A Thin Tracheal Silicone Washer to Solve Periprosthetic Leakage in Laryngectomies: Direct Results and Long‐Term Clinical Effects

Abstract

Objectives: Assessment of the immediate results and long-term clinical effects of a thin silicone washer placed behind the tracheal flange of voice prostheses to treat periprosthetic leakage.Patients and Methods: Three year retrospective analysis of 32 laryngectomized patients with 107 periprosthetic leakage events (PLEs). Custom-made silicone washers (outer diameter 18 mm, inner diameter 7.5 mm, thickness 0.5 mm) were placed behind the tracheal flange either in combination with prosthesis replacement or later.Results: There was immediate resolution of periprosthetic leakage in 88 PLEs (median, 38 d; mean, 53 d; range, 8 -330 d) and in 6 PLEs with the washer still in situ at the date of analysis (median, 75; mean, 97 d; range, 38 -240 d). There was no resolution for periprosthetic leakage in 13 PLEs. Thus, in total, 94 of 107 PLEs (88%) were successfully resolved. In 29 of 32 (91%) patients, the washer resolved the problem at least in one PLE successfully. Twelve of 32 patients, including all 3 with washer failures, also required other interventions to ultimately solve the problem. The vast majority of patients (80%) did not consider placement of the washer to be inconvenient.Conclusions: In consideration of the high success rate and limited inconvenience for patients, this simple thin silicon washer application provides a good first option for the treatment of periprosthetic leakage.

The management of periprosthetic leakage in the presence of supra-oesophageal reflux after prosthetic voice rehabilitation

“…Periprosthetic leakages should best be managed using a specific algorithm. In patients with minor periprosthetic leakage and a fistula diameter between 8 and 11 mm, we recommend the replacement of the prosthesis by a shorter one, the insertion of a silicone washer, or the use of a custom-fit voice prosthesis with a larger oesophageal flange in order to prevent aspiration [14,21,25,29]. In patients with substantial fistula enlargement, treatment should consist of soft-tissue augmentation by the injection of various substances such as granulocyte-macrophage colony-stimulating factor (GMCSF), autologous fat, siloxanes (Vox Implant Ò ) or collagen, which sufficiently control leakage in most cases [25].…”

“…The literature describes only a few cases of severe life-threatening complications such as oesophageal perforation with mediastinitis, soft-tissue abscesses, or spinal injuries [1,13,25]. In contrast, minor local problems occur more often and include the formation of biofilms on the prosthesis with subsequent prosthesis failure, spasms, or stenoses in the cricopharyngeal segment with limited swallowing and voicing as well as granulation tissue formation in the region of the tracheo-oesophageal fistula, periprosthetic leakage as a result of fistula enlargement with subsequent aspiration symptoms [13,14,29,30]. Owing to the aspiration of saliva and food, periprosthetic leakage considerably reduces the quality of life of affected patients.…”

Problemlösung bei Stimmrehabilitation mittels Stimmprothesen

“…Tetraplegie [1,29] B i l d u n g v o n K r u s t e n u n d B o r k e n Mediastinitis/Mediastinalabszess [3,16,36] Bildung eines Biofilms/Candidabewuchs [2,18] Schwere lokale Hautinfektion [1] Granulationsgewebe, Webbildung, Bildung einer intramuralen Tasche Ösophagusstriktur [6,31] Prothesendefekt Ileus nach Stimmprotheseningestion [12] Inkarzeration der Prothese intramural in der Ösophaguswand [7] Aspiration der Stimmprothese [4, 5, 8-10, 14, 19, 30, 33] Leckage und Prothesenfehlfunktion bei intrathorakalem Unterdruck [11] Schwere Stimmfistelerweiterung [21,14] Augmentationsmaterialien In der Literatur wird die Verwendung von Eigenfett, Bioplastic ® , Kollagen, Hyaluronsäure, Zymera und GM-CSF (Granulozyten-Makrophagen-Koloniestimulierender Faktor) beschrieben. Die Kollektivgröße in den Falldarstellungen liegt zwischen 1 und 10 Patienten.…”

Practice of laryngectomy rehabilitation interventions

“…A fairly recent solution for this is application of a thin silicone washer behind the tracheal flange, which solves mild peripheral leakage in the vast majority of cases, at least temporarily, until a more definitive solution is chosen. 32 A second option here is to apply a purse string suture. 33 A third option is to augment the TEP tract with e.g.…”