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Treatment of tracheoesophageal fistula after laryngectomy by a customized tracheal prosthesis
Author(s) -
Mueller Simon Andreas,
Dehnbostel Sylvia,
Dehnbostel Falk,
Giger Roland
Publication year - 2018
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.27027
Subject(s) - medicine , laryngectomy , laryngology , general surgery , prosthesis , university hospital , otorhinolaryngology , head and neck surgery , surgery , larynx
The management of persistent tracheoesophageal fistulas (TEF) after laryngectomy in previously irradiated patients is challenging. A persistent TEF can develop spontaneously or result from the enlargement of a tracheoesophageal puncture (TEP) harboring the voice prosthesis (VP). Patients treated with radiotherapy are especially at risk of TEP enlargement, with an incidence as high as 17% after prelaryngectomy and 27% after postlaryngectomy radiotherapy. A TEF or enlarged TEP leads to the leakage of fluids and food into the trachea. In case of an enlarged TEP, spontaneous shrinking or closing may be achieved by removing the VP. This requires the insertion of a tracheal cannula with an inflated cuff and feeding via nasogastric or percutaneous gastric tube to avoid aspiration. Other conservative measures include the placement of an anterior collar around the VP, and the injection of fat or collagen to corset the TEP. When conservative treatments fail, closure of an enlarged TEP can be achieved by purse string suture or by more complex closing techniques using pedicled or free flap reconstructions. When surgery is not successful or is impossible due to comorbidities, options are limited. Herzog et al. have described TEF closure by means of customized pharyngoesophageal stents. These stents are usually inserted in general anesthesia and cannot be removed and cleaned by the patient. They may also hinder physiological peristalsis and carry the risk of food impaction. We describe the development of a customized removable tracheal prosthesis intended to close the TEF, allowing oral nutrition without aspiration and phonation with an incorporated VP.