The development and treatment of periprosthetic leakage after prosthetic voice restoration. A literature review and personal experience part I: the development of periprosthetic leakage

Abstract

In the past 30 years, the use of a voice prosthesis has become the treatment of choice for the restoration of speech following laryngectomy. Not only is the placement of a voice prosthesis a simple surgical procedure, but it is also associated with a low rate of complications and an excellent success rate. Approximately, 20-30 % of all patients with voice prostheses, however, develop periprosthetic leakage with aspiration over time. Periprosthetic leakage is usually caused by an enlargement of the tracheo-oesophageal fistula and substantially affects the quality of life of the patients concerned. In a retrospective analysis of our patients, the incidence of periprosthetic leakage was 35.7 % in a total of 232 patients who underwent laryngectomy during a period of 20 years. Substantial enlargement of the tracheo-oesophageal fistula which required multiple treatments occurred in 12.5 % of the patients. In this review, the various causes of fistula enlargement are discussed on the basis of the literature and the experience that we have accumulated during the past 20 years in the management of patients with voice prostheses.

Repair of pharyngoesophageal stenosis and a tracheoesophageal fistula using a dual‐paddled radial forearm free flap: Flap design and surgical technique

“…Following total laryngectomy for laryngeal cancer, vocal rehabilitation often involves the creation of a tracheoesophageal fistula (TEF) and insertion of a voice prosthesis . The placement of a voice prosthesis immediately postlaryngectomy is advantageous because it provides both primary voice restoration and allows for immediate voice rehabilitation . A literature review by Lorenz revealed success rates of 85% to 95% for voice restoration with modern prostheses following laryngectomy .…”

“…Further, these patients often require radiation therapy, which can lead to pharyngoesophageal stenosis (PES) . Krause et al and Pattani et al postulated that the development of strictures in the pharyngoesophageal region may predispose to periprosthetic leakage . Narrowing of this region increases flow rate and pressure during bolus transport through this segment of the upper aerodigestive tract, resulting in leakage and a widening of the fistula tract surrounding the voice prosthesis .…”

“…1 A literature review by Lorenz revealed success rates of 85% to 95% for voice restoration with modern prostheses following laryngectomy. 1 However, one known complication of this form of alaryngeal speech is the failure of the TEF site to heal, leading to persistent leakage.…”

“…The placement of a voice prosthesis can be performed in the primary or secondary settings. 1 Hutcheson et al analyzed 23 studies and reported no significant difference in the incidence of periprosthetic leakage between patients who underwent primary (4%, range 2%-13%) or secondary (11%, range 5%-13%) tracheooesophageal puncture prior to voice prosthesis insertion (P 5 0.297). 2 Further, these patients often require radiation therapy, which can lead to pharyngoesophageal stenosis (PES).…”

“…2 Krause et al and Pattani et al postulated that the development of strictures in the pharyngoesophageal region may predispose to periprosthetic leakage. 1 Narrowing of this region increases flow rate and pressure during bolus transport through this segment of the upper aerodigestive tract, resulting in leakage and a widening of the fistula tract surrounding the voice prosthesis. 1 Following a retrospective review of 194 patients, Hutcheson et al concurred with these findings and reported a threefold increased risk of periprosthetic leakage in the presence of a stricture.…”