Voice Prosthesis Insertion Research Articles

A Case of Tracheogastric Puncture Using Transnasal Esophagoscopy After Total Laryngopharyngoesophagectomy and Gastric Pull-Up Reconstruction

Voice rehabilitation after total laryngopharyngoesophagectomy is a significant challenge, especially when accompanied by gastric pull-up reconstruction. In 2021, a study revealed that tracheoesophageal puncture is also safe and feasible option for voice rehabilitation in patients who underwent gastric pull-up surgery. Here, we report for the first time in South Korea a case that represents an instance of voice prosthesis insertion after gastric pull-up surgery. The case demonstrates the feasibility and safety of voice prosthesis insertion in patients who undergo total laryngopharyngoesophagectomy and gastric pull-up surgery, providing evidence that voice prosthesis insertion is achievable and can be performed in the outpatient setting using transnasal esophagoscopy.

A Case of Difficulty in Closing the Refactory Tracheojejunal Shunt After Insertion of Voice Prosthesis

A Case of Difficulty in Closing the Refactory Tracheojejunal Shunt After Insertion of Voice Prosthesis

Definitive Closure of the Tracheoesophageal Puncture Site after Oncologic Laryngectomy: A Systematic Review and Meta-Analysis.

Tracheoesophageal puncture (TEP) and voice prosthesis insertion following laryngectomy may fail to form an adequate seal. When spontaneous closure of the fistula tract does not occur after conservative measures, surgical closure is required. The purpose of this study was to summarize the available evidence on surgical methods for TEP site closure.A comprehensive search across PubMed, Web of Science, SCOPUS, and Cochrane was performed to identify studies describing surgical techniques, outcomes, and complications for TEP closure. We evaluated the rate of unsuccessful TEP closure after surgical management. A meta-analysis with a random-effect method was performed.Thirty-four studies reporting on 144 patients satisfied inclusion criteria. The overall incidence of an unsuccessful TEP surgical closure was 6% (95% confidence interval [CI] 1–13%). Subgroup analysis showed an unsuccessful TEP closure rate for silicone button of 8% (95% CI < 1–43%), 7% (95% CI < 1–34%) for dermal graft interposition, < 1% (95% CI < 1–37%) for radial forearm free flap, < 1% (95% CI < 1–52%) for ligation of the fistula, 17% (95% CI < 1–64%) for interposition of a deltopectoral flap, 9% (95% CI < 1–28%) for primary closure, and 2% (95% CI < 1–20%) for interposition of a sternocleidomastoid muscle flap.Critical assessment of the reconstructive modality should take into consideration previous history of surgery or radiotherapy. Nonirradiated fields and small defects may benefit from fistula excision and tracheal and esophageal multilayer closure. In cases of previous radiotherapy, local flaps or free tissue transfer yield high successful TEP closure rates. Depending on the defect size, sternocleidomastoid muscle flap or fasciocutaneous free flaps are optimal alternatives.

Reconstruction of Pharyngolaryngeal Defects with the Ileocolon Free Flap: A Comprehensive Review and How to Optimize Outcomes.

Several reconstructive methods have been reported to restore the continuity of the aerodigestive tract following resection of pharyngeal and hypopharyngeal cancers. However, high complication rates have been reported after voice prosthesis insertion. In this setting, the ileocolon free flap (ICFF) offers a tubularized flap for reconstruction of the hypopharynx while providing a natural phonation tube. Herein, we systematically reviewed the current evidence on the use of the ICFF for reconstruction of the aerodigestive tract. A systematic literature search was conducted across PubMed MEDLINE, Web of Science, ScienceDirect, Scopus, and Ovid MEDLINE(R). Data on the technical considerations and surgical and functional outcomes were extracted. Twenty-one studies were included. The mean age and follow-up were 54.65 years and 24.72 months, respectively. An isoperistaltic or antiperistaltic standard ICFF, patch flap, or chimeric seromuscular-ICFF can be used depending on the patients' needs. The seromuscular chimeric flap is useful to augment the closure of the distal anastomotic site. The maximum phonation time, frequency, and sound pressure level (dB) were higher with ileal segments of 7 to 15 cm. The incidence of postoperative leakage ranged from 0 to 13.3%, and the majority was occurring at the coloesophageal junction. The revision rate of the microanastomosis ranged from 0 to 16.6%. The ICFF provides a reliable and versatile alternative for reconstruction of middle-size defects of the aerodigestive tract. Its three-dimensional configuration and functional anatomy encourage early speech and deglutition without a prosthetic valve and minimal donor-site morbidity.

A Multidisciplinary Approach to Secondary Tracheoesophageal Puncture for Voice Prosthesis Insertion Using Flexible Esophagoscopy

BackgroundTracheoesophageal puncture (TEP) with voice prosthesis (VP) insertion is the gold standard of surgical voice restoration in postlaryngectomy patients. The conventional technique involves rigid esophagoscopes and trocar performed by ENT surgeons alone, with technical limitations encountered in patients with cervical abnormalities - in particular those with free or rotational flap reconstructions and postradiotherapy strictures. We report our technique using flexible endoscopy which we show to be feasible and without major safety events, as a possible consideration in the anticipated difficult TEP. MethodsOur study describes a multidisciplinary approach to secondary TEP involving a combined upper gastrointestinal (UGI) and (Ear, Nose, and Throat) ENT procedure, under the guidance of flexible esophagoscopy, with intraoperative involvement of the speech pathologist to guide VP insertion and placement. The procedure was performed with ease without major complications. ResultsWe identified nine postlaryngectomy and laryngopharyngectomy patients in our institution who underwent secondary TEP with VP insertion using flexible esophagoscopy and multidisciplinary intra-operative involvement. All patients had pharyngeal reconstruction, including radial forearm free flap (n = 4), pectoralis major rotational flap (n = 3), and anterolateral thigh flap (n = 2). Eight out of nine patients underwent adjuvant radiotherapy. The technique was successfully performed in all patients. There were three cases of early TEP displacement in two patients, of which one patient had a successful repeat procedure. We found the technique advantageous in terms of feasibility and practicality compared to the conventional approach, and without intraoperative difficulties encountered in achieving the desired field of views or navigating the challenging anatomy in a free flap and post-radiotherapy patients. This includes distorted cervical anatomy, the presence of bulky and hair-bearing flap skin, and stricture formation. Minor complications in our cohort included pharyngo-esophageal spasm, TEP displacement, granulation tissue, and peri-prosthetic leaks. ConclusionOur multidisciplinary approach to secondary TEP was performed with flexible esophagoscopy without major related complications. The technique is advantageous in the surgical approach to VP insertion in postlaryngectomy and laryngopharyngectomy patients who have had radiotherapy or pharyngeal reconstruction. It allows for safe anatomical insertion and thorough evaluation of the upper aerodigestive tract for comorbid benign or malignant esophageal pathology.

A novel procedure of secondary voice prosthesis insertion from the inside out: The modified Fukuhara method

ObjectiveTo present a new procedure for inserting a secondary voice prosthesis from the inside to the outside, which improves on the method previously reported by Fukuhara et al. MethodsA flexible nasopharyngoscope was used to puncture pharynx (or transplanted jejunum) from the inside to the outside. In this method, it was possible to use the PROVOX® VegaTM Puncture Set as it is used for the placement of the voice prosthesis. ResultsWe were able to place the PROVOX® VegaTM in all cases we experienced. Most of the cases had a history of radiation therapy. The time required for surgery ranged from 11–59 minutes (mean: 29 minutes) and there was no measurable amount of bleeding. ConclusionThis new method using the PROVOX® VegaTM Puncture Set, which is designed for the original purpose of voice prosthesis implantation, was therefore found to be safe and effective.

Surgical rehabilitation of the voice post total laryngectomy

Introduction Almost 150 years after the first surgery, total laryngectomy continues to be the surgery of choice for advanced stage laryngeal tumours as well as for the revision of therapeutic failures of radiotherapy that cannot be resolved with other types of partial procedures. Materials and methods Our study was conducted at the University Hospital of Catania, from 1 January 2010 to 31 December 2020. Voice prosthesis following tracheoesophageal puncture was performed as a primary choice in 13 cases while as a secondary procedure in 29 cases. The use of the oesophageal voice through adequate rehabilitation, on the other hand, was the choice for 15 patients. Results The VrQoL questionnaire revealed significantly better results in both the Socio-Emotional and Functional domains of the group of patients who underwent voice rehabilitation via voice prosthesis after TEP compared to the group rehabilitated via oesophageal voice. The V-RQoL score showed a worsening of the well-being indices among the patients who had tracheoesophageal fistula related disorders at the control compared to the group rehabilitated with the oesophageal voice. Discussion Tracheo-oesophageal puncture (TEP) with voice prosthesis (VP) insertion is currently considered the technique of choice for restoring a voice as close as possible to the pre-laryngectomy. It should also be considered that this type of device also offers excellent performance from a psychological point of view, making this type of intervention the best accepted by patients in terms not only of phoniatric but also of improving the quality of life.

Secondary tracheoesophageal puncture with a flexible transillumination device: a new technique and its outcomes

ObjectivesThis study aims to describe a new secondary tracheoesophageal puncture technique with voice prosthesis insertion under local anesthesia with a low-cost device and evaluate its outcome. MethodsWith a transoral flexible transillumination device of aluminum of 2.3 mm with fiberoptic light, the esophagus’s anterior wall is visualized through the tracheostomy. A tracheoesophageal fistula is made with a blade and passed through the fistula. Then a bent trocar is introduced into the lumen using the device as a guidewire. Once in the lumen, a thin guide wire is passed through up to the mouth. The voice prosthesis is positioned with retrograde insertion. Then, the patient is discharged without hospitalization. Results15 patients submitted to this technique had a successful surgical outcome. There were no complications as pneumothorax, esophageal perforation, bleeding, or hospitalization. ConclusionThe new device is feasible under local anesthesia.

Surgical Outcome and Quality of Life After Total Laryngectomy in Advanced Laryngeal Cancer- A Study in Combined Military Hospital, Dhaka

Introduction: Total laryngectomy is the gold standard treatment for advanced laryngeal cancer. Sacrifice of voice is one of the most important shortcomings of the procedure. Possibility of achieving good quality voice is greater with prosthesis compared to other method. Post laryngectomy voice rehabilitation with prosthesis yield excellent outcome in most of the cases. Swallowing, pulmonary and olfactory rehabilitation should be managed by multidisciplinary team for better quality of life (QoL).&#x0D; Objectives: The purpose of this study was to observe the outcomes of voice, swallowing pulmonary and olfactory rehabilitation and QoL following total laryngectomy.&#x0D; Methods: This cross sectional retrospective clinical study was conducted at the Head &amp; Neck Oncology Unit, Combined Military Hospital (CMH), Dhaka. Total 57 candidates were selected. Diagnosis was done by thorough clinical examination, Fibre Optic Laryngoscopy. Contrast Enhanced Computed Tomography (CECT) scan of neck was done except few cases where MRI of neck was done for subtle cartilage erosion was suspected. Examination under anaesthesia, direct larangoscopy and biopsy was done for every cases. Candidates were post chemo-radiated/ radiated biopsy proven recurrent cases, clinically nonfunctional larynx with aspiration and radiologically evident of cartilage erosion. In all cases artificial voice prosthesis was used. All the laryngectomees underwent voice, swallowing, pulmonary and olfactory rehabilitation in laryngectomy club of head &amp; neck oncology unit, CMH Dhaka for a period of 3 months as per standard protocol.&#x0D; Results: Among the 57 patients 42 of them are using voice prosthesis without any complications till to date. Voice rehabilitation started after wound healing &amp; developed meaningful voice in around 6 weeks. Satisfactory speech &amp; voice outcomes were observed near about 3 months. Voice quality was assessed by multivariate statistical analysis. Excellent voice was observed for 38 patients, good voice for 12 patients, fair voice for 05 patients and poor voice for 02 patients. Troubleshooting like mycotic infection developed in 6 patients which was managed by anti-fungal medication with regular appropriate cleaning, Pharyngocutaneous fistula developed in 5 patients, 3 healed later by pressure dressing and anticholinergic &amp; 1 required exploration and flap reconstruction, 01 developed recurrent stomal stenosis which managed surgically by Y-V advancement. Prosthesis expelled out in 3 cases. 02 cases developed dysphagia due to tonicity of pharyngoesophageal (PE) segment &amp; managed by botox injection. Significantly better voice &amp; swallowing were reported by patients undergone laryngectomy alone in comparison with patients receiving adjuvant radiotherapy &amp; patient undergoing salvage laryngectomy.&#x0D; Conclusion: Awareness should be developed as sacrifice of voice box is no more a permanent comorbidity of total laryngectomy. Excellent voice can be developed by insertion of voice prosthesis as well as swallowing pulmonary and olfactory rehabilitation following laryngectomy for better of QoL.&#x0D; Bangladesh J Otorhinolaryngol; April 2021; 27(1): 5-11

Complications following secondary voice prosthesis insertion and impact of previous irradiation on their appearance.

The aim of this study was to analyze the complications following secondary voice prosthesis insertion and impact of previous irradiation on their appearance. This study included 106 totally laryngectomized patients who underwent secondary Provox 2 voice prosthesis insertion. Among them, 79 (74.5%) were irradiated. Surgery, prosthesis, fistula, and voice-related complications were analyzed and presented. Complications occurred in 23 (22%) patients. Fifteen of them were previously irradiated. There were no surgery-related complications. In the group of prosthesis-related complications, one patient had increased negative pressure during swallowing with extremely short prosthesis life time. There were 17 complications in the group of fistula related ones; 3 patients had excessive granulation tissue around the fistula and 14 patients experienced prosthesis displacement (7 had closed esophageal end of the fistula, 5 had the prosthesis turned sideways in an open fistula, one patient inhaled and one ingested the prosthesis). Tracheoesophageal voice was not established in 5 patients. Previous irradiation had no statistically significant influence on the complication rate (P = 0,251). The majority of complications following secondary voice prosthesis insertion are fistula-related ones, among which, displacement of the voice prosthesis is the most common. Previous irradiation does not significantly increase the risk of developing complications.

A New Classification System to Predict Functional Outcome after Laryngectomy and Laryngopharyngectomy.

Simple SummaryEvaluation of the long-term functional outcome after primary or salvage laryngopharyngectomy. Long term functional outcome mainly depends on extent of pharyngectomy and salvage situation, which is reflected by our new classification system. (1) Objective: To evaluate long-term functional outcome in patients who underwent primary or salvage total laryngectomy (TL), TL with partial (TLPP), or total pharyngectomy (TLTP), and to establish a new scoring system to predict complication rate and long-term functional outcome; (2) Material and Methods: Between 1993 and 2019, 258 patients underwent TL (n = 85), TLPP (n = 101), or TLTP (n = 72). Based on the extent of tumor resection, all patients were stratified to (i) localization I: TL; II: TLPP; III: TLTP and (ii) surgical treatment (A: primary resection; B: salvage surgery). Type and rate of complication and functional outcome, including oral nutrition, G-tube dependence, pharyngeal stenosis, and voice rehabilitation were evaluated in 163 patients with a follow-up ≥ 12 months and absence of recurrent disease; (3) Results: We found 61 IA, 24 IB, 63 IIA, 38 IIB, 37 IIIA, and 35 IIIA patients. Complications and subsequently revision surgeries occurred most frequently in IIIB cases but rarely in IA patients (57.1% vs. 18%; p = 0.001 and 51.4% vs. 14.8%; p = 0.002), respectively. Pharyngocutaneous fistula (PCF) was the most common complication (33%), although it did not significantly differ among cohorts (p = 0.345). Pharyngeal stenosis was found in 27% of cases, with the highest incidence in IIIA (45.5%) and IIIB (72.7%) patients (p < 0.001). Most (91.1%) IA patients achieved complete oral nutrition compared to only 41.7% in class IIIB patients (p < 0.001). Absence of PCF (odds ratio (OR) 3.29; p = 0.003), presence of complications (OR 3.47; p = 0.004), and no need for pharyngeal reconstruction (OR 4.44; p = 0.042) represented independent favorable factors for oral nutrition. Verbal communication was achieved in 69.3% of patients and was accomplished by the insertion of voice prosthesis in 37.4%. Acquisition of esophageal speech was reached in 31.9% of cases. Based on these data, we stratified patients regarding the extent of surgery and previous treatment into subgroups reflecting risk profiles and expectable functional outcome; (4) Conclusions: The extent of resection accompanied by the need for reconstruction and salvage surgery both carry a higher risk of complications and subsequently worse functional outcome. Both factors are reflected in our classification system that can be helpful to better predict patients’ functional outcome.

Voice Rehabilitation After Laryngectomy: A Regional Cancer Centre Experience and Review of Literature.

Alaryngeal speech in laryngectomees has revolutionized the patient outlook toward the morbid procedure and the concept of permanent stoma unlike olden era when stigma of stoma with loss of voice was rampant. To analyse acceptance of voice rehabilitation options and their success and management of complications in a tertiary care centre. All patients who underwent laryngectomy from August 2014 to 2018 June at our institution were included in the study. The voice rehabilitation options like oesophageal speech, tracheao-oesophageal puncture and voice prosthesis insertion (TEP), and electrolarynx were explained to the patients. The options put forward to the patients, the importance of Taub test, Interval between treatment and secondary TEP insertion, life span of the prosthesis, Patients acceptance and success rates and the troubleshooting were noted. A total of 96 patients underwent total laryngectomy, 72 patients were willing for rehabilitation. 15% (11) patients had primary TEP, 22% (16) had secondary TEP insertion, esophageal speech in 36% (26) patients and 27% (19) patients opted for the electrolarynx. The rest 24 patients were not keen on any further interventions after laryngectomy. Speech rehabilitation is an integral part in surgical management of carcinoma of the larynx. Alaryngeal speech in laryngectomees have revolutionized the patient outlook towards the morbid procedure. Esophageal speech is the least successful method of rehabilitation but still the cheapest method and requires a lot of motivation. Primary and Secondary TEP insertions have similar success rates. Successful treatment for cancer of larynx ends with successful voice rehabilitation.

Alternative technique in secondary tracheoesophageal puncture using flexible endoscope and overtube in patients with difficult post-laryngectomy abnormalities

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.

Factors influencing clinical consistency and variability in voice prosthesis management

Purpose: Anecdotally it is recognised that management of tracheoesophageal speech (TES) post-laryngectomy varies between speech language pathology (SLP) services and clinicians. This study reviewed patterns of practice for TES management to examine patterns of practice and explore factors influencing variability.Method: A national survey was completed by SLP’s from clinical services which manage TES. This online survey examined demographic and caseload information, initial voice prosthesis (VP) placement and procedures, VP cleaning and care recommendations, humidification management, equipment and service provision, and service delivery options at each site.Result: Lead clinicians from 34 sites (85% response rate) responded. Most clinical practice regarding initial VP insertion and management, as well as the timing and delivery of voice rehabilitation was highly consistent. Patient use of antifungal medications, TES and associated equipment provision, humidification management immediately post-surgery and some aspects of initial VP insertion were variable between services. The nature of the clinical setting, equipment funding and level of research evidence influenced variability in practice.Conclusion: Variability exists in a number of aspects of practice across Australian services offering TES management. Sources of variability need to be addressed nationally to ensure there is consistent, quality care available for all patients.

Indwelling voice prosthesis insertion after total pharyngolaryngectomy with free jejunal reconstruction.

ObjectivesTotal pharyngolaryngectomy with free jejunal reconstruction is often performed in patients with hypopharyngeal carcinoma. However, postoperative speechlessness significantly decreases patient quality of life. We investigated whether Provox® insertion could preserve speech after total pharyngolaryngectomy with free jejunal reconstruction.Study DesignRetrospective chart review.MethodsA total of 130 cases of secondary Provox® insertions after total pharyngolaryngectomy with free jejunal reconstruction were analyzed. Communication outcomes were compared using the Head and Neck Cancer Understandability of Speech Subscale. Outcomes and complications associated with insertion site (jejunal insertion vs. esophageal insertion) and adjuvant irradiation therapy were also evaluated.ResultsProvox® insertion had favorable communication outcomes in 102 cases (78.4%). Neither the insertion site nor irradiation affected the communication outcome. Complications were observed in 20 cases (15.4%). Local infection was the most common complication. Free jejunal insertion, in which the resection range was enlarged, had a lower complication rate than did esophageal insertion, and its complication rate was unaffected by previous irradiation. For all patients, the hospitalization duration and duration of speechlessness were 13.4 days and 14.6 months, respectively. Patients receiving jejunal insertions had a significantly shorter hospitalization duration than did those receiving esophageal insertions. Unlike Provox®2, Provox®Vega significantly reduced the complication rate to zero.ConclusionFor jejunal inserson of a Provox® prosthetic, a sufficient margin can be maintained during total pharyngolaryngectomy and irradiation can be performed, and satisfactory communication outcomes were observed. Provox® insertion after total pharyngolaryngectomy with free jejunal reconstruction should be considered the standard therapy for voice restoration.Level of Evidence4.

Candida biofilm formation on voice prostheses.

Laryngopharyngeal malignancy is treated with radiotherapy and/or surgery. When total laryngectomy is required, major laryngeal functions (phonation, airway control, swallowing and coughing) are affected. The insertion of a silicone rubber voice prosthesis in a surgically created tracheoesophageal puncture is the most effective method for voice rehabilitation. Silicone, as is the case with other synthetic materials such as polymethylmethacrylate, polyurethane, polyvinyl chloride, polypropylene and polystyrene, has the propensity to become rapidly colonized by micro-organisms (mainly Candida albicans) forming a biofilm, which leads to the failure of the devices. Silicone is used within voice prosthetic devices because of its flexible properties, which are essential for valve function. Valve failure, as well as compromising speech, may result in aspiration pneumonia, and repeated valve replacement may lead to either tract stenosis or insufficiency. Prevention and control of biofilm formation are therefore crucial for the lifespan of the prosthesis and promotion of tracheoesophageal tissue and lung health. To date, the mechanisms of biofilm formation on voice prostheses are not fully understood. Further studies are therefore required to identify factors influencing Candida biofilm formation. This review describes the factors known to influence biofilm formation on voice prostheses and current strategies employed to prolong their life by interfering with microbial colonization.

Safety and Efficacy of Primary vs. Secondary Tracheo-Esophageal Puncture (TEP) for the Insertion of Voice Prosthesis

Safety and Efficacy of Primary vs. Secondary Tracheo-Esophageal Puncture (TEP) for the Insertion of Voice Prosthesis

食道内腔からの穿刺による局所麻酔下での新しい二期的ボイスプロステーゼ挿入法

食道内腔からの穿刺による局所麻酔下での新しい二期的ボイスプロステーゼ挿入法

English

CASE REPORT: A 40 year male patient presented to us with the history of having coughed out moderate quantities of blood on two occasions during the preceding week. During one episode he had coughed out a piece of tissue as well. The hemoptysis subsided spontaneously. On further questioning he reported occasional breathing difficulty on exertion, mild intermittent change in voice and minimal discomfort in the throat during the previous one and a half month. He gave no history of evening rise of temperature, chest pain, and loss of weight or appetite. He was not habituated to smoking or alcohol consumption. General examination and systemic examination including chest and abdominal examination was unremarkable. There was no stridor. Indirect laryngoscopic examination revealed a congested and thickened right vocal cord. Both vocal cords were found to move normally. No ulcer or mass was visible in the larynx or pharynx. Neck nodes were not palpable. During one of the episodes of hemoptysis he had coughed out a piece of tissue. This had been sent for histological examination by the doctor he had consulted initially for hemoptysis and it was reported as adenoid cystic carcinoma. The chest Xray, urinalysis and routine blood tests were normal. Tomogram of the larynx showed a soft tissue shadow in the right subglottis, direct laryngoscopy and bronchoscopy revealed a pinkish, sessile mass in the right half of the subglottis with an irregular surface. There was no other lesion in the tracheobronchial tree. He underwent total laryngectomy with right hemithyroidectomy. The upper tracheal rings were resected with the larynx. No enlargement of neck nodes was noticed during surgery. The resected specimen showed a 1.5 x 1.5 cm sized pink, fleshy, sessile mass in the right subglottis extending from 1 cm below the free margin of the vocal cord to the second tracheal ring (Fig. 1). Histopathological examination of the excised specimen showed adenoid cystic carcinoma (Fig. 2). The patient had an uneventful postoperative recovery. Later on, he developed tracheostomal stenosis for which he underwent stomoplasty. Seven months after the initial surgery he underwent successful surgical voice restoration by secondary tracheo-oesophageal puncture and Blom-Singer’s voice prosthesis insertion. The patient was disease free 32 months after surgery, when last seen.

New device for single-stage in-office secondary tracheoesophageal puncture: Animal studies

A new device is described for secondary tracheoesophageal puncture (TEP). We hypothesize that the device can be used to create the puncture, size, and insert the voice prosthesis in antegrade fashion in a single procedure suitable for office-based use. A measurement and insertion device (MAID) was designed with the hypothesis in mind and tested on 3 pigs while they were under general anesthesia. The procedure was easy and successful in all 3 animals. The MAID allowed measurement of tracheoesophageal wall thickness and antegrade insertion of voice prosthesis with a single device. Transnasal esophagoscopy (TNE) allowed visualization of markings on the MAID within the esophagus to facilitate sizing. Intraesophageal visualization using TNE also enabled accurate positioning, reduced risk of posterior esophageal wall injury, and practically eliminated false passage formation. We believe the MAID can facilitate single-stage office-based secondary TEP in postlaryngectomy patients.