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Published on: March 15, 2024
Modified Technique for Difficult Secondary Tracheoesophageal Puncture
Michelle Yoon1,2, Justin Joseph1,2, Ricardo Ramirez2,3
1THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA.
Abstract:
Tracheoesophageal puncture (TEP) with voice prosthesis (VP) placement is commonly used to restore voice in laryngectomy patients. The conventional procedure utilizes a rigid esophagoscope to open and visualize the pharyngeal inlet. However, this approach is challenging in patients with postradiation changes, reduced neck extension, or trismus. Here, we demonstrate a modified technique involving flexible endoscopy and endotracheal tube placement to reestablish the TEP tract in a patient with a challenging anatomic profile. This step-by-step video demonstrates retrieval of a dislodged prosthesis and TEP/VP placement under general anesthesia, which results in effective voice restoration. This modified technique can safely and effectively restore voice in patients with difficult exposure.
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