title: [Perforation of the esophagus with a mediastinal abscess].
abstract: BACKGROUND
  Surgical voice rehabilitation after total laryngectomy is still only a partially solved problem. Because of easy handling and rare complications, the Provox voice prosthesis has become common in voice rehabilitation.
  
  
  METHODS
  The 69 year old patient underwent laryngectomy, selective bilateral neck dissection and the implantation of a Provox voice prosthesis because of a glottic squamous cell carcinoma (pT(4), pN(0), M(0)). Postoperative healing ensued without any complications. During adjuvant radiochemotherapy, the patient developed distinctive cervical edema which led to a tilting of the Provox prosthesis. Due to a perforation of the posterior esophageal wall, the patient developed a pronounced mediastinal abscess which was relieved through a transcervical mediastinotomy. Antibiotic therapy led to a partial remission of the symptoms.
  
  
  CONCLUSIONS
  Severe complications may not only occur during the early phase of surgical voice rehabilitation, but also at a much later stage, after completion of the healing process. A voice prosthesis which is too long or generates pressure from a radiogenic edema, cannula and finger pressure used to close the tracheostoma is transmitted through the prosthesis and may lead to a perforation of the posterior esophageal wall. In particular, when the tissue is injured during the course of radiotherapy, this type of complication should be taken into consideration.
authors.affiliation: HNO-Klinik des Klinikums der Stadt Ludwigshafen/Rhein gGmbH. scheuerk@klilu.de
authors.forename: K
authors.initials: K
authors.lastname: Scheuermann
authors.forename: K-W
authors.initials: KW
authors.lastname: Delank
mesh_terms: D000038:Abscess / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery*; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D004939:Esophageal Perforation / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007831:Larynx, Artificial / Q000009:adverse effects*; D008297:Male; D008477:Mediastinal Diseases / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery*; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery*; D016896:Treatment Outcome; D014832:Voice Disorders / Q000534:rehabilitation / Q000601:surgery
chemical_list: D000900:Anti-Bacterial Agents