Management of leaking tracheoesophageal puncture with hyaluronic acid injection

Twomey, Kevin; Lehn, Belinda; Vasani, Sarju

doi:10.1002/hed.25162

Cited by 6 publications

(17 citation statements)

References 11 publications

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“…Temporary removal of the prosthesis and feeding with a nasogastric tube is usually the first‐choice conservative treatment for the spontaneous narrowing of the fistula diameter 8 . Increasing the tracheoesophageal wall thickness and reducing the fistula diameter with filler materials such as hyaluronic acid, autologous fat, or calcium hydroxyapatite is another conservative method 9,10 …”

Section: Discussionmentioning

confidence: 99%

Tracheoesophageal puncture closure with annular mucosal flap

Yavûz

Vural

2021

Head & Neck

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Background To present an effective and easily applicable method for tracheoesophageal puncture (TEP) closure by using a localized annular flap instead of bulky and distant flaps. Methods The medical records of patients who underwent TEP closure surgery with the annular mucosal flap technique between July 2012 and August 2018 were retrospectively reviewed. Fistula size, indication for closure, duration of surgery, radiotherapy status, and surgery results were analyzed. Results We have used our technique in nine patients. No postoperative bleeding, wound infection, esophageal stenosis, and tracheostoma stenosis occurred. In all these patients except one, successful closure was achieved. None of the patients had a recurrence of the TEP. Conclusion The annular mucosal flap technique for TEP closure is easy and quick to apply. The patient's oral feeding at the sixth hour after procedure without using a nasogastric tube makes the technique preferable as a priority.

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Section: Discussionmentioning

confidence: 99%

Tracheoesophageal puncture closure with annular mucosal flap

Yavûz

Vural

2021

Head & Neck

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“…Advantages of using synthetic products (i.e., polydimethylsiloxane elastomer implant VoxImplant ® , Bioplasty BV, Geleen, The Netherlands, calcium hydroxylapatite Radiesse ® , Bioform Medical, San Mateo, CA, USA, hyaluronic acid) include immediate availability and an outpatient clinic setting [ 20 , 28 , 29 , 30 ], but certain disadvantages limit their use. Among these, chronic inflammation and granuloma formation is associated with the use of non-resorbable biomaterials, particularly polydimethylsiloxane, and the rapid resorption rate of hyaluronic acid, broken down by hyaluronidase enzyme, requires that the procedure be repeated multiple times, with up to six injections over 18 months [ 20 ]. The advantages of using adipose tissue over other options include greater biocompatibility, no immune response, long-lasting results, and regenerative properties.…”

Section: Discussionmentioning

confidence: 99%

“…Often these procedures have to be performed one after the other on the same patient. Although the purpose of the mentioned procedures is to narrow the fistula or to increase the tracheal and/or esophageal flanges of the prosthesis, another approach consists of augmenting the tracheoesophageal wall to increase its bulk and prevent further leakages [ 20 ]. Among various substances that can be injected to obtain a volumetric augmentation, good results can be achieved with a medical silicone elastomer implant (Vox Implant ® , Bioplasty BV, Geleen, The Netherlands), hyaluronic acid, and autologous fat.…”

Section: Introductionmentioning

confidence: 99%

Regenerative Strategy for Persistent Periprosthetic Leakage around Tracheoesophageal Puncture: Is It an Effective Long-Term Solution?

Parrilla

Almadori

Longobardi

et al. 2021

Cells

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Autologous tissue-assisted regenerative procedures have been considered effective to close different types of fistula, including the leakage around tracheoesophageal puncture. The aim of this study was to retrospectively review 10 years of lipotransfer for persistent periprosthetic leakage in laryngectomized patients with voice prosthesis. Clinical records of patients who experienced periprosthetic leakage from December 2009 to December 2019 were reviewed. Patients receiving fat grafting were included. The leakage around the prosthesis was assessed with a methylene blue test. Twenty patients experiencing tracheoesophageal fistula enlargement were treated with fat grafting. At the one-month follow-up, all patients were considered improved with no leakage observed. At six months, a single injection was sufficient to solve 75% of cases (n 15), whereas 25% (n 5) required a second procedure. The overall success rate was 80% (n 16). Results remained stable for a follow-up of 5.54 ± 3.97 years. Fat grafting performed around the voice prosthesis, thanks to its volumetric and regenerative properties, is a valid and lasting option to solve persistent periprosthetic leakage.

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“…other conservative approaches such as replacement with silicone ring expanded prosthesis, 4 purse-string sutures, 5 hyperbaric oxygen therapy, 6 or injections of different substances such as autologous fat, 6 hyaluronic acid, 7 and granulocyte-macrophage colony-stimulating factor to reduce the diameter of the tracheoesophageal fistula (TEF) have been reported. 4,5,[8][9][10][11] Unfortunately, TEPs may persist despite conservative management and formal surgical closure may be indicated to avoid morbid consequences. 12 The purpose of this study was to systematically review the available evidence on the surgical methods employed for TEP closure focusing on outcomes and reported complications.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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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.

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Management of leaking tracheoesophageal puncture with hyaluronic acid injection

Abstract: Hyaluronic acid injection in the treatment of persistent TEP or peripheral leak around a voice prosthesis is a useful treatment option to provide immediate and occasionally long-lasting relief from symptoms.

Cited by 6 publications

References 11 publications

Tracheoesophageal puncture closure with annular mucosal flap

Tracheoesophageal puncture closure with annular mucosal flap

Regenerative Strategy for Persistent Periprosthetic Leakage around Tracheoesophageal Puncture: Is It an Effective Long-Term Solution?

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

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