Enlarged tracheoesophageal puncture after total laryngectomy: A systematic review and meta‐analysis

Abstract

Background Enlargement of the tracheoesophageal puncture (TEP) is a challenging complication after laryngectomy with TEP. We sought to estimate the rate of enlarged puncture, associated pneumonia rates, potential risk factors, and conservative treatments excluding complete surgical TEP closure. Methods A systematic review was conducted (1978–2008). A summary risk estimate was calculated using a random-effects meta-analysis model. Results Twenty-seven peer-reviewed manuscripts were included. The rate of enlarged puncture and/or leakage around the prosthesis was reported in 23 articles (range, 1% to 29%; summary risk estimate, 7.2%; 95% confidence interval [CI], 4.8% to 9.6%). Temporary removal of the prosthesis and TEP- site injections were the most commonly reported conservative treatments. Prosthetic diameter (p =.076) and timing of TEP (p = .297) were analyzed as risk factors; however, radiotherapy variables were inconsistently reported. Conclusion The overall risk of enlarged puncture seems relatively low, but it remains a rehabilitative challenge. Future research should clearly establish risk factors for enlarged puncture and optimal conservative management.

Total Closure of Enlarged Tracheoesophageal Puncture with Septal Button: Long-Term Results

“…The use of a large-diameter VP is another potential risk factor. Higher rates of enlarged TEP were reported in cohorts that used a 22-Fr or larger-diameter prosthesis [5,6]. …”

“…The incidence of enlarged TEP with leakage around the VP is reported as 1-29% [5]. Enlargement of the TEP may result in aspiration pneumonia through the leakage of foods, liquids, and saliva into the airway.…”

“…The reported rate of complete surgical closure of TEP was 14-50% [5]. Suturing of esophageal and tracheal mucosa separately after dissecting the TE space and dividing the TE tract as well as inset of well-vascularized tissue and muscular flaps including sternohyoid, sternocleidomastoid, intercostal, latissimus dorsi, pectoralis major, or radial free flaps between the trachea and esophagus constitute the mainstay of the surgical repair of enlarged TEP [7,8].…”

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.…”

Feasibility of a bilateral regional sternocleidomastoid muscular flap in the closure of a persistent acquired tracheopharyngeal fistula

“…Documented risk of a periprosthetic leak can rise up to 10% and may put the patient at risk for aspiration pneumonia 2. Most fistulas have a tendency to heal spontaneously after the removal of the prosthesis but some may persist due to various factors such as an underlying comorbidity.…”