Tracheoesophageal voice prosthesis

A tracheoesophageal voice prosthesis is a medical device that connects the trachea and esophagus to restore voice and speech communication following a total laryngectomy. It allows patients to generate the most natural and intelligible sound and voice compared to other laryngeal speech techniques¹.

Contraindications

Not all patients with total laryngectomy benefit from a voice prosthesis since these devices require daily cleaning, care, and replacement at regular intervals ^2.

The main contraindications are ¹:

• impaired pulmonary function and/or mental status

• poor dexterity and eyesight

• inability to take care of tracheostomy and voice prosthesis

• recurrent dislodging of the prosthesis

Technique

The voice prosthesis is a one-way valve prosthesis inserted through a tracheoesophageal puncture after a total laryngectomy.

This prosthesis allows immediate sound creation after its insertion ³.

The prosthesis comprises an anterior tracheal flange and a posterior esophageal flange. The two are connected by a barrel containing a one-way valve that allows air flow when the tracheostoma is occluded.

Complications

Althoug primary transoeophageal puncture (realized during the total laryngectomy) avoids additional surgical procedures, it is associated with more post-operative complications such as:

• local infection

• leakage at the puncture site

• stomal stenosis

Long-term complications are:

• aspiration pneumonitis - fluid leakage from the esophagus to the trachea

• leakage around the prosthesis due to dilatation of the tracheoseophageal puncture tract, or displacement of the prosthesis

• bronchial aspiration of the voice prosthesis - dislodged within the tracheobronchial tree

• valve dysfucntion (stuck in open position due to a piece of food or mucus)

• prosthesis is not fitted (too long) for the patient's tract

• dysphagia - the configuration of the esophageal flange may interrupt bolus flow. It can also contribute to residue accumulation on the prosthesis resulting in swallowing difficulties ^4,5. Other than the voice prosthesis, many others factors can influence the amount of residue and dsyphagia, such as anatomy,type and amount of food consistency ⁴.

History and etymology

This surgical voice restorating method is first introduced in by Singer and Blom in 1979 ⁶.