Simple and safe puncture technique for voice prosthesis implantation.
OBJECTIVE
A simplified esophagotracheal (ET) puncture technique is described for use instead of the Blom-Singer method for voice prosthesis implantation, with the aim to offer an easier alternative for the same purpose. Study population Of 68 study patients, there were 10 women and 58 men (age range, 46 to 80 years) who had been operated on during a 5-year period with use of this technique. Of the 68 patients, 57 were able to learn to speak in a fluent voice acceptable for everyday communication after the implantation. Seven of the 57 patients had a spasm in the cricopharyngeus muscles and were able to speak only after myotomy.


METHODS
Sixty-eight patients were implanted with voice prosthesis using the ET puncture technique as follows: through the laryngoscope, the distal bent blunt end of the endoextralaryngeal needle carrier is led into the esophagus. The needle with the leading thread (2-0 Prolene) is pushed through in the upper third of the tracheostoma from inside out. Afterward, the cone-trocar catheter is pulled through the stitching canal in the upper third of the tracheostoma. Using the ET puncture technique, the puncture site is the same as with the use of the Blom-Singer method, 5 to 8 mm below the mucocutaneous junction. Then the cone-trocar is cut off from the 18 charrier catheter and the guide wire is pushed inside the catheter through the esophagus, pharynx, and mouth. The voice prosthesis will be fixed on the guide wire and then pulled back in the opening of the fistula.


RESULTS
There were no problems or complications with this technique. In 4 cases, the ET puncture could be performed on patients in whom it was not previously possible with the Blom-Singer technique.


CONCLUSIONS
This management approach offers an alternative to the Blom-Singer technique. The advantage of the ET puncture is that it is simple and safe and that the back wall of the pharynx or esophagus cannot be damaged. Using the ET puncture technique, the possibility of complications is eliminated.
Lichtenberger
György
G
Department of Otorhinolaryngology, Head and Neck Surgery, Szent Rókus Hospital and Institutions, Budapest, Hungary. ORL.rokus@mailbox.hu
D000368:Aged; D000369:Aged, 80 and over; D004947:Esophagus / Q000601:surgery*; D005260:Female; D006801:Humans; D007825:Laryngectomy; D007831:Larynx, Artificial; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000379:methods*; D011677:Punctures; D013071:Speech, Alaryngeal; D014132:Trachea / Q000601:surgery*