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Crotty TJ, Sexton GP, Kavanagh F, Kinsella J, Lennon P, Timon CV, Fitzgerald CWR. Fatal cerebritis and ventriculitis secondary to tracheoesophageal prosthesis. J Surg Case Rep 2024; 2024:rjae243. [PMID: 38638922 PMCID: PMC11026056 DOI: 10.1093/jscr/rjae243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 03/27/2024] [Indexed: 04/20/2024] Open
Abstract
Tracheoesophageal puncture and voice prosthesis placement is the preferred method of voice restoration following total laryngectomy. Although this is a safe and effective means of optimizing voice, severe complications can occur. We present the case of a patient who developed cerebritis and ventriculitis secondary to a tracheoesophageal prosthesis eroding his cervical vertebrae 20 years following pharyngo-laryngo-esophagectomy. Despite optimal antimicrobial therapy, he deteriorated and succumbed to his disease. Although tracheoesophageal prostheses are a safe and effective means of voice restoration, life-threatening complications can occur. This case report highlights a rare but severe case of cervical osteomyelitis, epidural abscess, and cerebritis and ventriculitis secondary to tracheoesophageal prosthesis. Clinicians must be aware of this severe complication in postlaryngectomy patients with tracheoesophageal prostheses.
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Affiliation(s)
- Thomas J Crotty
- Department of Otolaryngology–Head and Neck Surgery, St James’s Hospital, James Street, Dublin 8, Ireland
| | - Gerard P Sexton
- Department of Otolaryngology–Head and Neck Surgery, St James’s Hospital, James Street, Dublin 8, Ireland
| | - Fergal Kavanagh
- Department of Otolaryngology–Head and Neck Surgery, St James’s Hospital, James Street, Dublin 8, Ireland
| | - John Kinsella
- Department of Otolaryngology–Head and Neck Surgery, St James’s Hospital, James Street, Dublin 8, Ireland
| | - Paul Lennon
- Department of Otolaryngology–Head and Neck Surgery, St James’s Hospital, James Street, Dublin 8, Ireland
| | - Conrad V Timon
- Department of Otolaryngology–Head and Neck Surgery, St James’s Hospital, James Street, Dublin 8, Ireland
| | - Conall W R Fitzgerald
- Department of Otolaryngology–Head and Neck Surgery, St James’s Hospital, James Street, Dublin 8, Ireland
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Parrilla C, Longobardi Y, Paludetti G, Marenda ME, D'Alatri L, Bussu F, Scarano E, Galli J. A one-year time frame for voice prosthesis management. What should the physician expect? Is it an overrated job? ACTA ACUST UNITED AC 2021; 40:270-276. [PMID: 33100338 PMCID: PMC7586190 DOI: 10.14639/0392-100x-n0587] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 04/24/2020] [Indexed: 11/23/2022]
Abstract
Management of late complications represents the main reason for reluctance in using voice prosthesis rehabilitation. The aim of this paper is to report our experience by describing the one-year management of a large cohort of patients in order to clarify how demanding management is in terms of burden on clinicians. Between June 2017 and June 2018, each access made at the Otolaryngology Clinic of our Institute for issues related to prosthesis by 70 laryngectomised patients rehabilitated by voice prosthesis was registered in a specific database. A review of the data provided information on the incidence, management and outcomes of adverse events encountered during the selected time frame. In addition, a T test was used to evaluate the differences between irradiated and non-irradiated patients and between primary and secondary tracheo-oesophageal-puncture. Leakage through the prosthesis was the most common cause for access (51.86%). The median number of accesses per patient per year was 3.47. The speech therapist autonomously managed 18.1% of accesses. The median number of accesses per patient per year needing a physician was 2.84. The median lifetime of the prosthesis was 4.85 months. Radiotherapy or modality (primary or secondary) of the puncture did not influence the number of accesses per year or the prosthesis lifetime. This retrospective analysis of results highlighted the most frequent issues and the most effective measures to deal with them, which allowed us to define a systematic algorithm to standardise and ease long-term outpatient management.
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Affiliation(s)
- Claudio Parrilla
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Istituto di Otorinolaringoiatria, Rome, Italy
| | - Ylenia Longobardi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Istituto di Otorinolaringoiatria, Rome, Italy
| | - Gaetano Paludetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Istituto di Otorinolaringoiatria, Rome, Italy
| | - Maria Elisabetta Marenda
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Istituto di Otorinolaringoiatria, Rome, Italy
| | - Lucia D'Alatri
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Istituto di Otorinolaringoiatria, Rome, Italy
| | - Francesco Bussu
- Otolaryngology Division AOU, Sassari, Italy.,Università Cattolica del Sacro Cuore, Istituto di Otorinolaringoiatria, Rome, Italy
| | - Emanuele Scarano
- Università Cattolica del Sacro Cuore, Istituto di Otorinolaringoiatria, Rome, Italy
| | - Jacopo Galli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Istituto di Otorinolaringoiatria, Rome, Italy
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Gupta A, Bharti RK, Kumar B. Foreign Body Induced Infective Cervical Spondylodiscitis with Compressive Myelopathy with Quadriparesis. Neurol India 2021; 69:759-761. [PMID: 34169887 DOI: 10.4103/0028-3886.319219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Ashish Gupta
- Department of Neurosurgery and Spine, Fortis Escorts Hospital, Faridabad 121001, Delhi-NCR, India
| | - Rajesh K Bharti
- Department of Neurosurgery and Spine, Fortis Escorts Hospital, Faridabad 121001, Delhi-NCR, India
| | - Bidyanand Kumar
- Department of Neurosurgery and Spine, Fortis Escorts Hospital, Faridabad 121001, Delhi-NCR, India
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Eenhuis LL, Bijl HP, Kuijlen JMA, Wedman J. Cervical Stabilization in Patients with Instability Resulting from Osteoradionecrosis with Subsequent Spondylodiscitis After Radiotherapeutic Treatment for Head- and Neck Carcinoma. Indian J Otolaryngol Head Neck Surg 2019; 71:784-789. [PMID: 31742064 DOI: 10.1007/s12070-018-1548-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 12/04/2018] [Indexed: 10/27/2022] Open
Abstract
High dose of radiation to bone may cause necrosis. Osteoradionecrosis of the cervical vertebrae is a rare adverse event of radiotherapy in patients treated for head and neck cancer. The risk on osteoradionecrosis will increase with doses exceeding 60 Gy. Minimal trauma of the overlying mucosa of the heavily irradiated cervical spine causes subsequent infections or instability may cause neck pain and severe neurological disability. In four patients the cervical spine received up to 100 Gy due to reirradiation. Clinically the patients presented with neck pain. All patients had defects in the pharyngeal posterior wall and cervical instability due to osteoradionecrosis of several cervical vertebrae. Despite optimal conservative treatment the patients developed sensory and motor function loss of the upper extremities. Laminectomies were performed and the cervical spine was stabilized. The pharyngeal posterior wall defects could not be reconstructed. All patients received lifelong antibiotic treatment. Pain and neurological deficits declined after surgery and initiating antibiotics. Eventually all patients could take up their daily activities. Three patients died between 6 months and 2 years after surgery. The cause of death was not related to the osteoradionecrosis. In case of cervical osteoradionecrosis, with secondary infections, stability of the spine should be restored even when the integrity of the pharyngeal posterior wall cannot be restored. Our cases demonstrate that even when an anterior approach is impossible, due to irradiation changed tissue structures of the pharyngeal posterior wall, a combination of lifelong antibiotic treatment and posterior stabilization is a good alternative. The vertebrae affected by osteoradionecrosis and secondary infection can be left in situ. This intervention leads to improvement in quality of life.
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Affiliation(s)
- L L Eenhuis
- 1Department of Otorhinolaryngology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - H P Bijl
- 2Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J M A Kuijlen
- 3Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J Wedman
- 1Department of Otorhinolaryngology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB Groningen, The Netherlands
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Spondylodiscitis after transoral robotic surgery: Retrospective 7-case series from the GETTEC group. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 136:179-183. [PMID: 30905532 DOI: 10.1016/j.anorl.2019.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Cervical spondylodiscitis is a rare but severe complication of pharyngeal surgery. MATERIAL AND METHODS This multicenter retrospective study reported all patients in the database of the French head and neck tumor study group (GETTEC) affected by cervical spondylodiscitis after transoral robotic surgery (TORS) for malignant pharyngeal tumor from January 2010 to January 2017. OBJECTIVES To describe cases of post-TORS cervical spondylodiscitis, identify alarm signs, and determine optimal management of these potentially lethal complications. RESULTS Seven patients from 6 centers were included. Carcinomas were located in the posterior pharyngeal wall. Tumor stage was T1 or T2. All patients had risk factors for spondylodiscitis. Mean time to diagnosis was 12.6days. The interval between surgery and spondylodiscitis diagnosis ranged from 20days to 4.5months, for a mean 2.1months. The most common symptom was neck pain (87%). Infections were polymicrobial; micro-organisms were isolated in 5 cases and managed by intravenous antibiotics, associated to medullary decompression surgery in 3 cases. Follow-up found favorable progression in 4 cases, and 3 deaths (mortality, 43%). CONCLUSION This French multicenter study found elevated mortality in post-TORS spondylodiscitis, even in case of limited resection. Surgeons must be aware of this complication and alerted by persistent neck pain, fever, asthenia, impaired or delayed posterior pharyngeal wall wound healing or elevation of inflammatory markers. MRI is the most effective diagnostic radiological examination.
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Song Y, Kiyosaki K, Damrose EJ. Epidural abscess and paraplegia: Delayed sequela of tracheoesophageal puncture. OTOLARYNGOLOGY CASE REPORTS 2017. [DOI: 10.1016/j.xocr.2017.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Mastoraki A, Mastoraki S, Papanikolaou IS, Tsikala-Vafea M, Tsigou V, Lazaris A, Arkadopoulos N. Spondylodiscitis Associated with Major Abdominal Surgical Intervention: Challenging Diagnostic and Therapeutic Modalities. Indian J Surg Oncol 2017; 8:274-278. [DOI: 10.1007/s13193-017-0641-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 02/27/2017] [Indexed: 11/28/2022] Open
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Espitalier F, de Keating-Hart A, Morinière S, Badet JM, Asseray N, Ferron C, Malard O. Cervical spondylodiscitis following an invasive procedure on the neopharynx after circumferential pharyngolaryngectomy: a retrospective case series. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:3894-3901. [PMID: 27566300 DOI: 10.1007/s00586-016-4741-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 07/22/2016] [Accepted: 08/07/2016] [Indexed: 12/19/2022]
Abstract
PURPOSE To highlight cervical spondylodiscitis as an infrequent complication following an invasive procedure on the neopharynx in patients previously treated with circumferential pharyngolaryngectomy with pectoralis major myocutaneous flap reconstruction. METHODS Patients diagnosed with cervical spondylodiscitis after circumferential pharyngolaryngectomy between 2001 and 2013 were retrospectively studied using a questionnaire sent to the French head and neck tumour study group. Medical history; tumour management; clinical symptoms; biological, microbiological and imaging results; and management of the infection were collected for each patient. RESULTS Six men aged 51-66 years were diagnosed with spondylodiscitis on average 5.6 years after circumferential pharyngolaryngectomy, and a mean 2 months following an invasive procedure on the neopharynx (oesophageal dilatation, phonatory prosthesis insertion). The patients presented with cervical pain and increased CRP level. MRI showed epidural abscess and communication between the pharynx and vertebral bodies in most cases. Microbiological samples yielded bacteria from the pharynx flora. Infection was managed using antibiotics adjusted according to the culture results and spinal immobilisation for duration of 6-12 weeks. No surgical treatment was required. During follow-up, no patient experienced recurrence or residual disability. CONCLUSIONS Cervical spondylodiscitis is a rare but potentially severe complication following an invasive procedure on the neopharynx after circumferential pharyngolaryngectomy. Therefore, the onset of nonspecific symptoms should not be overlooked, and MRI must be performed if infection is suspected. Microbiological confirmation is critical in optimising treatment, which should be aggressive, even if overall prognosis seems to be good.
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Affiliation(s)
- Florent Espitalier
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Nantes, Nantes, France. .,Service d'ORL et chirurgie cervico-faciale, CHU Hôtel Dieu, 1, place Alexis Ricordeau, 44093, Nantes Cedex 1, France.
| | - Anne de Keating-Hart
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Nantes, Nantes, France
| | - Sylvain Morinière
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Tours, Tours, France
| | - Jean-Michel Badet
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Besançon, Besançon, France
| | - Nathalie Asseray
- Department of Infectious Diseases, University Hospital of Nantes, Nantes, France
| | - Christophe Ferron
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Nantes, Nantes, France
| | - Olivier Malard
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Nantes, Nantes, France
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González-Paz T, Nehme-Paz AR, Rodríguez-Acevedo N, Arán-González I. Cervical Spondylodiscitis Secondary to Insertion of Voice Prosthesis. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2016. [DOI: 10.1016/j.otoeng.2016.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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10
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González-Paz T, Nehme-Paz AR, Rodríguez-Acevedo N, Arán-González I. Cervical spondylodiscitis secondary to insertion of voice prosthesis. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2015; 67:239-41. [PMID: 26593224 DOI: 10.1016/j.otorri.2015.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 07/13/2015] [Accepted: 07/21/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Tamara González-Paz
- Servicio de Otorrinolaringología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, España.
| | - Abdul R Nehme-Paz
- Servicio de Otorrinolaringología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, España
| | - Nieves Rodríguez-Acevedo
- Servicio de Otorrinolaringología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, España
| | - Ismael Arán-González
- Servicio de Otorrinolaringología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, España
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Honda K, Asato R, Tsuji J, Kanda T, Watanabe Y, Mori Y, Tsujimura T. Pyogenic spondylodiscitis after transoral surgery for oropharyngeal cancer. Auris Nasus Larynx 2012; 40:320-2. [PMID: 22682475 DOI: 10.1016/j.anl.2012.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 04/28/2012] [Accepted: 05/05/2012] [Indexed: 11/15/2022]
Abstract
We report the case of a patient with pyogenic spondylodiscitis after transoral surgery for oropharyngeal cancer. The patient was a 66-year-old man with a history of hepatic cell carcinoma, alcoholic cirrhosis, and chronic pancreatitis. The tumor was resected via a transoral approach with concurrent bilateral elective neck dissections. Although the initial postoperative course was uneventful, the patient experienced severe cervical pain because of which he revisited the hospital. The patient was diagnosed with pyogenic spondylodiscitis, according to the results of magnetic resonance imaging. Continuous treatment with parenteral antibiotics and a cervical brace was required for 2 months before all his symptoms and signs diminished. To the best of our knowledge, this is the first reported case of pyogenic spondylodiscitis as a complication of transoral resection for head and neck cancer.
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Affiliation(s)
- Keigo Honda
- Department of Head and Neck Surgery, National Hospital Organization Kyoto Medical Center, 1-1-1 Fukakusa Mukaihata-cho, Fushimi-ku, Kyoto, Japan.
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Park SY, Chung HK, Yoon KW, Jung SI, Park CH, Joo YE, Kim HS, Choi SK, Rew JS. Infectious spondylodiscitis caused by esophageal injury after blunt chest trauma. Gastrointest Endosc 2010; 72:1095-7. [PMID: 20541194 DOI: 10.1016/j.gie.2010.02.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Accepted: 02/15/2010] [Indexed: 02/08/2023]
Affiliation(s)
- Seon-Young Park
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chonnam National University Medical School, Dong-ku, Gwangju, Korea
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Sudhakar PJ, Al Dossary J, Malik N. Spondylodiscitis complicated by the ingestion of a button battery: a case report. Korean J Radiol 2009; 9:555-8. [PMID: 19039273 PMCID: PMC2627235 DOI: 10.3348/kjr.2008.9.6.555] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
A one-and-a-half year old boy who presented with a cough, irritability, and refusal of food was found to have an impacted foreign body in his upper esophagus. We present the radiologic findings of the foreign body (a button battery) impacted in the upper esophagus and its complications; namely, mediastinitis and spondylodiscitis after endoscopic removal. Further, plain radiograph and MR imaging findings are discussed along with literature review.
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Holmgaard R, Jakobsen LP. Cervical Spondylodiscitis—A Rare Complication of Palatopharyngeal Flap Surgery. Cleft Palate Craniofac J 2008; 45:674-6. [DOI: 10.1597/07-167.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cervical spondylodiscitis was diagnosed in a 31-year-old man 2 months after palatopharyngeal flap surgery. Symptoms included pain in the neck and tingling and numbness in the left arm. The diagnosis was confirmed by magnetic resonance imaging, and the patient recovered on antibiotic treatment. We propose that the spondylodiscitis may have occurred as a result of a local infection in and around the surgical wound in the posterior pharyngeal wall.
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Affiliation(s)
- Rikke Holmgaard
- Department of Plastic Surgery, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Linda P. Jakobsen
- Department of Plastic Surgery, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
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Malik T, Bruce I, Cherry J. Surgical complications of tracheo-oesophageal puncture and speech valves. Curr Opin Otolaryngol Head Neck Surg 2007; 15:117-22. [PMID: 17413414 DOI: 10.1097/moo.0b013e3280964dc8] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Speech rehabilitation following total laryngectomy is central to future quality of life. Although other options exist, surgical voice restoration has emerged as the 'gold standard' management strategy in the majority of laryngectomees. Taking this into account, what are the complications of this technique and how should they be successfully managed? The purpose of this review is to provide a comprehensive review of the subject, with particular reference to technique, complications and outcome. RECENT FINDINGS As with any surgical intervention, complications may occur in the early postoperative period or later. The article provides a detailed explanation of the varying problems detailed in individual reports, and in case series. Primary or secondary tracheo-oesophageal puncture is also discussed, along with complications resulting from the speech valve itself. SUMMARY The positive impact of surgical voice restoration on quality of life in the alaryngeal patient considerably outweighs the complications commonly associated with the procedure. Greater knowledge of the potential problems should continue to reduce the complication rate. Primary puncture, in a patient selected and subsequently managed in a multidisciplinary environment, would appear to provide the best outcome for the patient.
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Affiliation(s)
- Tass Malik
- Department of Otolaryngology Head and Neck Surgery, Royal Blackburn Hospital, Blackburn, UK
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