Introduction
Tracheoesophageal voice prosthesis (TEP) is the gold standard in speech rehabilitation for laryngectomy patients, but placement at the time of laryngectomy is not always possible. Delayed puncture may sometimes be utilised in patients undergoing salvage surgery or pharyngo-laryngo-esophagectomy. We present, with HD video and audio, our technique for in-office TEP placement.
Method
Following informed consent, the patient receives atomized topical local anaesthesia to the pharynx and trachea. The planned puncture site is selected and marked. A flexible pharyngoscopy is performed and under direct vision a 22g needle is introduced through the tracheoesophageal partition. A guidewire is inserted, and the fistula is sequential dilated until it can accommodate an artery clamp. A valve size is selected and mounted, the clamp removed and the valve inserted with endoscopic visualisation.
Conclusion
We suggest that the use of a modified Seldinger technique to insert a TEPunder local anaesthesia is safe and well-tolerated in select patients. This technique avoids the need for general anaesthesia and permits immediate speech restoration, making this an efficient way to restore speech in laryngectomy patients in the outpatient setting.
Deirdre Leavy, Sorcha McManus, Caoimhe Mulgrew, James Griffin, Eoin Cleere, Justin Hintze, CW Fitzgerald
Department of Otolaryngology, Head and Neck Surgery, St James’s Hospital