Surgical complications of tracheo-oesophageal puncture and speech valves

Speech rehabilitation following total laryngectomy is central to future quality of life. Although other options exist, surgical voice restoration has emerged as the 'gold standard' management strategy in the majority of laryngectomees. Taking this into account, what are the complications of this technique and how should they be successfully managed? The purpose of this review is to provide a comprehensive review of the subject, with particular reference to technique, complications and outcome.

As with any surgical intervention, complications may occur in the early postoperative period or later. The article provides a detailed explanation of the varying problems detailed in individual reports, and in case series. Primary or secondary tracheo-oesophageal puncture is also discussed, along with complications resulting from the speech valve itself.

The positive impact of surgical voice restoration on quality of life in the alaryngeal patient considerably outweighs the complications commonly associated with the procedure. Greater knowledge of the potential problems should continue to reduce the complication rate. Primary puncture, in a patient selected and subsequently managed in a multidisciplinary environment, would appear to provide the best outcome for the patient.