An Alternative Approach for Secondary Tracheoesophageal Puncture in the Difficult Laryngectomy Neck

摘要

Restoration of speech is the ultimate goal in the rehabilitation of patients who have undergone a laryngectomy. Voice restoration using a tracheoesophageal puncture (TEP) is the current treatment of choice for postlaryngectomy speech rehabilitation. TEP and placement of a voice prosthesis was first introduced by Singer and Blom1 in 1980. The original voice prosthesis, the Blom-Singer, and a second-generation device, the Provox, both use a rigid esophago-scope for creation of a tracheoesophageal fistula and subsequent placement of a voice prosthesis. Although use of a rigid esophagoscope for placement of the prosthesis is the most widely used technique, variations to the procedure have been reported. These variations include the KTP laser, both rigid and flexible endoscopes, percutaneous gastrostomy sets, as well as a variety of introducer kits and clamps.