Primary versus Secondary Tracheoesophageal Puncture for Speech Rehabilitation in Total Laryngectomy: Long‐Term Results with Indwelling Voice Prosthesis

Abstract

The success rate of voice rehabilitation with VP was 94%. In primary TEP, the success rate was 97%, whereas in secondary TEP it was 78%; 2 years later, it was 96% and 75%, respectively. A tendency for a higher success rate in voice rehabilitation after TL was observed in primary TEP. The use of xRT and age of patient had no influence on the success rate.

Post laryngectomy speech rehabilitation outcome in elderly patients

“…These are particularly notable in patients who have undergone radiotherapy, that should be treated first with appropriate logopedic training, before using more complex options such as chemical denervation, botulinum toxin injection, secondary myotomy of pharyngeal constrictor with, if necessary, unilateral neurectomy of pharyngeal plexus. The choice, in such group of patients, of primary implant should be considered according to the aforementioned problems, and the need for a primary myotomy of the cricopharyngeal muscle during laryngectomy, reducing the chances of hypertonicity and/or spasm, which could lead to treatment failure and to further procedures, interfering with the motivation of an older patient [3].…”

“…Data addressing the tracheoesophageal vocal recovery in older patients are given by Chone et al [3] in a study enlisting 71 patients with a success rate of 96 % for primary TEP and 75 % in secondary TEP, concluding that age does not hinder rehabilitation success.…”

“…Therefore, it is clear that, today, laryngectomees or patients who are going to undergo laryngectomy must be properly informed, during presurgical counseling, about the various chances of voice rehabilitation, underling both advantages and limits related to the aforementioned methods of voice recovery. This is particularly important especially if it is considered that recent data suggest an age range for patients being referred to total laryngectomy (TL) between the 6th and the 7th decades of life [2][3][4][5][6][7]. According to this point of view, patients over 70 years of age deserve particular care because they are not only mutilated in their vocal function, but even lack, for age reasons, appropriate motivations to any voice recovery.…”

Uso de manometria computadorizada para estudo do espasmo do segmento faringoesofágico em pacientes com voz traqueoesofágica inadequada antes e após aplicação de toxina botulínica

“…This PES alteration can be treated in three different ways: myotomy of middle and lower pharynx constrictors, neurectomy of the pharyngeal plexus, and the recently published technique of chemically denervating the PES with botulinum toxin (BT) [6][7][8]10,11,[14][15][16][17][18][19][20][21][22][23][24] . Botulinum toxin is a pre-synaptic blocker that prevents the release of acetylcholine in the neuromuscular junction.…”

Reabilitação fonatória do laringectomizado total: utilização de toxina botulínica na voz tráqueo-esofágica com prótese fonatória

“…[1][2][3][4][5][6][7][8][9][10][11][12][13] There are three approaches for the treatment of PES alterations: myotomy of the middle and lower constrictors of the pharynx, neurectomy of the pharyngeal plexus, and the recently described chemical denervation of the PES with the botulinum toxin (BT). 6,7,8,10,11,[14][15][16][17][18][19][20][21][22][23] The BT is a presynaptic blocker of acetylcholine release at the neuromuscular junction. Videofluoroscopy 3,4,7,15,24 and computed manometry (CM) demonstrate relaxation of the PES following the use of BT in this region.…”