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Jabbour N, Rodriggs T, O'Dea M, Mur T, Vitale K, L Faden D. Protocolized awake secondary tracheoesophageal puncture with immediate voicing. Head Neck 2023; 45:2735-2740. [PMID: 37671696 DOI: 10.1002/hed.27506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/25/2023] [Accepted: 08/20/2023] [Indexed: 09/07/2023] Open
Abstract
Tracheoesophageal (TE) puncture with voice prosthesis placement is a common method for vocal rehabilitation in patients who have undergone total laryngectomy. Tracheoesophageal voice prosthesis (TEP) placement after laryngectomy, known as secondary TE puncture, is traditionally done in the operating room, using rigid esophagoscopy. Traditional secondary TEP placement carries a number of downsides including risks associated with general anesthesia, high cost, and technical challenges associated with anatomical variables. As a result, in-office secondary TE puncture has become an increasingly utilized procedure with many advantages but currently lacks standardization. Here, we describe a kit-based, awake, in-office secondary TE puncture with primary TEP placement technique. This technique calls for an endoscopic snare in the event there is difficulty passing the guidewire in the cranial trajectory. No surgical technique videos demonstrating in-office secondary TE puncture currently exist. Here, we present a video tutorial of our technique, breaking down the procedure into 10 steps from analgesia to voicing.
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Affiliation(s)
- Nicolette Jabbour
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Timothy Rodriggs
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Meredith O'Dea
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Avedisian School of Medicine, Boston University Chobanian, Boston, Massachusetts, USA
- MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Taha Mur
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kailey Vitale
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Avedisian School of Medicine, Boston University Chobanian, Boston, Massachusetts, USA
| | - Daniel L Faden
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Avedisian School of Medicine, Boston University Chobanian, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
- Massachusetts Eye and Ear, Boston, Massachusetts, USA
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Ananthapadmanabhan S, Jabbour J, Lai S, Suruliraj A, Smith M, Riffat F, Devadas M, Liem H, Sritharan N. A Multidisciplinary Approach to Secondary Tracheoesophageal Puncture for Voice Prosthesis Insertion Using Flexible Esophagoscopy. J Voice 2022:S0892-1997(22)00076-5. [PMID: 35418350 DOI: 10.1016/j.jvoice.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Tracheoesophageal puncture (TEP) with voice prosthesis (VP) insertion is the gold standard of surgical voice restoration in postlaryngectomy patients. The conventional technique involves rigid esophagoscopes and trocar performed by ENT surgeons alone, with technical limitations encountered in patients with cervical abnormalities - in particular those with free or rotational flap reconstructions and postradiotherapy strictures. We report our technique using flexible endoscopy which we show to be feasible and without major safety events, as a possible consideration in the anticipated difficult TEP. METHODS Our study describes a multidisciplinary approach to secondary TEP involving a combined upper gastrointestinal (UGI) and (Ear, Nose, and Throat) ENT procedure, under the guidance of flexible esophagoscopy, with intraoperative involvement of the speech pathologist to guide VP insertion and placement. The procedure was performed with ease without major complications. RESULTS We identified nine postlaryngectomy and laryngopharyngectomy patients in our institution who underwent secondary TEP with VP insertion using flexible esophagoscopy and multidisciplinary intra-operative involvement. All patients had pharyngeal reconstruction, including radial forearm free flap (n = 4), pectoralis major rotational flap (n = 3), and anterolateral thigh flap (n = 2). Eight out of nine patients underwent adjuvant radiotherapy. The technique was successfully performed in all patients. There were three cases of early TEP displacement in two patients, of which one patient had a successful repeat procedure. We found the technique advantageous in terms of feasibility and practicality compared to the conventional approach, and without intraoperative difficulties encountered in achieving the desired field of views or navigating the challenging anatomy in a free flap and post-radiotherapy patients. This includes distorted cervical anatomy, the presence of bulky and hair-bearing flap skin, and stricture formation. Minor complications in our cohort included pharyngo-esophageal spasm, TEP displacement, granulation tissue, and peri-prosthetic leaks. CONCLUSION Our multidisciplinary approach to secondary TEP was performed with flexible esophagoscopy without major related complications. The technique is advantageous in the surgical approach to VP insertion in postlaryngectomy and laryngopharyngectomy patients who have had radiotherapy or pharyngeal reconstruction. It allows for safe anatomical insertion and thorough evaluation of the upper aerodigestive tract for comorbid benign or malignant esophageal pathology.
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Affiliation(s)
| | - Joe Jabbour
- Department of Otolaryngology, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Stephanie Lai
- Department of Speech Pathology, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Anand Suruliraj
- Department of Otolaryngology, Nepean Hospital, Kingswood, New South Wales, Australia; Department of Otolaryngology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Mark Smith
- Department of Otolaryngology, Nepean Hospital, Kingswood, New South Wales, Australia; Department of Otolaryngology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Faruque Riffat
- Department of Otolaryngology, Nepean Hospital, Kingswood, New South Wales, Australia; Department of Otolaryngology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Michael Devadas
- Department of Upper GI Surgery, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Han Liem
- Department of Upper GI Surgery, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Niranjan Sritharan
- Department of Otolaryngology, Nepean Hospital, Kingswood, New South Wales, Australia; Department of Otolaryngology, Westmead Hospital, Westmead, New South Wales, Australia
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Tracheo Esophageal Prosthesis Insertion Under Endoscopic Guidance and Local Anaesthesia- Feasibility and Outcome. Indian J Otolaryngol Head Neck Surg 2022; 74:39-44. [PMID: 35070924 PMCID: PMC8743319 DOI: 10.1007/s12070-020-02149-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/14/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Voice rehabilitation after laryngectomy is by tracheo esophageal puncture (TEP) and prosthesis insertion. Secondary TEP is very difficult due to neck fibrosis. Puncture under local anaesthesia with endoscopy guidance is a feasible option. METHODS Retrospective review of all laryngectomy patients from March 2009 till March 2019 was done and the methods of voice rehabilitation were assessed. The patients undergoing the procedure were classified according to the timing of insertion and type as primary insertion under general anaesthesia (Group P), secondary insertion under local anaesthesia (Group L), secondary insertion under general anaesthesia (Group G). The speech outcome and the procedure outcome were compared. RESULTS There were 148 patients who underwent laryngectomy, of which groups P, G, L were 12, 12 and 11. The rate of successful insertion was 100% in primary, 91.6% in secondary in general anaesthesia and 91% in secondary under local anaesthesia. All secondary TEP were done after surgery and radiotherapy. Complications related to the insertion techniques were minimal. Speech outcome were similar on intelligibility rating scale and longevity was not affected by the method. CONCLUSION TEP in local anaesthesia is feasible and has comparable outcome with TEP in general anaesthesia. Financial burden was very much less in group L compared to the other two groups.
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Park SJ, Park YH. Simplified technique of in-office secondary tracheoesophageal puncture with immediate voice prosthesis placement under transnasal esophagoscope guidance. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138 Suppl 2:53-54. [PMID: 34116948 DOI: 10.1016/j.anorl.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/17/2021] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Affiliation(s)
- S J Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 10 63-ro, Yeongdeungpo-gu, Seoul, 07345, Korea
| | - Y H Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 10 63-ro, Yeongdeungpo-gu, Seoul, 07345, Korea.
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Extended role of transnasal oesophagoscopy: a review of the literature. The Journal of Laryngology & Otology 2020; 134:481-486. [PMID: 32616097 DOI: 10.1017/s002221512000105x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Advances in endoscopic technology have allowed transnasal oesophagoscopy to be used for a variety of diagnostic and therapeutic procedures. METHOD A review of the literature was carried out to look into the extended role of transnasal oesophagoscopy within otolaryngology, using the Embase, Cinahl and Medline databases. RESULTS There were 16 studies showing that transnasal oesophagoscopy is safe and cost effective and can be used for removal of foreign bodies, tracheoesophageal puncture, laser laryngeal surgery and balloon dilatation. CONCLUSION This study presents a summary of the literature showing that transnasal oesophagoscopy can be used as a safe and cost-effective alternative or adjunct to traditional rigid endoscopes for therapeutic procedures.
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Rocke J, Ahmed S. Transnasal Esophagoscopy-Our Experience. Int Arch Otorhinolaryngol 2018; 23:7-11. [PMID: 30647777 PMCID: PMC6331291 DOI: 10.1055/s-0038-1661359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 05/06/2018] [Indexed: 11/26/2022] Open
Abstract
Introduction
Transnasal esophagoscopy (TNE) is a widely used tool both in the diagnosis and treatment of patients presenting complaints within the head and the neck. This is because this investigative adjunct examination provides the advantage of visualizing above the level of the cricopharyngeus muscle when compared to the more widely used esophagogastroduodenoscopy (EGD).
Objectives
We have assessed if the implementation of TNE within a district general hospital (DGH) was feasible, and investigated if the resources of our patients could be better directed away from other investigations such as barium swallow and EGD in favor of this novel technique. The TNE technique has been largely applied in central teaching hospitals within the United Kingdom, but there are still no published reports of a DGH investigating its applicability in this smaller-sized clinical environment.
Method
We have analyzed our theater database to find all the patients who had undergone TNE, and recorded their reason for presenting, the preceding investigations, and the procedural findings.
Results
In most cases, the TNE was conducted without technical issues, and we were able to identify positive findings in 43% of the patients who underwent Esophagogastroduodenoscopy (EGD). We were able to treat patients successfully during the investigation when a cricopharyngeal stricture or narrowing was found. A normal EGD did not preclude further investigations with TNE. All but one of our patients were treated as day-case procedures.
Conclusion
Transnasal esophagoscopy can be successfully delivered within a DGH. A previous EGD does not mean that the TNE will not reveal positive findings due to its superior visualization of the pharynx and the upper esophagus.
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Affiliation(s)
- John Rocke
- Department of ENT, Lancaster Royal Infirmary, Lancaster, United Kingdom of Great Britain and Northern Ireland
| | - Shadaba Ahmed
- Department of ENT, Lancaster Royal Infirmary, Lancaster, United Kingdom of Great Britain and Northern Ireland
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Ricci E, Riva G, Dagna F, Seglie E, Cavalot A. In-clinic secondary tracheoesophageal puncture and voice prosthesis placement in laryngectomees. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:349-352. [DOI: 10.1016/j.anorl.2017.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 08/26/2017] [Accepted: 09/24/2017] [Indexed: 10/17/2022]
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