Tracheo-esophageal Puncture Revisited
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ORIGINAL ARTICLE
Tracheo-esophageal Puncture Revisited Ravi. P. Deo1
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A. Sagayaraj1
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Balan Ashok Kumar1
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S. M. Azeem Mohiyuddin1
Received: 10 September 2020 / Accepted: 21 September 2020 Ó Association of Otolaryngologists of India 2020
Abstract This study aims to propose a novel surgical technique to rehabilitate patients with long term complication of trachea-esophageal puncture and stomal stenosis. Ours is retrospective study. Ten patients with tracheoesophageal puncture who developed long term complications and who failed conservative management were included in our study. Majority of our patients were males within the age group of 50–70 years of age. Most of our patients had received adjuvant radiotherapy (8/10). All patients had multiple change of prosthesis. Nine patients suffered from multiple complications of TEP. Most common complication was that of progressive thinning of trachea-esophageal wall. All the patients who underwent this procedure healed well without any major complications. Long term trachea-esophageal puncture may undergo significant modification in terms of position and size. This technique gives a satisfactory and viable method of excising the altered anatomy and establishes speech & swallowing in such patients who fail conservative management. Keywords Tracheo-eshophageal puncture Laryngectomy Voice prosthesis Stomal stenosis Aspiration
Introduction Since the introduction of Tracheo-Esophageal Puncture (TEP) and subsequent development of voice prosthesis by Bloom and Singer in early 800 s, this procedure has become a standard,well accepted and easily reproducible method of speech rehabilitation following total Laryngectomy [1]. Long term survivors of this procedure tend to develop various complications, commonest being enlargement of fistula, thinning of tracheo-esophageal wall, displacement of fistula either up or down and last but not the least, stomal stenosis. These complications predispose the patient to salivary leak, chronic aspiration leading to frequent lung infection, poor quality of voice, difficulty in valve maintenance and frequent change of prosthesis. Various methods, surgical and non-surgical, have been employed to address these complications with variable outcomes. In the eventuality of failure, closure of fistula is the only option left thereby depriving the patients of their voice. This study proposes a novel surgical technique to address the above mentioned long term complications of TEP with or without stomal stenosis and re-establish communication.
Material and Methods
& A. Sagayaraj [email protected] 1
Our’s is a retrospective study carried out from 2015–2020 at department of otorhinolaryngolgy and head and neck surgery, Sri Devaraj Urs Medical College. After obtaining institutional ethical committee clearance, 10 patients were included in our study.
Department of Otorhinolaryngology and Head and Neck Surgery, Sri Devaraj Urs Medical College, SDUAHER, Kolar, India
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Indian J Otolaryngol Head Neck Surg
Inclusion Criteria Patients who
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