laryngectomy after chemoradiation therapy. Twenty patients underwent primary TEP and 10 patients underwent secondary TEP. Comorbidities, postoperative complications, speech fluency, and time to speech fluency were evaluated in each patient. Pharyngocutaneous fistula (PCF) occurred in 10 of 20 (50%) patients who underwent primary TEP and in 0 of 10 (0%) patients in the secondary TEP group (P < 0.05). Overall, 25 of 25 (100%) patients who had placement of a tracheoesophageal prosthesis achieved fluent speech. Median time to fluency was 63 days in the primary TEP group and 125 days in the secondary TEP group. There is an increased risk of PCF in patients undergoing primary TEP compared with secondary TEP following chemoradiation. No difference in acquisition of speech fluency was identified between the two groups. Patients undergoing primary TEP achieved fluent speech 62 days sooner than their secondary TEP counterparts.

Long Term Results of Speech Rehabilitation in Total Laryngectomy Patients: Primary Versus Secondary Tracheoesophageal Punctures

1. Bien S, Rinaldo A, Silver CE, et al. History of voice rehabilitation following laryngectomy. Laryngoscope 2008; 118: 453-8 2. Blom ED, Singer MI, Hamaker RC. A Prospective study of tracheoesophageal speech. Arch Otolaryngol Head Neck Surg 1986; 112: 440-7 3. Singer MI, Blom ED. An endoscopic technique for restoration of voice after Laryngectomy. Ann Otol Rhinol Laryngol 1980; 89: 529-33 4. Singer MI, Blom ED, Hamaker RD. Further Experience with voice restoration after total Laryngectomy. Ann Otol Rhinol Laryngol 1981; 90: 498-502 5. Cheng E, Ho M, Ganz C et al. Outcomes of primary and secondary tracheoesophageal puncture: A 16 year retrospective analysis. ENT 2006; 85: 262-67 OBJECTIVE This study was designed to evaluate the success of voice rehabilitation and complication rate in patients who underwent laryngectomy with primary tracheoesophageal puncture (pTEP). INTRODUCTION The first successful laryngectomy was performed in 1873 by Theodore Billroth and by 1874, Gussenbauer had devised the first artificial larynx for Billroth’s patients. Yet it wasn’t until 1979 when Singer and Blom developed the tracheoesophageal puncture (TEP) prosthesis that would forever change voice rehabilitation in total laryngectomy patients. Voice rehabilitation with esophageal speech has been documented in the literature between 24% to 32% successful. When Singer and Blom first popularized the TEP as a technique for voice rehabilitation, 88% of their patients had attained successful vocalization following total laryngectomy (1). Since this historical publication, many studies have looked at the success rates for TEP and reported rates have ranged from 40 to 90%.

Endoscopic-guided retrograde technique for secondary tracheo-oesophageal puncture and valve insertion

Endoscopic-guided retrograde technique for secondary tracheo-oesophageal puncture and valve insertion