Primary tracheo-esophageal puncture voice restoration with laryngectomy

In 1979 Singer and Blom introduced a technique of tracheo-esophageal puncture for restoration of voice in the post-laryngectomy patient. This procedure is usually done as a staged secondary procedure, six months after the primary laryngectomy. This study compares 13 patients who have had a laryngectomy and primary tracheo-esophageal fistula formation with 13 patients in whom the procedure is performed as a delayed operation. A clinical evaluation of the results of tracheo-esophageal puncture is presented. Acceptable results were obtained in 77% of the primary tracheo-esophageal puncture group whereas only 54% of the delayed group attained acceptable results. The advantages of primary tracheo-esophageal puncture include an improved patient morale and acceptance of the procedure, as well as the ability to feed the patient through the Foley catheter. The disadvantages of performing the procedure primarily include an increased rate of postoperative mucocutaneous fistula. The relationship of the tracheo-esophageal puncture to the increased fistulization rate is discussed. Further experience is required before firm conclusions can be drawn about the role this procedure will take in the management of patients for cancer of the larynx.