Use of Ultrasound for Sizing Tracheoesophageal Puncture Prostheses

Abstract

Tracheoesophageal puncture (TEP) with voice prosthesis placement is the gold standard voice rehabilitation following total laryngectomy. Ultrasound may be useful to determine tracheoesophageal wall thickness, guiding prosthesis choice. Therefore, 14 patients undergoing total laryngectomy and TEP or prosthesis change with 16-mHz ultrasound measurement of the posterior tracheal wall were included. Seven patients underwent secondary TEP, 3 primary TEP, and 4 TEP changes. Six patients underwent flap reconstruction, while 8 patients were closed primarily. Average party wall thickness was 9.6 ± 1.7 mm, without a difference ( P = .08) between primary closure (10.3 ± 1.7 mm) and flap reconstruction (8.6 ± 1.4 mm). Change from the hypothesized sizing was noted in 11 patients (79%). Prosthesis size did not correlate with age (-0.19, P = .51), height (-0.12, P = .69), weight (0.26, P = .38), body mass index (0.22, P = .46), or flap status (-0.48, P = .079). These data suggest that ultrasound is beneficial in patients with distorted or less predictable anatomy (eg, flap reconstruction) but also important for those patients undergoing primary closure.

Head and Neck Ultrasound Utilization Rates: 2012 to 2019

“…4 Its use has expanded to include ultrasound examination of the thyroid gland, vocal cord motion, parotid gland, submandibular gland, lymph nodes, head and neck primary biopsy, arterial evaluation, tracheaesophageal puncture (TEP) placement, abscess drainage, and submucosal cleft evaluation. 5 For Otolaryngologists, the increased use of HNUS across recent years is noteworthy. For example, in 2012, 9.82% of OTOs in the were classified as super users, submitting more than 100 charges apiece.…”

“…Point‐of‐care ultrasound allows same visit service and management decisions 4 . Its use has expanded to include ultrasound examination of the thyroid gland, vocal cord motion, parotid gland, submandibular gland, lymph nodes, head and neck primary biopsy, arterial evaluation, trachea‐esophageal puncture (TEP) placement, abscess drainage, and submucosal cleft evaluation 5 …”