Abstract
Background
Tracheoesophageal puncture (TEP) with voice prosthesis (VP) insertion is the gold
standard of surgical voice restoration in postlaryngectomy patients. The conventional
technique involves rigid esophagoscopes and trocar performed by ENT surgeons alone,
with technical limitations encountered in patients with cervical abnormalities - in
particular those with free or rotational flap reconstructions and postradiotherapy
strictures. We report our technique using flexible endoscopy which we show to be feasible and
without major safety events, as a possible consideration in the anticipated difficult
TEP.
Methods
Our study describes a multidisciplinary approach to secondary TEP involving a combined
upper gastrointestinal (UGI) and (Ear, Nose, and Throat) ENT procedure, under the
guidance of flexible esophagoscopy, with intraoperative involvement of the speech
pathologist to guide VP insertion and placement. The procedure was performed with
ease without major complications.
Results
We identified nine postlaryngectomy and laryngopharyngectomy patients in our institution
who underwent secondary TEP with VP insertion using flexible esophagoscopy and multidisciplinary
intra-operative involvement. All patients had pharyngeal reconstruction, including
radial forearm free flap (n = 4), pectoralis major rotational flap (n = 3), and anterolateral
thigh flap (n = 2). Eight out of nine patients underwent adjuvant radiotherapy. The
technique was successfully performed in all patients. There were three cases of early
TEP displacement in two patients, of which one patient had a successful repeat procedure.
We found the technique advantageous in terms of feasibility and practicality compared
to the conventional approach, and without intraoperative difficulties encountered
in achieving the desired field of views or navigating the challenging anatomy in a
free flap and post-radiotherapy patients. This includes distorted cervical anatomy,
the presence of bulky and hair-bearing flap skin, and stricture formation. Minor complications
in our cohort included pharyngo-esophageal spasm, TEP displacement, granulation tissue,
and peri-prosthetic leaks.
Conclusion
Our multidisciplinary approach to secondary TEP was performed with flexible esophagoscopy
without major related complications. The technique is advantageous in the surgical
approach to VP insertion in postlaryngectomy and laryngopharyngectomy patients who
have had radiotherapy or pharyngeal reconstruction. It allows for safe anatomical
insertion and thorough evaluation of the upper aerodigestive tract for comorbid benign
or malignant esophageal pathology.
Key Words
Abbreviations:
CRE (controlled radial expansion), ENT (Ear, Nose, and Throat), FDG (fluorodeoxyglucose), PET (positron emission tomography), SP (speech pathologist), TEP (tracheoesophageal puncture), UGI (upper gastrointestinal), UGIS (upper gastrointestinal surgeon), VP (voice prosthesis)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 10, 2022
Accepted:
March 10,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
