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Safe and simple method for secondary tracheoesophageal puncture using curved forceps

Published online by Cambridge University Press:  23 May 2008

N P Trivedi ,
V Kekatpure ,
M A Kuriakose  and
S Iyer
N P Trivedi
Affiliation:
Head and Neck Department, Amrita Institute of Medical Science, Cochin, Kerala, India
V Kekatpure
Affiliation:
Head and Neck Department, Amrita Institute of Medical Science, Cochin, Kerala, India
M A Kuriakose
Affiliation:
Head and Neck Department, Amrita Institute of Medical Science, Cochin, Kerala, India
S Iyer*
Affiliation:
Head and Neck Department, Amrita Institute of Medical Science, Cochin, Kerala, India
*
Address for correspondence: Dr Subramania Iyer, Head and Neck Department, Amrita Institute of Medical Science, Cochin, Kerala 682026, India. Fax: +91 4842802028 E-mail: [email protected]
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Abstract

Introduction:

Secondary tracheoesophageal puncture is sometimes difficult and has a higher complication rate. In the irradiated neck, where neck extension is difficult, the traditional tracheoesophageal puncture method of insertion with a rigid endoscope is not possible. We describe a simple, safe and effective alternative method of tracheoesophageal puncture using curved forceps (Kocher's curved intestinal clamp forceps or Mixter forceps).

Surgical technique:

The procedure is performed under local or general anaesthesia with equal ease. Maximum neck extension is achieved. The curved intestinal forceps are passed through the mouth into the oesophageal lumen. The instrument tip can easily be seen or felt at the posterior wall of the tracheostoma. A small incision is made in the mucosa to allow the forceps tip to emerge, and a guide wire is passed through this incision out of the mouth. The prosthesis can be guided over the guide wire, in retrograde fashion, to fit the puncture hole.

Results:

Secondary tracheoesophageal puncture was performed in five cases with severe neck fibrosis. In all cases, valve insertion was easily achieved after secondary tracheoesophageal puncture, without any peri-operative complications.

Conclusion:

This is a safe, simple and effective method for secondary tracheoesophageal puncture. It can be performed easily in any setting and is not associated with any complications.

Keywords

LaryngectomyAlaryngeal SpeechTracheaOesophagus
Type
Online Only Short Communication
Information
The Journal of Laryngology & Otology , Volume 123 , Issue 10 , October 2009 , e19
Copyright
Copyright © JLO (1984) Limited 2008

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References

1Brown, DH, Hilgers, FJ, Irish, JC, Balm, AJ. Postlaryngectomy voice rehabilitation: state of the art at the millennium. World J Surg 2003;27:824–31CrossRefGoogle ScholarPubMed
2Stafford, FW. Current indications and complications of tracheoesophageal puncture for voice restoration. Curr Opin Otolaryngol Head Neck Surg 2003;11:89–95CrossRefGoogle ScholarPubMed
3Lau, WF, Wei, WI, Ho, CM, Lam, KH. Immediate tracheoesophageal puncture for voice restoration in laryngopharyngeal resection. Am J Surg 1988;156:269–72CrossRefGoogle ScholarPubMed
4Ruth, H, Davis, WE, Renner, G. Deep neck abscess after tracheo-esophageal puncture and insertion of a voice button prosthesis. Otolaryngol Head Neck Surg 1985;93:809–11CrossRefGoogle ScholarPubMed
5Andrews, JC, Mickel, RA, Hanson, DG, Monahan, GP, Ward, PH. Major complications following tracheoesophageal puncture for voice rehabilitation. Laryngoscope 1987;97:562–7CrossRefGoogle ScholarPubMed
6Spiro, JD, Spiro, RH. Retropharyngeal abscess and carotid hemorrhage following tracheoesophageal puncture and voice prosthesis insertion: a case report. Otolaryngol Head Neck Surg 1990;102:762–3CrossRefGoogle ScholarPubMed
7Ng, RW, Lam, P, Wong, BY. Insertion of Provox®2 voice prosthesis using the anterograde technique immediately after secondary tracheoesophageal puncture. J Laryngol Otol 2005;119:988–90CrossRefGoogle ScholarPubMed
8Görür, K, Ozcan, C, Unal, M, Ozkul, MD. A new and simple modification of the prosthetic voice restoration technique. J Laryngol Otol 2003;117:365–7CrossRefGoogle ScholarPubMed
9Maniglia, AJ. Vocal rehabilitation after total laryngectomy: a flexible fiberoptic endoscopic technique for tracheoesophageal fistula. Laryngoscope 1982;92:1437–9CrossRefGoogle ScholarPubMed
10Mazzara, CA, Baredes, S. Technique of tracheoesophageal puncture using flexible fiberoptic esophagoscopy. Laryngoscope 1993;103:928–9CrossRefGoogle ScholarPubMed
11Bach, KK, Postma, GN, Koufman, JA. In-office tracheoesophageal puncture using transnasal esophagoscopy. Laryngoscope 2003;113:173–6CrossRefGoogle ScholarPubMed
12Shaw, GY, Searl, JP. Secondary tracheoesophageal puncture using a KTP laser. Laryngoscope 2000;100:1574–7CrossRefGoogle Scholar
13Singh, V, Brockbank, MJ, Flower, N, Frost, RA. Tracheo- esophageal puncture using a flexible gastroscope and a percutaneous endoscopic gastrostomy set. J Laryngol Otol 1997;111:447–8CrossRefGoogle Scholar
14Rhys Evens, PH. Tracheo-oesophageal puncture without tears: the forceps technique. J Laryngol Otol 1991;105:748–9CrossRefGoogle Scholar
15Padhya, TA, Athavale, SM, Morgan, JM, McCaffrey, TV. An alternative approach for secondary tracheoesophageal puncture in the difficult laryngectomy neck: Laryngoscope 2008;118:266–9CrossRefGoogle ScholarPubMed