The Difficult Secondary Tracheoesophageal Puncture: A Technique for Safe Insertion

ORL ◽  
2018 ◽  
Vol 81 (1) ◽  
pp. 10-15
Author(s):  
Dunia Abdul-Aziz ◽  
Joseph Zenga ◽  
Daniel G. Deschler
Keyword(s):  
Tracheoesophageal Puncture

Secondary tracheoesophageal puncture with the blind technique: 10 years’ experience

2021 ◽  
Author(s):  
Luca Gazzini ◽  
Elisa Laura ◽  
Gabriele Molteni ◽  
Daniele Marchioni ◽  
Gian Paolo Pighi
Keyword(s):  
Tracheoesophageal Puncture

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.

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.

scholarly journals MAJOR COMPLICATIONS FOLLOWING TRACHEOESOPHAGEAL PUNCTURE FOR VOICE REHABILITATION

1987 ◽  
Vol 97 (5) ◽  
pp. 562???567 ◽  
Author(s):  
JAMES C. ANDREWS ◽  
ROBERT A. MICKEL ◽  
DAVID G. HANSON ◽  
GAIL P. MONAHAN ◽  
PAUL H. WARD
Keyword(s):  
Voice Rehabilitation ◽  
Major Complications ◽  
Tracheoesophageal Puncture

S154 – Primary TEP and Patch Free-Flap Laryngectomy Reconstruction

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P128-P128 ◽  
Author(s):  
Tamer Abdel-Halim Ghanem ◽  
Justin McLarty ◽  
Farhad Ardeshirpour ◽  
Christopher F Baranano ◽  
Eben L Rosenthal ◽  
...  
Keyword(s):  
Free Flap ◽  
Total Laryngectomy ◽  
Demographic Data ◽  
Free Flaps ◽  
Fistula Formation ◽  
Increased Risk ◽  
Radial Forearm ◽  
Speech Therapist ◽  
Fistula Rate ◽  
Tracheoesophageal Puncture

Objectives 1. Assess speech outcomes for patients undergoing primary tracheoesophageal puncture (TEP) following total laryngectomy (TL) with patch free flap reconstruction. 2. Evaluate risk of fistulization following primary TEP vs. no TEP in patch free flap TL reconstruction. Methods Patients undergoing reconstruction with patch free-flaps following TL were studied retrospectively. Demographic data, surgical procedures, speech outcomes, and postoperative complications were collected. Patients were divided in 2 groups depending on whether TEP was performed at the time of ablation (primary TEP). Voice outcomes were assessed by a speech therapist. Results 77 patients underwent TL, mean age of 63 years. Glottis (60%), followed by hypopharynx (18%), and supraglottis (17%) were the most common tumor sites. Most patients had T3 and T4 disease (71%) on initial presentation, and there were 57% undergoing salvage total laryngectomy. The radial forearm fascioucutaneous free flap was used in 90% of the cases. Primary TEP was performed in 44 patients (57%), and only 1 of 33 patients underwent a TEP procedure secondarily. Voice outcomes for the TEP group were good. The overall fistula rate was 39%, half of which healed spontaneously. The fistula rate in the primary TEP group was 41%, and in the group not receiving primary TEP it was 36.7% (p=0.87). Conclusions Primary TEP performed at the time of free-flap patch reconstruction after TL enhances speech outcomes for patients, and does not lead to an increased risk in fistula formation.

INDICATIONS FOR TRACHEOESOPHAGEAL PUNCTURE SPEECH REHABILITATION

1986 ◽  
Vol 96 (10) ◽  
pp. 1065???1068 ◽  
Author(s):  
FRED M. S. MCCONNEL ◽  
SIGSBEE W. DUCK
Keyword(s):  
Speech Rehabilitation ◽  
Tracheoesophageal Puncture

Impact of Primary Tracheoesophageal Puncture on Outcomes after Total Laryngectomy

2017 ◽  
Vol 158 (1) ◽  
pp. 103-109 ◽  
Author(s):  
Aru Panwar ◽  
Oleg Militsakh ◽  
Robert Lindau ◽  
Andrew Coughlin ◽  
Harlan Sayles ◽  
...  
Keyword(s):  
Total Laryngectomy ◽  
Attributable Risk ◽  
Wound Complications ◽  
Medical Complications ◽  
Improvement Program ◽  
Data Set ◽  
Surgical Quality ◽  
Postoperative Wound ◽  
Tracheoesophageal Puncture ◽  
Length Of Hospitalization

Objectives To identify differences in postoperative wound complications associated with a primary tracheoesophageal puncture (TEP) at the time of laryngectomy versus no TEP. Study Design Retrospective review of large national data set. Setting Academic and nonacademic health care facilities in United States, contributing de-identified, risk-adjusted clinical data to the American College of Surgeons National Surgical Quality Improvement Program. Subjects and Methods The National Surgical Quality Improvement Program data set for years 2006 to 2012 identified 430 patients who underwent total laryngectomy with or without a primary TEP. Patients who underwent a TEP at the time of laryngectomy (n = 68) were compared with patients who underwent laryngectomy without a TEP (n = 362). Postoperative wound complications and secondary outcomes, including medical complications and length of hospitalization, were compared between the groups. Results The incidence of “superficial” and “deep or organ space” surgical site infection, medical complications, return to the operating room, and length of hospitalization were similar between the groups. Patients in the TEP group had a higher overall wound complication rate (relative risk, 2.02; 95% CI = 1.06-3.84; attributable risk, 8.17%; number needed to harm, 12). Conclusions Performance of a primary TEP concurrent to total laryngectomy contributed to a small increase in attributable risk for overall wound complications but did not add substantial risk for “superficial” or “deep or organ space” surgical site infection, medical complications, or increased burden for resource utilization. These data may help inform patient choice and physician recommendations for primary alaryngeal speech rehabilitation.

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

2011 ◽  
Vol 122 (1) ◽  
pp. 134-136 ◽  
Author(s):  
Emily E. Crozier ◽  
Kevin Klein ◽  
Janis Deane ◽  
Laura E. Toles ◽  
Larry L. Myers
Keyword(s):  
Video Laryngoscopy ◽  
Neck Extension ◽  
Tracheoesophageal Puncture
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