			Home About us Contact

Tracheoesophageal Puncture (tracheoesophageal + puncture)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Hunsaker Mon-Jet Tube for Secondary Tracheoesophageal Puncture

THE LARYNGOSCOPE, Issue 6 2007
MRCSED, Muhammad Shakeel MBBS
No abstract is available for this article. [source]

Stricture associated with primary tracheoesophageal puncture after pharyngolaryngectomy and free jejunal interposition

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 3 2006
Gurston G. Nyquist MD
Abstract Background. Free jejunal interposition has been one of the standard reconstructive options for patients undergoing total laryngopharyngoesophagectomy. Tracheoesophageal puncture (TEP) done primarily is a well-accepted means of voice restoration. The rapid recovery of swallowing and communication in patients who have advanced cancer of the upper aerodigestive tract is a valid goal. The objective of this study was to evaluate the functionality and complications of primary TEP in patients with a free jejunal interposition graft. Methods. Twenty-four consecutive patients who had free jejunal interposition were studied. Thirteen of these patients had a primary TEP. Stricture was assessed through barium swallow, laryngoscopy, and CT scan. Results. A statistically significant greater number of patients had stricture develop after primary TEP (p < .0325). All these patients had stricture develop at the distal anastomosis. These patients also tended to have a poorer quality of diet. Moreover, speech with a TEP prosthesis in patients with a free jejunal interposition was less intelligible and functional than speech with a TEP prosthesis after simple laryngectomy. Conclusions. This article recognizes an increased incidence of stricture formation after primary TEP as compared with non-TEP in patients undergoing pharyngolaryngectomy with free jejunal interposition. The morbidity and possible etiology of this complication are discussed. This clinical data have been translated into a change in clinical practice. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX,XXX, 2005 [source]

Cervical spondylodiscitis: A rare complication after phonatory prosthesis insertion

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 1 2006
Andrea Bolzoni MD
Abstract Background. Tracheoesophageal puncture has excellent voice rehabilitation after total laryngectomy. However, despite its easy insertion and use, severe complications have been reported. Methods. We report a case of cervical spondylodiscitis, occurring in a 67-year-old woman submitted to phonatory prosthesis insertion. After 1 month, she complained of severe cervicalgia associated with fever. Spondylodiscitis involving C6, C7, and the intervening vertebral disk with medullary compression was detected by means of imaging studies. Results. A right cervicotomy with drainage of necrotic tissue was performed, and a deepithelialized fasciocutaneous deltopectoral flap was interposed between the neopharynx-esophagus and the prevertebral fascia to protect the neurovascular axis. MR performed 1 month later showed a complete resolution of the infectious process. Conclusions. Severe neck pain after tracheoesophageal puncture should alert the physician about the possibility of a cervical spondylodiscitis. MR is the most useful imaging technique for preoperative and postoperative evaluation. When neurologic symptoms are detected, surgical exploration of the neck is mandatory. © 2005 Wiley Periodicals, Inc. Head Neck28: XXX,XXX, 2005 [source]

Stricture associated with primary tracheoesophageal puncture after pharyngolaryngectomy and free jejunal interposition

Cervical spondylodiscitis: A rare complication after phonatory prosthesis insertion

Laryngeal Preservation With Supracricoid Partial Laryngectomy Results in Improved Quality of Life When Compared With Total Laryngectomy,

THE LARYNGOSCOPE, Issue 2 2001
Gregory S. Weinstein MD
Abstract Objectives/Hypotheses Study 1: To assess the oncologic outcome following supracricoid partial laryngectomy (SCPL). Study 2: To compare the quality of life (QOL) following SCPL to total laryngectomy (TL) with tracheoesophageal puncture (TEP). Study 3: To analyze whole organ TL sections to determine the percentage of lesions amenable to SCPL. Study Design Study 1: A retrospective review of patients who underwent SCPL. Study 2: A non-randomized, prospective study using QOL instruments to compare patients who underwent either SCPL or TL. Study 3: A retrospective histopathologic study of TL specimens assessed for the possibility of performing an SCPL. Methods Study 1: Twenty-five patients with carcinoma of the larynx underwent SCPL between June 1992 and June 1999. Various rates of oncologic outcome were calculated. Study 2: Thirty-one patients participated in the QOL assessment. This included the SF-36 general health status measure, the University of Michigan Head and Neck Quality of Life (HNQOL) instrument, and the University of Michigan Voice-Related Quality of Life (VRQOL) instrument. Study 3: Ninety surgical specimens were obtained and studied from the total laryngectomy cases in the Tucker Collection. Multiple sites were evaluated for the presence of carcinoma. A computer program was written to classify whether the patient was amenable to SCPL. Results Study 1: The overall local control rate was 96% (24/25). The local control rate following SCPL with cricohyoidoepiglottopexy (CHEP) was 95% (20/21). The local control rate following SCPL with cricohyoidopexy (CHP) was 100% (4/4). Study 2: The SCPL had significantly higher domain scores than TL and TEP in the following categories for the SF-36: physical function, physical limitations, general health, vitality, social functioning, emotional limitations, and physical health summary. The significantly higher domains for the SCPL when compared with the TL and TEP for the HNQOL were eating and pain. Finally, when voice-related QOL was assessed with the V-RQOL, the domains of physical functioning and the total score were significantly better with SCPL when compared with TL and TEP. Study 3: Forty of 90 (44%) laryngeal whole organ specimens were determined to be resectable by SCPL. In 16 (18%) specimens, the patients could have undergone SCPL with CHEP and in 24 (27%) specimens the patients could have undergone SCPL with CHP. Among the 40 (44%) specimens determined to be able to have undergone SCPL, 19 were glottic (1 T1, 15 T2, 3 T3) and 21 were supraglottic (9 T2, 12 T3). Conclusions 1) A review of the literature and an analysis of the data in this study indicate that excellent local control may be expected following SCPL. 2) The QOL following SCPL, as measured by three validated QOL instruments, is superior to TL with TEP. 3) A histologic assessment of whole organ sections of TL specimens indicates that many patients who have been subjected to TL may have been candidates for SCPL. 4) If the indications and contraindications are rigorously adhered to, SCPLs are reasonable alternatives to TL in selected cases. [source]

Reflux as a cause of tracheoesophageal puncture failure

THE LARYNGOSCOPE, Issue 1 2009
Kavita M. Pattani MD
Abstract Objective: To evaluate the response to empiric reflux management in treatment of tracheoesophageal punctures (TEP) failures. Methods: A retrospective chart review of patients with failed TEP was performed (n = 37). Only those patients without any documented anatomic cause for failure (n = 22) were then further reviewed to determine if empiric treatment for reflux improved voicing. Evidence of reflux was determined by either using video flexible scope of the neopharynx, barium swallows, 24-hour pH probes, and /or transnasal esophagoscopy (TNE). In 13 of 22 patients who had voicing difficulties and no evidence of reflux on these tests, empiric treatment with antireflux medications had been documented. The 22 patients were closely monitored to determine the role of reflux therapy and subsequent voicing outcomes. Results: Of the 22 patients studied, 9 were noted to have granulation tissue on the tracheal side of the prosthesis. All nine patients had complete resolution of the granulation tissue after antireflux treatment, and seven of nine were able to voice again. Of the patients with no obvious reason for TEP failure who were empirically treated for reflux, 62% (8 of 13) had TEP voice after treatment. Seventy-seven percent of our patients (17 of 22) had a positive response to treatment with aggressive reflux therapy. Conclusions: Previous studies have demonstrated patients with a total laryngectomy and/or radiation therapy have increased reflux. This study addresses reflux as a potential cause of TEP voicing problems. We noted 41% (9 of 22) of patients with voicing difficulties had granulation tissue surrounding the prosthesis as a result of reflux. Aggressive antireflux therapy proved beneficial in eradicating this problem. Prophylactic antireflux therapy may be warranted for patients undergoing TEP to reduce voicing problems. Laryngoscope, 119:121,125, 2009 [source]

Functional Outcomes after Circumferential Pharyngoesophageal Reconstruction

THE LARYNGOSCOPE, Issue 7 2005
Jan S. Lewin PhD
Abstract Objective: To determine functional speech and swallowing outcomes, morbidity, and complication rates after reconstruction of circumferential pharyngoesophageal defects using a jejunal versus an anterolateral thigh (ALT) flap. Study Design: Retrospective analysis. Methods: We reviewed the medical records of 58 patients with circumferential pharyngoesophageal defects, 27 with ALT flap reconstruction, and 31 with jejunal interposition. We compared complication rates, intensive care unit (ICU) and hospital stays, nutritional intake, number of tracheoesophageal punctures (TEPs) performed, TE speech fluency, and functional use. Modified barium swallow studies assessed swallowing physiology. Results: Patient characteristics were similar. Total flap loss occurred in one (3.7%) patient with an ALT flap and two (6.5%) patients with jejunal interposition (P = 1.000), fistula in two (7.4%) ALT patients and one (3.2%) jejunal patient (P = .5931), and anastomotic stricture in four (15%) ALT patients and six (19.4%) jejunal patients (P = .7371). ICU and hospital stays were greater for jejunal patients (P = .001, <.001, respectively). TEPs were performed in eight jejunal patients and nine ALT patients. Eighty-nine percent of ALT patients and 63% of jejunal patients were fluent, whereas 78% of ALT patients and 25% of jejunal patients used TE speech to communicate. Ninety-one percent of ALT patients and 73% of jejunal patients resumed oral intake (P = .151). The most common causes of dysphagia were impaired tongue base retraction (62% jejunum) and disordered motility (62% jejunum, 67% ALT). Conclusions: For circumferential pharyngoesophageal reconstruction, the ALT flap results in similar complication rates, but shorter ICU and hospital stays, and better speech and swallowing compared with jejunal reconstruction. [source]