title: A thin tracheal silicone washer to solve periprosthetic leakage in laryngectomies: direct results and long-term clinical effects.
abstract: OBJECTIVE
  Assessment of the immediate results and long-term clinical effects of a thin silicone washer placed behind the tracheal flange of voice prostheses to treat periprosthetic leakage.
  
  
  METHODS
  Three year retrospective analysis of 32 laryngectomized patients with 107 periprosthetic leakage events (PLEs). Custom-made silicone washers (outer diameter 18 mm, inner diameter 7.5 mm, thickness 0.5 mm) were placed behind the tracheal flange either in combination with prosthesis replacement or later.
  
  
  RESULTS
  There was immediate resolution of periprosthetic leakage in 88 PLEs (median, 38 d; mean, 53 d; range, 8-330 d) and in 6 PLEs with the washer still in situ at the date of analysis (median, 75; mean, 97 d; range, 38-240 d). There was no resolution for periprosthetic leakage in 13 PLEs. Thus, in total, 94 of 107 PLEs (88%) were successfully resolved. In 29 of 32 (91%) patients, the washer resolved the problem at least in one PLE successfully. Twelve of 32 patients, including all 3 with washer failures, also required other interventions to ultimately solve the problem. The vast majority of patients (80%) did not consider placement of the washer to be inconvenient.
  
  
  CONCLUSIONS
  In consideration of the high success rate and limited inconvenience for patients, this simple thin silicon washer application provides a good first option for the treatment of periprosthetic leakage.
authors.affiliation: Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. f.hilgers@nki.nl
authors.forename: Frans J M
authors.initials: FJ
authors.lastname: Hilgers
authors.forename: Jessica
authors.initials: J
authors.lastname: Soolsma
authors.forename: Annemieke H
authors.initials: AH
authors.lastname: Ackerstaff
authors.forename: Fons J M
authors.initials: FJ
authors.lastname: Balm
authors.forename: I Bing
authors.initials: IB
authors.lastname: Tan
authors.forename: Michiel W M
authors.initials: MW
authors.lastname: van den Brekel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001672:Biocompatible Materials; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007825:Laryngectomy / Q000009:adverse effects; D007831:Larynx, Artificial; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010614:Pharynx / Q000601:surgery; D011183:Postoperative Complications / Q000517:prevention & control; D011474:Prosthesis Design; D011475:Prosthesis Failure; D017755:Prosthesis Fitting; D018714:Radiotherapy, Adjuvant; D019651:Plastic Surgery Procedures; D012008:Recurrence; D012189:Retrospective Studies; D012828:Silicones; D013499:Surface Properties; D016896:Treatment Outcome
chemical_list: D001672:Biocompatible Materials; D012828:Silicones