Use of Ultrasound for Sizing Tracheoesophageal Puncture Prostheses

Area of Science:

• Otolaryngology
• Medical Imaging
• Speech Rehabilitation

Background:

• Tracheoesophageal puncture (TEP) with voice prosthesis is standard for voice restoration post-total laryngectomy.
• Accurate prosthesis sizing is crucial for successful voice rehabilitation.
• Ultrasound offers a non-invasive method to assess tracheoesophageal anatomy.

Purpose of the Study:

• To evaluate the utility of 16-mHz ultrasound in measuring posterior tracheal wall thickness.
• To determine if ultrasound measurements guide voice prosthesis selection in patients undergoing total laryngectomy and TEP.
• To assess the correlation between party wall thickness and patient factors or surgical approach.

Main Methods:

• 14 patients undergoing total laryngectomy with TEP or prosthesis change were included.
• 16-mHz ultrasound was used to measure the posterior tracheal wall (party wall) thickness.
• Measurements were compared between primary closure and flap reconstruction groups, and correlated with patient demographics and prosthesis size.

Main Results:

• The average party wall thickness was 9.6 ± 1.7 mm.
• No significant difference in thickness was found between primary closure (10.3 ± 1.7 mm) and flap reconstruction (8.6 ± 1.4 mm) groups (P = .08).
• In 79% of patients (11/14), the measured thickness led to a change from the initially hypothesized prosthesis size.

Conclusions:

• Ultrasound measurement of the tracheoesophageal party wall is beneficial for voice prosthesis selection.
• This imaging modality is particularly useful in patients with distorted or unpredictable anatomy, such as those with flap reconstruction.
• Ultrasound guidance is also recommended for patients undergoing primary closure to optimize prosthesis fit.