Nonsurgical management of the stoma to maximize tracheoesophageal speech

Lewin, Jan S.

doi:10.1016/j.otc.2004.01.004

Cited by 10 publications

(7 citation statements)

References 7 publications

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Section: Resultsmentioning

confidence: 99%

“…One hundred twenty patients (83%) had a postoperative complication (major or minor), including those that were directly related and those that were not related to the TEP (Table 2). 11,[23][24][25][26][27][28][29][30][31][32][33] Eighty-nine patients (61%) had 2 or more complications. A majority of complications were minor and were managed conservatively (89%), whereas 13 patients (11%) had direct TEP-related complications that required surgery (including 7 patients with spontaneous closure who subsequently underwent repuncture; Table 2).…”

Section: Complicationsmentioning

confidence: 99%

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Influence of timing, radiation, and reconstruction on complications and speech outcomes with tracheoesophageal puncture

et al. 2016

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Background We evaluated impact of radiation, reconstruction and timing of tracheoesophageal puncture (TEP) on complications and speech outcomes. Methods Retrospective review identified 145 TEP patients between 2003–2007. Results Ninety-nine patients (68%) had primary and 46 (32%) secondary TEP, with complications occurring in 65% and 61% respectively (p=0.96). Twenty-nine patients (20%) had major complications (18 primary; 11 secondary, p=0.42). Ninety-four patients (65%) had pre-TEP radiation, 39 (27%) post-TEP radiation, and 12 (8%) no radiation. With patients grouped by TEP timing and radiation history, there was no difference in complications, fluency, or TEP use. With mean 4.7-year follow up, 82% primary and 85% secondary used TEP for primary communication (p=0.66). Free-flap patients used TEP more commonly for primary communication after secondary versus primary TEP (90% v 50%, p=0.02). Conclusions Primary and secondary tracheoesophageal speakers experience similar high rates of complications. Extent of pharyngeal reconstruction, rather than radiation, may be more important in selection of TEP timing.

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Section: Resultsmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

Influence of timing, radiation, and reconstruction on complications and speech outcomes with tracheoesophageal puncture

et al. 2016

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“…One of the 3 patients who were unable to achieve good speech had problems with digital occlusion of the stoma because it was deep-seated and irregularly shaped; however, it was a postoperative anatomical finding that was unrelated to the TEP itself. The patient was offered prosthetic 14,15 or surgical 16 correction but refused.…”

Section: Commentmentioning

confidence: 99%

Secondary Tracheoesophageal Puncture With In-Office Transnasal Esophagoscopy

LeBert

McWhorter

Walvekar

et al. 2009

Arch Otolaryngol Head Neck Surg

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Objective To evaluate the outcomes of voice restoration using office-based transnasal esophagoscopy (TNE) to guide placement of the secondary tracheoesophageal puncture (TEP). Design Retrospective chart review. Setting Two tertiary care medical centers. Patients The study included 39 patients who underwent the TNE-TEP procedure from January 2004 to December 2008. Main Outcome Measures Clinical, demographic, and TE speech–related data were recorded to examine the ease, efficiency, complications, and speech-related outcomes. Results Among 39 patients identified, the average age was 65 years (age range, 47–83 years), with 32 male (82%) and 7 female (16%) patients. Twenty-five patients (64%) underwent total laryngectomy; 8 (21%) underwent total laryngectomy with partial pharyngectomy; and 14 (36%) underwent microvascular flap reconstruction. The overall success rate of secondary TNE-assisted TEP placement was 97% (n = 38), with 1 unsuccessful attempt. There was no statistically significant correlation found between patients having undergone radiation therapy (either before or after oncologic resection) or a cricopharyngeal myotomy and successful TEP placement, type of reconstruction used to close the pharyngeal defect when compared with the difficulty in the placement of the TEP, development of complications associated with TEP placement, use of the TEP prosthesis, or speech intelligibility at the last follow-up visit. Thirty-one patients (79%) were still using their TEP prosthesis for speech at the last follow-up visit. Of the patients reviewed, 28 (72%) had understandable TE speech. Conclusions In-office TNE-assisted TEP placement can safely be performed, with excellent speech outcomes. Reconstruction with musculocutaneous or microvascular free-tissue transfer did not limit our ability to place secondary TEPs with TNE.

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“…In view of these considerations, we should emphasize the importance of occlusion and of aerodynamic aspects for the quality of communicative proficiency by means of a tracheoesophageal prosthesis . Together with the Bernoulli effect, promoted by airflow, there is the need for hermetic occlusion of the stoma, equilibrated breathing, and preserved pulmonary function so that these factors may act together with the remnant mucosa of the PET for sound production.…”

Section: Discussionmentioning

confidence: 99%