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Objectives: Tracheoesophageal prosthesis (TEP) is a common method for post‐laryngectomy speech rehabilitation. Despite its common use, some patients ultimately fail TEP rehabilitation. TEP dysfunction negatively affects quality of life due to poor voice quality and need for repeated interventions to restore TEP function. Occasionally, voice rehabilitation with TEP is completely unsuccessful. We performed a scoping review to characterize the main reasons for total TEP failure, in hopes of guiding selection of optimal TEP candidates. Study design: Scoping review using PubMed of all English language articles from 1990 to 2020 addressing causes of TEP failure. Methods: This scoping review followed the population, intervention, comparison, outcome and study (PICOS) guidelines. Total TEP failure was defined as complete loss or abandonment of TEP voice or tract. A comprehensive search strategy using PubMed's MeSH subject headings and keywords was created. Causes and rates of failure were reviewed. Results: Among 544 peer‐reviewed journal articles reviewed for inclusion. Seventy articles met inclusion criteria, resulting in a total of 4928 TEP voice restoration patients for analysis. 15.2% of these patients had total TEP failure. The most common reasons for failure were dissatisfaction with voice (26.3%), leakage (17.9%), inadequate patient motivation (14.7%), comorbidities (14.2%), stoma problems (11.6%), and abandonment of TEP after dislodgement (10.6%). Conclusion: Common reasons for TEP failure included voice dissatisfaction, leakage, lack of patient motivation, patient comorbidities, and stoma problems. These factors should be considered when selecting candidates for TEP voice restoration. [ABSTRACT FROM AUTHOR]

Objective: Total laryngectomy (TL) is a standard induction treatment for laryngeal cancer. Patients have shown decreased quality of life (QOL) following laryngectomy potentially due to its impact on communication. This study is a systematic review of the effects of TEP on QOL in TL patients. Methods: Data was extracted from PubMed, Ovid Medline, and Web of Science. A systematic review of literature assessing QOL after TEP within the last decade was conducted using PRISMA methodology. The initial search yielded 71 publications filtered to 15 after removing duplicates, non‐English publications, and title screening. Two researchers independently reviewed abstracts, and 11 articles were retained. After a full article review, 6 examined QOL in TEP patients. Results: The studies concluded that post‐TL, patients with TEP experienced improved QOL than before the procedure or non‐TEP alternatives for speech. The collective sample size yielded 253 patients. Meta‐analysis demonstrated significant improvement in QOL described by the University of Washington—Quality of Life Index (p <.0001) and insignificant improvement defined by the Voice Handicap Index (p =.07). Several additional indices were included in the articles, all of which indicated improved QOL in TL patients post‐TEP. These scales could not undergo meta‐analysis due to their presence in only 1 study each. Conclusion: TEP is a valuable intervention in improving patient QOL and satisfaction following TL. There is no standardized tool for describing QOL in TL patients, so the authors recommend tools be chosen based on the specific aspects of QOL they represent. Level of evidence: 2a. [ABSTRACT FROM AUTHOR]

Background: Primary fit tracheoesophageal puncture (TEP) is widely preferred for individuals who have not undergone prior radiation. However, there is no consensus on the relative utility of primary‐fit TEP in the setting of salvage laryngectomy. Methods: A retrospective, single‐center review was conducted of individuals undergoing laryngectomy with primary fit TEP between 2012 and 2018. Multivariable analysis was conducted to compare short‐term and long‐term complications, as well as speech and swallowing outcomes, of those who underwent primary versus salvage laryngectomy. Results: In this study, 134 patients underwent total laryngectomy with primary fit TEP. Aside from a higher rate of peristomal dehiscence (13.1% vs. 1.4%) found in the salvage group, there was no difference in incidence of all other complications, including pharyngocutaneous fistula formation. The groups had comparable speech and swallow outcomes. Conclusion: Primary fit TEP is a safe and effective surgical choice for individuals undergoing salvage laryngectomy who desire a voice prosthesis. [ABSTRACT FROM AUTHOR]

Introduction: Total laryngectomy is used to cure advanced larynx cancer in many patients. The removal of the larynx requires the rehabilitation of the patient's ability to communicate, and one common method is to place a tracheoesophageal voice prosthesis (TEP) as a secondary procedure after the patient has completed cancer treatment. The traditional technique utilizes a rigid esophagoscope for access, but this can prove difficult in many patients who have kyphosis, scarring of the neck, or trismus. We describe a technique to allow TEP placement in these challenging patients that does not utilize rigid esophagoscopy to access the tracheoesophageal puncture site. Methods: For more than 15 years, the senior authors of this study have used this technique in patients in whom traditional methods of TEP with rigid esophagoscope were unsuccessful or not attempted due to the anticipated high probability of failure. The ease of this technique has prompted its use for all patients undergoing secondary TEP placement in their practice. The technique is described in detail in the Methods section below. Results: The described method has been successfully utilized to place TEPs in many patients with challenging anatomy. There have been no failed placements, including a patient with severe trismus who was able to have a TEP placed by placing the chest tube and flexible endoscope transnasally. Further, because of precise visualization and ease of the technique, there have been no observed complications of injury to the pharyngoesophageal lumen or creation of a false passage. Conclusion: The use of a chest tube and flexible scope allows for the protection of the pharyngoesophageal lumen, precise visualization and placement of the puncture, and avoidance of a false tracheoesophageal passage, all while minimizing the need for extension of the patient's neck. This has proven ideal for patients suffering the consequences of cancer treatment such as cervical scarring, fibrosis, kyphosis, and trismus. [ABSTRACT FROM AUTHOR]

Tracheoesophageal puncture (TEP) is one of the most established methods for voice reacquisition following total laryngectomy. The most difficult complication following TEP is the management of saliva leakage or secretion into the trachea due to TE fistula enlargement. In this study, we devised a new strategy to close TE fistulas and confirmed its safety and effectiveness. Skin incision: If the tracheal mucosa around the voice prosthesis appears intact and normal, an arcuate incision, from 10 to 2 o'clock, is made on the skin 5 mm superior to the edge of the stoma. However, if the surrounding tracheal mucosa is fragile because of leaking, the incision is made on the superior edge of the stoma, with later reconstruction of the posterior tracheal wall. Separation of the trachea and esophagus: If the esophagotracheal spatium appears normal and is easy to dissect, the connective pipes can be found easily. After cutting the pipe, a ligature alone is sufficient for the tracheal side; however, the esophageal wall is closed with Gambee sutures. If the esophagotracheal spatium is compromised and the posterior tracheal wall is fragile (due to saliva leakage), we remove the posterior wall and reconstruct the area using the superior skin flap. We performed our novel method on four patients with intractable conditions; postradiotherapy for laryngeal cancer, total pharyngo-laryngo-esophagectomy (TPLE) with jejunum reconstruction, TPLE with gastric lifting reconstruction, and in a patient who underwent cervicothoracic incisional drainage for descending necrotizing mediastinitis. None of the cases showed postoperative leakage from the fistula, and oral intake was resumed without difficulty. This study showed that this strategy based on TE fistula conditions is effective even in difficult-to-treat cases. [ABSTRACT FROM AUTHOR]

Acquired tracheobronchomalacia (ATBM) is a condition in which the tracheobronchial wall and cartilage progressively lose their rigidity, resulting in dynamic collapse during exhalation. In this report, we present a case of ATBM that developed following voice prosthesis implantation. To the best of our knowledge, this is the first documented case of such a condition in the medical English literature based on a PubMed search. A 63-year-old man was referred to National Kyushu Cancer Center in Japan with complaints of pharyngeal pain and a laryngeal tumor. The tumor was diagnosed as laryngeal cancer, and the patient underwent laryngectomy. Three months after the surgery, we implanted a voice prosthesis through a tracheoesophageal puncture. Two months after implantation, the patient experienced dyspnea. This condition was subsequently diagnosed as ATBM through computed tomography and bronchofiberscope examinations. After the removal of the voice prosthesis, there has been no progression of ATBM for over five years. While ATBM may not be a common occurrence in the practice of head and neck surgeons, it should be considered as a potential complication when patients report dyspnea following voice prosthesis implantation. [ABSTRACT FROM AUTHOR]

We report the case of a laryngectomized patient with an enlarged tracheoesophageal puncture (TEP) that is refractory to standard treatments and culminating in life‐threatening recurrent dislodgement and aspiration of custom fabricated dual extra‐large flange voice prostheses (VP). The fabrication and use of a novel intraluminal prosthetic device to prevent dislodgement, lessen aspiration, and preserve TE voice is described. A custom device insetting a commercial VP into the posterior wall of a LaryTube (coined "inset‐VP") was devised with the primary goal of eliminating chronic VP dislodgement and lessening aspiration while maintaining TE voice. Tools required to fabricate the device included a commercial laryngectomy tube, standard‐flanged commercial indwelling voice prosthesis, felt‐tip marker, 6 mm biopsy punch, and silk suture. After 7 months of using an inset‐VP LaryTube device, the patient has experienced zero episodes of VP aspiration. Thin liquid aspiration control is equivalent or better than prior management with custom 24–30 mm dual collar prostheses. TEP voice is fluent and functional with device in place. Novel strategies are needed to manage the rare but devastating effects of a severely enlarged TEP. Solutions to manage symptoms need to be patient‐specific, aligning with their anatomy, physiology, psychosocial needs, and goals. The inset‐VP device described in this report may offer improved prosthetic retention in select patients with enlarged TE puncture and frequent VP dislodgements. [ABSTRACT FROM AUTHOR]

A novel technique for tracheoesophageal puncture (TEP) closure is described in which the sternohyoid muscles are rotated and interposed between the tracheal and esophageal walls. The results of this technique are reported, following CARE guidelines, and compared with those obtained using the sternocleidomastoid flap. A literature review on the techniques previously described for TEP closure in irradiated patients is presented. The novel technique was performed in six patients in whom the infrahyoid muscles were preserved during total laryngectomy. All received adjuvant radiotherapy. Successful closure was achieved in three cases; in one case a small leak was noted after initial closure and was successfully managed with simple sutures; and the other two failures occurred in patients with diabetes. The sternocleidomastoid flap was performed in five patients (only one with previous radiation) and success was achieved in two patients. In another patient a micro-fistular orifice appeared six months after the operation. The sternohyoid muscles pose a low morbidity alternative to be considered in surgical TEP closure. Patient selection is a key factor to surgical success, and this technique should be reserved for small to moderate size fistulas and in the absence of multiple impaired wound healing conditions. [ABSTRACT FROM AUTHOR]

Tracheoesophageal puncture (TEP) performed during total laryngectomy in the primary treatment of laryngeal cancer is the standard method for voice restoration. Following adjuvant radiotherapy, the TEP site can experience complications resulting in a tracheoesophageal fistula (TEF) with chronic leakage making oral alimentation unsafe due to aspiration. Here, we describe a technique using chimeric ulnar artery perforator forearm free flaps (UAPFF) in the reconstruction of these complex deformities. Four patients underwent chimeric UAPFF reconstruction of TEP site TEFs following primary TL with TEP and adjuvant radiotherapy. No flap failures or surgical complications occurred. Average time from end of radiotherapy to persistent TEF was 66 months (range 4–190 months). All patients had resolution in their TEF with average time to total oral diet achievement of 22 days (14–42 days). Chimeric UAPFF reconstruction is a safe and effective method to reconstruct recalcitrant TEP site TEFs. [ABSTRACT FROM AUTHOR]

Head and neck cancer, the seventh most common cancer worldwide, often affects the larynx, with a higher incidence in men. Total laryngectomy, a common treatment, results in the loss of phonation, and tracheoesophageal voice rehabilitation is the current rehabilitation method of choice. Despite ongoing debates regarding the timing of tracheoesophageal puncture (TEP), a crucial procedure for voice prosthesis placement, the secondary puncture continues to be the preferred choice in the majority of cases. This underscores the persistent controversy and the absence of consensus in this field. The aim of this manuscript was to define evidence-based recommendations regarding the procedure of primary TEP with voice prosthesis placement, establish the conditions and requirements for performing primary TEP, determine the indications and contraindications of primary TEP, as well as to define the complications and management of primary TEP. A total of 19 statements were formulated, with 78.95% of them having a Level of Evidence 4 and a Grade of Recommendation C. There is not sufficient evidence comparing the outcomes of primary TEP versus secondary TEP. Future studies with robust methodologies are needed to clarify the role of primary and secondary TEP in the rehabilitation of patients undergoing total laryngectomy. [ABSTRACT FROM AUTHOR]

Tracheoesophageal (TE) puncture with voice prosthesis placement is a common method for vocal rehabilitation in patients who have undergone total laryngectomy. Tracheoesophageal voice prosthesis (TEP) placement after laryngectomy, known as secondary TE puncture, is traditionally done in the operating room, using rigid esophagoscopy. Traditional secondary TEP placement carries a number of downsides including risks associated with general anesthesia, high cost, and technical challenges associated with anatomical variables. As a result, in‐office secondary TE puncture has become an increasingly utilized procedure with many advantages but currently lacks standardization. Here, we describe a kit‐based, awake, in‐office secondary TE puncture with primary TEP placement technique. This technique calls for an endoscopic snare in the event there is difficulty passing the guidewire in the cranial trajectory. No surgical technique videos demonstrating in‐office secondary TE puncture currently exist. Here, we present a video tutorial of our technique, breaking down the procedure into 10 steps from analgesia to voicing. [ABSTRACT FROM AUTHOR]

Objective: We aimed to determine patterns of alaryngeal voice acquisition and predictive factors of vocal rehabilitation (VR) failure following total laryngectomy (TL) at a large Canadian tertiary care center. Methods: All consecutive patients having undergone a TL between January 1st, 2011 and December 31st, 2019, at the Centre Hospitalier de l'Université de Montréal were included. Results: One hundred and ninety‐seven laryngectomized patients were identified. Successful VR was achieved in 86 (59.0%) patients, while 59 (41.0%) failed to use a method of alaryngeal voice as their principal means of communication at 1 year postoperatively. The use of tracheoesophageal puncture (TEP) was associated with higher VR success rates (70.6%) when compared with the artificial larynx (48.6%), and esophageal voice (18.8%). The only independent predictor of VR failure on multivariate analysis at all time points was a low socioeconomic status. Conclusion: Failure to adopt an alaryngeal voice following TL is highly prevalent, despite comprehensive and free speech language pathologist services being offered at our center. A low resort to TEP at our institution and a poor acceptability and accessibility of alternative VR methods may contribute to this trend. The challenges of VR may be further exacerbated by the barriers linked to a lower socioeconomic status, which in turn may contribute to reduced candidacy for TEP. [ABSTRACT FROM AUTHOR]

Loss of speech function is one of the most important problems that arise in the treatment of laryngeal carcinoma by total laryngectomy. Implantation of a voice prosthesis in a surgically formed tracheoesophageal fistula is currently accepted as the gold standard. The purpose of the study was to analyze the results of our own modified methodology for tracheoesophageal puncture and voice prosthesis implantation, regarding the effectiveness of the method, the frequency and type of complications. A retrospective non-interventional two-center clinical study that included 51 patients who underwent tracheoesophageal fistulization for voice prosthesis implantation was performed. The study is part of a large-scale study, and the study protocol includes a detailed description of the design, inclusion and exclusion criteria, diagnostic and therapeutic procedures. The presented innovative modified technique for secondary TEP and fistula implementation based on Lichtenberger EENC is precise, safe and easier to perform compared to the original technique. Voice production in Bulgarian laryngectomized patients after TEP and voice prosthesis implantation is significantly superior to esophageal voice in terms of mean duration of phonation with one air bolus, number of words uttered with one bolus, tempo and expressiveness of speech. Voice rehabilitation through TEP and implantation of a voice prosthesis allows a significant increase in the quality of patients' lifestyle. Based on the presented results, the effectiveness of laryngeal prosthetics after laryngectomy is an undeniable factor improving the quality of life and giving good results compared to its alternatives. At а national level, it is necessary to create an information program and reimburse the voice prostheses by the NHIF. This would allow Bulgarian patients to have alternatives and make an informed choice. [ABSTRACT FROM AUTHOR]

Vocal rehabilitation post total laryngectomy (TL) lacks clinical guidelines, especially with the presence of multiple modalities. To describe the tendencies of vocal rehabilitation post TL in France and compare it with other countries. We try to identify the most practiced modalities and recognize statistically significant influencing factors. An electronic anonymous survey was answered by 75 ENT surgeons from France. The survey outlined the common practiced vocal rehabilitation modalities and had two versions depending on if the participant practices the tracheoesophageal speech (TES) or not. 96% use TES in their practice. Single modality TES and double modality TES with esophageal speech (ES) are the two most practiced modalities. 99% agreed that there is no age limit for the TES. Single modality ES was offered 92% more when more than 10 TL were performed per year (p <.05). No influencing factors found for single modality TES or double modality TES with ES (p >.05). Conclusion: In line with tendencies from other countries, the TES is the most practiced modality of vocal rehabilitation coupled or not with the ES. TES has no age limit as per our participants. The least practiced modality is the singe modality ALS. [ABSTRACT FROM AUTHOR]

Abstract Background Tracheoesophageal puncture (TEP) with use of a prosthesis is nowadays a standard for voice restoration after laryngectomy. Different TEP approaches exist. Methods We retrospectively reviewed our series of patients who underwent TEP by a novel technique, based partially on the Lichtenberger endo-extralaryngeal needle carrier. The instrument is covered with a protective Nelaton catheter and introduced via the mouth to the neopharynx/esophagus. No rigid endoscope is used for visualization of the TEP site. The tip is palpated through the stoma at the posterior tracheal wall and incision is done to the catheter tip. The prosthesis is introduced through the mouth and the neopharynx in a retrograde fashion. Results In 14 laryngectomees with postoperative radiation voice prosthesis was successfully placed with this technique. A total of 18 procedures were performed. One misplacement occurred. No other early or late complications were observed or any other TEP or prosthesis related problems. Conclusions The rationale of our technique is to simplify the procedure, avoid risk-bearing approaches and instruments such as rigid endoscopes, simplify the armamentarium and reduce tissue trauma. The initial clinical experience in 18 TEPs confirmed it usefulness in both standard and anatomically challenging situations. Trial registration The current study obtained the ethical approval from the Faculty of Medicine at Medical University "Prof. Dr. Paraskev Stoyanov"—Varna, Bulgaria (Protocol 087/24.10.2019 (retrospectively registered). Graphical abstract

Tracheoesophageal voice puncture and prosthesis (TEP) is a common method of voice restoration following total laryngectomy. A variety of complications, both minor and major, can be associated with the TEP and require timely intervention/management. Some of those complications include premature leakage, periprosthetic leakage, granulation tissue growth, TEP dislodgement, or embedding of the TEP. Patients may present with problems and/or complications with the voice prosthesis in an emergency setting or after clinic hours when a trained speech pathologist is not present or readily available for evaluation and management. This manuscript aims to provide guidance for management of acute TEP complications to otolaryngology responders, especially those who may be less familiar with TEP troubleshooting.Experiential and literature review was undertaken by a group of head and neck specialized Speech Language Professionals in high volume Head & Neck Oncology practices, to develop consensus guidelines for emergency TEP management.TEP emergencies were categorized as (1) leakage through, (2) leakage around, (3) sudden loss of voicing, (4) loss of prosthesis, still in tract, (5) loss of prosthesis, not in tract. Management strategies for each form of emergency were developed to achieve patient safety and stability until definitive measures could be performed by the patient’s Speech Language Professional.The goals of emergency management of TEP problems focused on minimizing risk of aspiration pneumonia, risk of foreign body aspiration, risk of wound complications at the puncture site. A simple management algorithm was developed for emergency or on-call otolaryngology responders. [ABSTRACT FROM AUTHOR]

Tracheoesophageal puncture (TEP) is a reliable method to restore voice and is an important part of voice rehabilitation following laryngectomy. However, complications following this procedure, including peri‐prosthetic leakage and resulting aspiration pneumonia, may necessitate surgical closure. In this study, we present an effective and reliable method for TEP closure using a stapler‐assisted technique. Case series study for patients who underwent stapler‐assisted TEP closure reviewed from 2017 to 2021. All five patients had successful closure of their TEP tract without further leakage. No postoperative bleeding, wound infection, or esophageal stenosis occurred. One patient had postoperative stomal stenosis. The stapler‐assisted technique for TEP closure is easy, quick, and effective. The reliability and quick return to oral intake post‐operatively make it a preferable option over previous techniques. [ABSTRACT FROM AUTHOR]

Objective: To present a new procedure for inserting a secondary voice prosthesis from the inside to the outside, which improves on the method previously reported by Fukuhara et al.Methods: A flexible nasopharyngoscope was used to puncture pharynx (or transplanted jejunum) from the inside to the outside. In this method, it was possible to use the PROVOX® VegaTM Puncture Set as it is used for the placement of the voice prosthesis.Results: We were able to place the PROVOX® VegaTM in all cases we experienced. Most of the cases had a history of radiation therapy. The time required for surgery ranged from 11-59 minutes (mean: 29 minutes) and there was no measurable amount of bleeding.Conclusion: This new method using the PROVOX® VegaTM Puncture Set, which is designed for the original purpose of voice prosthesis implantation, was therefore found to be safe and effective. [ABSTRACT FROM AUTHOR]

Background: Tracheoesophageal puncture (TEP) with use of a prosthesis is nowadays a standard for voice restoration after laryngectomy. Different TEP approaches exist. Methods: We retrospectively reviewed our series of patients who underwent TEP by a novel technique, based partially on the Lichtenberger endo-extralaryngeal needle carrier. The instrument is covered with a protective Nelaton catheter and introduced via the mouth to the neopharynx/esophagus. No rigid endoscope is used for visualization of the TEP site. The tip is palpated through the stoma at the posterior tracheal wall and incision is done to the catheter tip. The prosthesis is introduced through the mouth and the neopharynx in a retrograde fashion. Results: In 14 laryngectomees with postoperative radiation voice prosthesis was successfully placed with this technique. A total of 18 procedures were performed. One misplacement occurred. No other early or late complications were observed or any other TEP or prosthesis related problems. Conclusions: The rationale of our technique is to simplify the procedure, avoid risk-bearing approaches and instruments such as rigid endoscopes, simplify the armamentarium and reduce tissue trauma. The initial clinical experience in 18 TEPs confirmed it usefulness in both standard and anatomically challenging situations. Trial registration: The current study obtained the ethical approval from the Faculty of Medicine at Medical University "Prof. Dr. Paraskev Stoyanov"—Varna, Bulgaria (Protocol 087/24.10.2019 (retrospectively registered). [ABSTRACT FROM AUTHOR]

Tracheostomal stenosis following total laryngectomy presents a serious concern for surgeons and patients. Although various techniques correct tracheostomal stenosis, none address an existing tracheoesophageal puncture (TEP). We present an approach to repair tracheostomal stenosis, requiring tracheal resection, and preserve the TEP in a functional position needed for speech rehabilitation. A 62‐year‐old male with squamous carcinoma of the right true vocal fold underwent a salvage total laryngectomy with placement of a tracheoesophageal prosthesis. Seven years later, he developed tracheal narrowing. A tracheal resection and tracheoplasty were performed to manage the stenosis while maintaining the tracheoesophageal puncture. Six months postoperatively, the patient was well, with no stomal narrowing or trend toward collapse and uneventful healing. He achieved fluent voice easily with stomal occlusion. We present a novel surgical technique to correct for tracheostomal stenosis following total laryngectomy. Our technique allows for TEP preservation to facilitate speech rehabilitation postoperatively. [ABSTRACT FROM AUTHOR]

Abstract With the COVID-19 pandemic, there has been significant changes and challenges in the management of oncology patients. One of the major strategies to reduce transmission of the virus between patients and healthcare workers is deferral of follow-up visits. However, deferral may not be possible in total laryngectomy patients. Urgent procedures may be necessary to prevent complications related to ill-fitting tracheoesophageal puncture (TEP) voice prostheses, such as aspiration or loss of voicing. In this paper, we describe the Princess Margaret Cancer Center’s approach to managing this unique patient population.

Objective(s): To evaluate complication rate and abandonment rate after tracheoesophageal puncture and to assess factors associated with these outcome measures. Methods: Retrospective review of laryngectomy patients seen at a single academic institution between 1/1/2003 and 12/1/2018. Charts reviewed for demographics, medical comorbidities, tumor characteristics, surgical data, adjuvant treatment history, and complications related to laryngectomy or tracheoesophageal puncture. Complications were divided into minor and major. Results: A total of 293 laryngectomees met inclusion criteria. Of these, 69 patients (23.5%) underwent tracheoesophageal puncture. Average follow up was 64.6 months (SD 58.3). Overall laryngectomy complication rate was 43.3%. Overall tracheoesophageal puncture complication rate was 73.9%, with 39.1% of patients having major complications and 34.8% having minor complications only. Total abandonment rate for tracheoesophageal puncture was 34.8%. No associations were seen between tracheoesophageal puncture complication or abandonment rates based on age, gender, race, or insurance status. An increased rate of laryngectomy complications was seen after primary tracheoesophageal puncture (76.5% vs 41.3%, P =.005). Conclusion: Tracheoesophageal puncture outcomes were similar in patients with varied demographic, medical, and treatment backgrounds. When considering timing, our findings suggest that patients should be counseled on the possibility of increased complication risk after primary tracheoesophageal puncture. In those in whom the surgeon already has concerns about wound healing, it may be prudent to avoid primary tracheoesophageal puncture. The relatively high abandonment rate emphasizes the value of this measure of tracheoesophageal puncture outcome and highlights the need for appropriate patient counseling and prospective studies assessing the decision to abandon. [ABSTRACT FROM AUTHOR]

Background: Voice prosthesis is the current standard for post laryngectomy rehabilitation. Several clinical factors can affect the functional outcomes of voice prosthesis. Various complications are recorded with voice prosthesis. Objective: This study aimed to compare the results of primary and secondary provox insertion in patients with advanced laryngeal carcinoma undergoing total laryngectomy. Patients and Methods: Randomized-controlled clinical study included 24 patients with provox voice prosthesis rehabilitation 12 had primary tracheoesophageal puncture and 12 had secondary tracheoesophageal puncture. All patients were evaluated for successful voice restoration and complications rates. Results: Short-term success rate was 92% in the primary group and 83% in the secondary group. Long-term success rate was 83% in the primary group and 75% in the secondary group. Success rates were higher in the primary group but without statistically significant difference. Complications rate in the primary group was 58.3% and in the secondary group 66.6%. Complications rate was higher in the secondary group but without statistically significant difference. Conclusion: Provox voice prosthesis provides consistent and good voice results, which improve with time. Primary provox insertion had better success rates and fewer complications. Periprosthetic leak is the most common complication. [ABSTRACT FROM AUTHOR]

Background: To present an effective and easily applicable method for tracheoesophageal puncture (TEP) closure by using a localized annular flap instead of bulky and distant flaps. Methods: The medical records of patients who underwent TEP closure surgery with the annular mucosal flap technique between July 2012 and August 2018 were retrospectively reviewed. Fistula size, indication for closure, duration of surgery, radiotherapy status, and surgery results were analyzed. Results: We have used our technique in nine patients. No postoperative bleeding, wound infection, esophageal stenosis, and tracheostoma stenosis occurred. In all these patients except one, successful closure was achieved. None of the patients had a recurrence of the TEP. Conclusion: The annular mucosal flap technique for TEP closure is easy and quick to apply. The patient's oral feeding at the sixth hour after procedure without using a nasogastric tube makes the technique preferable as a priority. [ABSTRACT FROM AUTHOR]

Objective/Hypothesis: Tracheoesophageal diversion (TED) can prevent damage to the respiratory system in patients with swallowing disorders and/or repetitive aspiration pneumonia; however, TED may cause the loss of phonation. Our previous study demonstrated that TED with tracheoesophageal puncture (TEP) prevents aspiration while retaining phonation. In this study, we aimed to further evaluate the feeding status and phonation of patients who underwent TED with TEP to verify the reproducibility of this procedure. Study Design: Case series study. Methods: We retrospectively reviewed the medical records of 11 patients who underwent TED with TEP for intractable aspiration from February 2017 to August 2019 at Fukuoka Sanno Hospital. We evaluated the preoperative penetration aspiration score (PPAS), daily activities, preoperative and postoperative food intake level scale (FILS) score, nutrition route, maximum phonation time(MPT), and postoperative communication method. Results: The study population included 10 men and 1 woman (mean age, 66 years; range, 44–81) with a PPAS of 6.8 ± 1.0. The FILS score changed from 2.1 ± 0.5 preoperatively to 7.5 ± 2.0 postoperatively (paired t‐test, P <.05), while the MPT changed from 7.9 ± 4.1 to 10.3 ± 4.2 s (paired t‐test, P =.9). Preoperatively, a gastric fistula (eight patients [73%]) was the main nutrition route, followed by a gastric tube (two patients [18%]). Postoperatively, the main nutritional route for eight patients (73%) was oral, while the remaining three patients (27%) used the oral route occasionally. All patients maintained laryngeal phonation function, and eight (73%) used only laryngeal phonation for communication. Conclusions: Patients with intractable aspiration who wish to retain phonatory function should be advised to undergo TED with TEP. Level of Evidence: 4 Laryngoscope, 131:E1965–E1970, 2021 [ABSTRACT FROM AUTHOR]

Closure of a tracheoesophageal puncture site performed during voice prosthesis implantation may sometimes be required. Besides local techniques, more elaborate procedures, such as closure by means of free microvascular flaps, have been advocated. In this report, we describe a case of local treatment of a hard-to-heal fistula with local application of autologous platelet-rich fibrin matrix in a 77-year-old male patient. At one-week follow-up, the size of the fistula had decreased dramatically but some leakage remained when drinking. After one month, the patient was able to drink and eat normally without any leakage. There was no recurrence of the leakage at two years' follow-up. In summary, local application of platelet-rich fibrin seems to be a simple, safe and effective procedure for tracheoesophageal fistula closure. Declaration of interest: The authors have no conflicts of interest. [ABSTRACT FROM AUTHOR]

Background: Previous studies have assessed the capability of PRAAT for acoustic voice analysis in total laryngectomized (TL) patients, although this software was designed for acoustic analysis of laryngeal voice. Recently, we have witnessed the development of specialized acoustic analysis software, Tracheoesophageal Voice Analysis (TEVA). This study aims to compare the analysis with both programs in TL patients. Methods: Observational analytical study of 34 TL patients where a quantitative acoustic analysis was performed for stable phonation with vowels [a] and [i] as well as spectrographic characterization using the TEVA and PRAAT software. Results: The Voice Handicap Index (VHI-10) showed a mean score of 11.29 ± 11.16 points, categorized as a moderate handicap. TEVA analysis found lower values in the fundamental frequency vs. PRAAT ( p < 0.05). A significant increase in shimmer values was observed with TEVA (>20%). No significant differences were found between spectrographic analysis with TEVA and PRAAT. Conclusions: Tracheoesophageal speech is an alaryngeal voice, characterized by a higher degree of irregularity and noise compared to laryngeal speech. Consequently, it necessitates a more tailored approach using objective assessment tools adapted to these distinct features, like TEVA, that are designed specifically for TL patients. This study provides statistical evidence supporting its reliability and suitability for the evaluation and tracking of tracheoesophageal speakers.

Tracheoesophageal puncture (TEP) followed by voice prosthesis placement stands as the primary method for voice rehabilitation after laryngectomy, heralded for its effectiveness. While generally well-tolerated, the procedure does pose potential long-term complications. These include prosthesis valve leakage, scarring, and prosthesis displacement, all of which can impede phonation capabilities. Of these, prosthesis leakage emerges as the most critical concern, precipitated by the progressive widening of the fistula. This complication can precipitate aspiration pneumonitis, stemming from the loss of physical separation between the esophagus and trachea. This case series details three instances where persistent tracheoesophageal fistula arose following TEP, necessitating surgical intervention. Herein, we present the clinical manifestations, surgical approach employing a simple two-layer closure, and ensuing outcomes., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Noordiana et al.)

Introduction: Surgical procedures, especially total laryngectomy, have a profound adverse effect on the patient's physical, functional, as well as emotional health, and strongly decrease quality of life. Tracheoesophageal puncture is one of the most significant method that is widely performed successfully by physicians. Current valve technology enables long expiring duration; however, general duration for all types of valve appears to be approximately 3 to 6 months. Case Report: A 72-year-old patient with total laryngectomy and tracheoesophageal voice prosthesis (VP) presented our voice clinic with difficulty in swallowing and leakage around the valve of VP. In this report, we aim to present the patient who has used a single voice prosthesis for 17 years without a complication. Conclusion: In our case, the nutritional habits of our patient may have allowed him to use VP for 17 years without complications. We strongly advise following the suggested renewal time of voice prosthesis.

With the COVID-19 pandemic, there has been significant changes and challenges in the management of oncology patients. One of the major strategies to reduce transmission of the virus between patients and healthcare workers is deferral of follow-up visits. However, deferral may not be possible in total laryngectomy patients. Urgent procedures may be necessary to prevent complications related to ill-fitting tracheoesophageal puncture (TEP) voice prostheses, such as aspiration or loss of voicing. In this paper, we describe the Princess Margaret Cancer Center's approach to managing this unique patient population. [ABSTRACT FROM AUTHOR]

Enlargement of tracheoesophageal puncture (TEP) is seen in 1–29% of laryngectomee/laryngopharyngectomee using tracheoesophageal voice. It predisposes patient for recurrent aspiration pneumonia. Surgical closure of TEP is required in 30–67% of patients not responding to conservative measures. Surgical closure of an enlarged TEP using a flap may be time consuming, complex, and logistically challenging to organize. A novel technique of Fascia lata graft closure of an enlarged TEP is presented here. This technique can be useful in carefully selected patients with an enlarged TEP. [ABSTRACT FROM AUTHOR]

Background/aims: The tracheoesophageal prothesis (TEP) has become the primary modality for laryngeal communication after total laryngectomy due to high success rates, minimal morbidity, and more natural pulmonary driven speech. Fibrosis, kyphosis, and post-radiation contracture may preclude TEP placement through rigid esophagoscopy, and certain patients may not tolerate an in-office awake procedure. For such patients, a technique for flexible esophageal stenting and TEP placement is necessary.Methods: We performed a retrospective review of 3 patients who underwent TEP placement through endotracheal-tube esophageal stenting at the Massachusetts Eye and Ear Infirmary.Results: All 3 patients underwent laryngectomy after prior chemoradiotherapy for laryngeal cancer with resulting neck contracture and fibrosis preventing rigid esophagoscopy. All patients underwent successful TEP placement through endotracheal stenting without complication and developed excellent tracheoesophageal speech. Specific technical details are highlighted.Conclusions: In patients with anatomical constraints preventing traditional TEP placement through rigid esophagoscopy, fiberoptic guidance through an endotracheal tube stent provides a safe and efficient approach for TEP placement. [ABSTRACT FROM AUTHOR]

Background: Among voice restoration options following laryngectomy, tracheoesophageal puncture (TEP) appears to be the most common. Currently, there is no consensus that exists with regard to the timing of performing TEP and the decision to perform a primary or secondary TEP has mostly been based on physician preference and expert opinion rather than data. Objective of Review: The objective of this study was to compare primary and secondary tracheoesophageal puncture (TEP) for voice rehabilitation in laryngectomy patients in terms of success and complication rates. Type of Review: A systematic review of studies in the English literature was conducted for studies that directly compared primary and secondary TEP. Search Strategy: A comprehensive search of MEDLINE (January 1948‐15 July 2016), EMBASE (January 1974‐15 July 2016) and Web of Science (January 1970‐15 July 2016) was performed. Evaluation Method: Two authors (KL/BAC) independently reviewed titles and abstracts, read full‐text papers, extracted data and assessed quality. Disagreements were resolved via consensus. A third author (DV) resolved disagreements between reviewers when consensus was not possible. Results: Eleven retrospective clinical cohort studies were included. No randomised controlled trials were identified. Newcastle‐Ottawa score for assessment of quality ranged from 5 to 7. Success rate was defined differently across most studies. Two studies found higher success with primary TEP compared to secondary TEP; nine studies found no difference. Voice outcomes were inconsistently measured; no difference between groups was found in 4 studies. Complication rates were divided into TEP site related, infectious and stenosis. No difference between primary and secondary TEP was found in all but one study which showed a higher rate of pharyngocutaneous fistula in the primary TEP group in salvage laryngectomy patients. Conclusions: There is no robust evidence to suggest that primary TEP is associated with poorer outcomes compared to secondary TEP. A well‐designed randomised controlled trial is required to appropriately answer this question. [ABSTRACT FROM AUTHOR]

Abstract Secondary tracheoesophageal puncture (TEP) with voice prosthesis placement represents one of the possibility to restore vocal function after total laryngectomy. However, some patients have comorbidities that contraindicate general anesthesia. In our department, an in-clinic TEP procedure for retrograde voice prosthesis placement was developed. It allows the immediate placement of the prosthesis and the avoidance of the use of dilators. We described our technique with advantages and pitfalls. The Provox Vega Puncture Set was used. Our technique for in-clinic secondary TEP without general anesthesia or target controlled infusion was a safe and effective procedure. It allows the use of the traditional TEP set, with possibility of voice prosthesis placement after previous TEP closure. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Tracheoesophageal puncture (TEP) can be performed at the time of laryngectomy (primary) or postoperatively (secondary). Prior studies demonstrate safe and earlier voice acquisition and rehabilitation with primary TEP. The objectives of this study were to assess national trends in primary TEP and identify factors associated with its use.Study Design: Retrospective review.Methods: Retrospective analysis of the Nationwide Inpatient Sample (NIS) from 2010 to 2014 was performed. The NIS was queried for patients who underwent total laryngectomy (TL) (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] 30.3-30.4) and primary TEP (ICD-9-CM 31.95). Patient demographics, comorbidities, and factors known to influence the decision to perform TEP were characterized. Factors associated with primary TEP were identified by multivariable regression.Results: A total of 15,410 patients underwent TL during the study period. Of this cohort, 1,124 patients (7.3%) underwent primary TEP. Among patients who underwent primary TEP, 80.9% had laryngeal cancer, 16.4% had pedicled or free-flap reconstruction at the time of TL, 4.2% underwent partial pharyngectomy, and 48.0% underwent cricopharyngeal myotomy (CPM). The majority of primary TEPs were performed at urban teaching hospitals (90.6%). In multivariable regression, patients who underwent CPM were at significantly increased odds of primary TEP (odds ratio: 3.79, P < .0001). Flap reconstruction, partial pharyngectomy, age, gender, history of laryngeal cancer, hospital region, and teaching status were not associated.Conclusions: Primary TEP is associated with earlier voice restoration after TL but is infrequently performed. The majority of primary TEPs are performed in teaching hospitals, and primary TEP is associated with concurrent cricopharyngeal myotomy. Future studies should investigate practice patterns associated with primary TEP.Level Of Evidence: 4. Laryngoscope, 128:2320-2325, 2018. [ABSTRACT FROM AUTHOR]

Background: Tracheoesophageal puncture (TEP) for post-laryngectomy speech rehabilitation can be performed at the time of laryngectomy (primary) or at a subsequent time (secondary). Traditionally, the secondary procedure is performed using a rigid esophagoscope. Diseases like esophageal stricture, limited neck extension, and soft-tissue fibrosis can make this procedure technically challenging or impossible. We developed a novel device to perform a secondary tracheoesophageal puncture using a flexible esophagoscope.Objective: To test the feasibility of a novel device used to create a secondary TEP in post-laryngectomy cadavers.Methods: In this study, we performed a total laryngectomy on 3 fresh cadavers to establish the feasibility of our prototype. In each cadaver, a flexible esophagoscope was passed into the pharynx with the prototype. The prototype was passed through a working port and deployed to distend the esophagus. The puncture was visualized and a wire was passed via the newly established fistula. The device was activated, securing the wire, and then the esophagoscope and device were removed.Results: There was 100% successful deployment of the prototype device, allowing rapid creation of the puncture and security of the guide wire in each cadaver. There was no evidence of collateral mucosal injury or esophageal perforation.Conclusions: The prototype device offers an alternative method to safely and efficiently perform a secondary TEP without the requirement of rigid esophagoscopy which can sometimes be technically impossible in this patient population. [ABSTRACT FROM AUTHOR]

Aim: Tracheoesophageal speech with voice prosthesis is a gold standard in voice rehabilitation of laryngectomized patients. One of the possible complications associated with the use of voice prosthesis is downward migration of tracheoesophageal puncture. The aim of this paper is to present a new surgical method for closing downward migrated tracheoesophageal puncture. Patients and methods: The study included 6 patients with downward migrated tracheoesophageal puncture. In the treatment we used a new surgical method for closing downward migrated tracheoesophageal puncture, based on displaying the tracheoesophageal puncture in the full range of 360° and placing a double ligature on tracheoesophageal puncture. Results: There were no complications associated with the surgical treatment (infection, bleeding) or with recurrence of downward migration of speech prosthesis. All patients had a well rehabilitated voice and speech after reinserting the speech prosthesis. Conclusions: The method that was used for closing downward migrated tracheoesophageal puncture is simple and effective, and does not require special instruments and thus we believe it can be used in everyday ENT practice. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: This study compares the overall durability, phonation effort, and speech quality achieved by the Blom-Singer Dual Valve prosthesis to the same characteristics achieved by the single-valve prosthesis used in a select population of total laryngectomy patients who have demonstrated single-valve prosthesis failure within 3 months of placement.Study Design: Prospective phase IV study.Methods: Fourteen patients who had previously experienced early valve failure using a single-valve prosthesis had a Dual Valve placed by a speech language pathologist. A total of seventeen Dual Valves were inserted during routine clinical visits for valve replacement. Time intervals from insertion to replacement of the Dual Valve, as well as the average lifespan of patients' three previous single valves were collected. Subjective, categorical responses to speech quality and phonation effort for the Dual Valve compared to the single valve were collected on a questionnaire upon failure of the device.Results: The mean duration of the single valve was 60 days, with a median of 51 days, whereas the mean duration of the Dual Valve was 164 days, with a median duration of 84 days. Both sets of data were statistically significant, with a P value of .0131. Valve life was increased in 86% of patients, with 43% experiencing greater than 150 days improvement in valve duration when using the Dual Valve. Phonation effort was increased in 14% of patients, and speech quality was not significantly affected in any patients.Conclusions: In this select population, the Dual Valve offers improved durability over the single valve without sacrificing speech quality, making it a preferred prosthesis option for patients experiencing single-valve failure in less than 3 months.Level Of Evidence: 4. Laryngoscope, 128:422-426, 2018. [ABSTRACT FROM AUTHOR]

Objectives To identify differences in postoperative wound complications associated with a primary tracheoesophageal puncture (TEP) at the time of laryngectomy versus no TEP. Study Design Retrospective review of large national data set. Setting Academic and nonacademic health care facilities in United States, contributing de-identified, risk-adjusted clinical data to the American College of Surgeons National Surgical Quality Improvement Program. Subjects and Methods The National Surgical Quality Improvement Program data set for years 2006 to 2012 identified 430 patients who underwent total laryngectomy with or without a primary TEP. Patients who underwent a TEP at the time of laryngectomy (n = 68) were compared with patients who underwent laryngectomy without a TEP (n = 362). Postoperative wound complications and secondary outcomes, including medical complications and length of hospitalization, were compared between the groups. Results The incidence of "superficial" and "deep or organ space" surgical site infection, medical complications, return to the operating room, and length of hospitalization were similar between the groups. Patients in the TEP group had a higher overall wound complication rate (relative risk, 2.02; 95% CI = 1.06-3.84; attributable risk, 8.17%; number needed to harm, 12). Conclusions Performance of a primary TEP concurrent to total laryngectomy contributed to a small increase in attributable risk for overall wound complications but did not add substantial risk for "superficial" or "deep or organ space" surgical site infection, medical complications, or increased burden for resource utilization. These data may help inform patient choice and physician recommendations for primary alaryngeal speech rehabilitation. [ABSTRACT FROM AUTHOR]

Tracheoesophageal puncture (TEP) with voice prosthesis placement is the gold standard voice rehabilitation following total laryngectomy. Ultrasound may be useful to determine tracheoesophageal wall thickness, guiding prosthesis choice. Therefore, 14 patients undergoing total laryngectomy and TEP or prosthesis change with 16-mHz ultrasound measurement of the posterior tracheal wall were included. Seven patients underwent secondary TEP, 3 primary TEP, and 4 TEP changes. Six patients underwent flap reconstruction, while 8 patients were closed primarily. Average party wall thickness was 9.6 ± 1.7 mm, without a difference ( P = .08) between primary closure (10.3 ± 1.7 mm) and flap reconstruction (8.6 ± 1.4 mm). Change from the hypothesized sizing was noted in 11 patients (79%). Prosthesis size did not correlate with age (-0.19, P = .51), height (-0.12, P = .69), weight (0.26, P = .38), body mass index (0.22, P = .46), or flap status (-0.48, P = .079). These data suggest that ultrasound is beneficial in patients with distorted or less predictable anatomy (eg, flap reconstruction) but also important for those patients undergoing primary closure. [ABSTRACT FROM AUTHOR]