Major complications following tracheoesophageal puncture for voice rehabilitation

Abstract

The successful use of the tracheoesophageal voice prosthesis for speech rehabilitation of the total laryngectomy patient has lead to common application of this device. Although the creation of a tracheoesophageal fistula is a simple procedure, it is not without complications. A review of 104 patients who underwent this procedure indicated a complication rate of 25%. Complications were related primarily to the fistula and included migration and progressive enlargement of the puncture, persistent or recurring infection of the fistula site, aspiration pneumonia, and death. Other problems included aspiration of the prosthesis, vertebral osteomyelitis, and tracheal stomal and esophageal stenosis. Many of these patients required hospitalization, intravenous antibiotics, and major surgical procedures to treat these complications. Guidelines for early identification and management of these problems as well as methods to prevent complications are discussed.

Factors influencing the longevity and replacement frequency of Provox voice prostheses

“…(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) Since the average success rate of oesophageal speech is only 33%, the use of voice prostheses is often the preferred method for speech rehabilitation. (19)(20)(21) The success rate of the Provox prosthesis in achieving speech in the present study (i.e. 85.0%) is consistent with the rates reported in the literature.…”

“…The main complications include mediastinitis, cervical cellulitis, deep neck abscess, oesophageal perforation, aspiration pneumonia and prosthesis aspiration. (20,21) Complications such as fluid leakage around or through the prosthesis, development of granulation tissue, accidental swallowing of the prosthesis and tracheostomal stenosis are more frequently encountered. None of the aforementioned main complications were encountered in the present study.…”

Candida biofilm formation on voice prostheses

“…As a result, VPs need to be replaced regularly and lifespan varies from several days to months or years (Ackerstaff et al, 1999). Non-indwelling devices can be removed and replaced by the patient for cleansing, but numerous displacements and fistula formation have been reported (Andrews et al, 1987;Blom et al, 1986;Manni & Van Den Broek, 1990;Van Weissenbruch et al, 1997a, b). The indwelling devices require less maintenance, but daily cleansing with brushes or cotton is recommended.…”

Laringectomia supracricóide (chep) para câncer glótico

“…Muito destes pacientes moram distante do hospital e apresentam baixas condições socioeconômicas o que dificulta a reabilitação com próte-ses vocais que necessitam de freqüentes trocas 8 e visitas ao hospital, além disso, os bons candidatos para o uso de tais próteses necessitam de boa habilidade manual e razoável compreensão da anatomia 9 . Da mesma maneira o sucesso do treinamento com a voz esofagiana está diretamente relacionado a uma capacitação difícil para o paciente e a algumas características próprias como a capacidade de retenção de ar no estômago.…”