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Tracheoesophageal puncture with immediate prosthesis placement
Author(s) -
Pagedar Nitin A.,
Bayon Rodrigo,
Gudgeon Jocelen,
Nelson Rick F.,
Daele Douglas J.,
Hoffman Henry T.
Publication year - 2014
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.23756
Subject(s) - medicine , otorhinolaryngology , head and neck surgery , head and neck , family medicine , general surgery , surgery
Tracheoesophageal puncture (TEP), with use of a TEP prosthesis, as described by Singer and Blom, is an outstanding option for voice restoration after total laryngectomy. TEP can be performed at the time of laryngectomy (primary TEP) or after an interval of time (secondary TEP). Multiple modifications of the classic technique have been developed for secondary TEP including use of potassium titanyl phosphate lasers, percutaneous gastrostomy sets, and flexible endoscopes. Most commonly, the puncture is created, and a temporary catheter is placed, which is replaced with a speech prosthesis after edema resolves. This two-step process creates a delay, during which patients cannot begin voice rehabilitation and must tolerate the inconvenience of an indwelling catheter. Patients may experience leakage at the puncture site around the catheter, which does not have flanges to create a seal, and may have troublesome obstruction and crusting at the tracheostomy. For these reasons, there has been increasing interest in techniques in which the prosthesis is immediately placed in a single-stage procedure. We describe a technique by which the prosthesis is placed immediately using instruments from a percutaneous tracheotomy kit to avoid these problems.