Current indications and complications of tracheoesophageal puncture for voice restoration after laryngectomy

Abstract

Surgical voice restoration by valved tracheoesophageal fistula is undoubtedly the most successful method of voice restoration for laryngectomy patients, is one of the most important developments in head and neck surgery, and has resulted in a greatly enhanced quality of life for most patients who have undergone this debilitating procedure. In developed countries, it is now unacceptable to perform laryngectomy without giving patients the opportunity to undergo surgical voice restoration. Successful voice acquisition should be achievable in approximately 80% of patients. Success rates will be highest and problems most effectively dealt with under the auspices of a properly organized surgical voice restoration program within a specialist head and neck cancer unit with a well structured specialist multidisciplinary team. This article reviews recent publications addressing indications for surgical voice restoration by tracheoesophageal puncture, expected success rates, and reasons for failure and complications and ways to manage them in the context of the author's own experience.

Voice Reconstruction with Free Ileocolon Flap Transfer: Implications for the Lower Respiratory Tract

“…However, the applicability of this procedure in hypopharyngolaryngectomy is narrowed to the cases where an adequate esophageal stump is present, although a limited experience has been reported in autologous esophageal reconstruction with free jejunum or fasciocutaneous flaps. Among the complications associated with the procedure, 14 leakage through or around the prosthesis represents the most common, affecting between 2 15 and 26 percent 16 of patients and represents the main cause for replacement of the implant. The average device life has been reported to be between 5 and 12 months, 17 with definitive closure being necessary in 5 percent of the patients.…”

Experimental results of the tracheoesophageal tissue connector for improved fixation of shunt valves in laryngectomized patients

“…Because large-diameter TEPs involve the risk of leakage, titanium rings in particular should be kept as small as possible. 10,44,45 Soft tissue anchored implants have been reported to be successful in animal experiments although most of them deal with percutaneous connections instead of permucosal. 13,22,37,46,47 Knowledge of soft tissue embedded permucosal connections and implants is scarce, 12 contrary to those in bone, such as dental implants.…”

Surgical complications of tracheo-oesophageal puncture and speech valves

“…Local flaps (sternomastoid) between the trachea and oesophagus, or myocutaneous flaps, have been performed. More recently, workers have injected collagen derivatives such as viscaugmentation [54]. Such material is quickly reabsorbed, however.…”

“…Candida resistant flouroplastic materials are under evaluation [61]. A biofilm may also lead to the accumulation of deposits of a glycocalyx-like substance in the oesophageal and hinge areas of the valve [62], resulting in its obstruction [54]. Most valves last 3-6 months (mean 148 days for Provox2) [63].…”