A Multidisciplinary Approach to Secondary Tracheoesophageal Puncture for Voice Prosthesis Insertion Using Flexible...

Area of Science:

• Otolaryngology
• Surgical Innovation
• Voice Restoration

Background:

• Tracheoesophageal puncture (TEP) with voice prosthesis (VP) insertion is standard for postlaryngectomy voice restoration.
• Conventional rigid esophagoscopy has limitations in patients with cervical abnormalities, free flaps, or post-radiation strictures.

Purpose of the Study:

• To describe a novel technique for secondary TEP using flexible endoscopy.
• To evaluate the feasibility, safety, and efficacy of this multidisciplinary approach in challenging patient populations.

Main Methods:

• A combined Ear, Nose, and Throat (ENT) and upper gastrointestinal (UGI) procedure guided by flexible esophagoscopy.
• Intraoperative involvement of a speech pathologist for voice prosthesis (VP) insertion and placement.
• Multidisciplinary team approach in nine postlaryngectomy patients with pharyngeal reconstruction and/or radiotherapy.

Main Results:

• The flexible endoscopy technique was successfully performed in all nine patients.
• No major complications occurred; minor issues included TEP displacement and granulation tissue.
• The technique proved feasible and practical, overcoming challenges posed by distorted anatomy, bulky flaps, and strictures.

Conclusions:

• A multidisciplinary approach using flexible esophagoscopy for secondary TEP is safe and effective.
• This technique offers advantages for voice prosthesis insertion in patients with complex post-surgical or post-radiation anatomy.
• It facilitates safe insertion and evaluation of the upper aerodigestive tract.