An unusual complication following tracheoesophageal puncture for alaryngeal voice restoration

Abstract

A laryngectomized patient who developed massive subcutaneous emphysema, pneumothorax, pneumomediastinum, and esophageal fistual with a retroesophageal collection following the creation of a tracheo-esophageal fistuls for alaryngeal voice restoration is presented, together with its management. A review of the literature is made, and possible causes of the three complications are discussed.

Trends in Voice Rehabilitation in the United Kingdom

“…There have been reports in the literature of potentially fatal complications from tracheooesophageal fistula formation [10][11][12], How ever, we feel that the potential for excellent speech outweighs the possibility of the occur rence of complications. With newer valves, it is our experience and that of others [13] that complications directly related to valve inser tion are rarely seen, and prosthesis-related complications tend to be minor.…”

Surgical complications of tracheo-oesophageal puncture and speech valves

“…Abscess formation in the retropharyngeal space with parapharyngeal extension resulting in carotid artery rupture 2 months after TOP has been described [41]. Inferior extension of the infection may result in a retro-oesophageal abscess requiring thoracotomy [42].…”

“…Septicaemia [34], delayed pneumomediastinum [46], cervical cellulitis [37] and sternoclavicular septic arthritis [26] have also been described. TOP patients should also be monitored for pneumothorax, pneumomediastinum [46] and subcutaneous emphysema [42]. False dissecting passages in the space between the trachea and oesophagus have been described [29,47] mimicking the chest pain of myocardial infarction [22].…”