Aspiration of tracheoesophageal prosthesis in a laryngectomized patient

Abstract

BackgroundThe voice prosthesis inserted into a tracheoesophageal fistula has become the most widely used device for voice rehabilitation in patients with total laryngectomy.Case presentationWe describe a case of tracheoesophageal prosthesis’ (TEP) aspiration in a laryngectomized patient, with permanent tracheal stoma, that appeared during standard cleaning procedure, despite a programme of training for the safe management of patients with voice prosthesis.ConclusionsThe definitive diagnosis and treatment were performed by flexible bronchoscopy, that may be considered the procedure of choice in these cases, also on the basis of the literature.

A Novel Approach in the Management of an Aspirated Voice Prosthesis in a Laryngectomized Patient

“…A flexible bronchoscopy plays an important role in the definitive diagnosis and this can be therapeutic, [2] while in some cases the rigid bronchoscopy or its modification, as was done in our patient is necessary. A periodic review of the maintenance techniques of voice prosthesis and tracheostomal care can possibly eliminate such unusual complications.…”

“…[1,2] This procedure involves the creation of a fistula between the trachea and esophagus, wherein a one way speaking valve containing silicon voice prosthesis is positioned. The patient is then trained to use and maintain the voice prosthesis by following a protocol for speech rehabilitation under the supervision of a speech therapist.…”

“…[1][2][3][4][5] This is usually believed to happen when patients self attempt to replace the prosthesis or following violent bouts of cough. The clinical presentation of prosthesis aspiration can be varied: some patient's present with life threatening chocking while others have minimal symptoms or at times asymptomatic [3,4].…”

“…A computed tomography of the chest with virtual bronchoscopy may be helpful in ascertaining the exact position of the aspirated prosthesis. [4] The common site of lodgment of the aspirated prosthesis is the right main bronchus, [2] although cases of impaction in the left main bronchus have been reported.…”

The Story of an Uncommon Aspiration, ''Where is the Voice Prosthesis?''

“…7 In the literature, aspiration cases were reported to be located in the right main bronchus, but in our case, two leaf of the voice prosthesis was sitting on the main carina. 8 In patients with voice prosthetic aspiration, patients may present with shortness of breath and cough symptoms. Some cases have been reported to be clinically asymptomatic, especially in the early period, as in our case.…”