title: Evaluation of voice prosthesis placement at the time of primary tracheoesophageal puncture with total laryngectomy.
abstract: OBJECTIVE
  Primary tracheoesophageal puncture (TEP) is a well-described and accepted method of surgical voice restoration and is standardly completed with a catheter placement intraoperatively, which is replaced with a prosthesis at a later date. This study evaluates the intraoperative placement of the voice prosthesis at the time of the primary TEP in an effort to understand the potential advantages and disadvantages of voice prosthesis placement at the time of primary TEP completed in conjunction with total laryngectomy.
  
  
  METHODS
  Retrospective chart review within an academic medical center.
  
  
  METHODS
  After approval by the institutional review board of the Massachusetts Eye and Ear Infirmary, a retrospective chart review was completed of all cases of primary tracheoesophageal prosthesis placement completed in conjunction with primary tracheoesophageal puncture performed at the time of total laryngectomy.
  
  
  RESULTS
  Thirty patients were identified, 29 of whom underwent laryngectomy for advanced laryngeal carcinoma. Twenty-eight of 29 patients received preoperative full-dose radiation therapy. Twenty-nine of 30 patients had a 20F classic Indwelling Blom-Singer prosthesis (InHealth Technologies, Carpinteria, CA) placed. One had placement of 16F Indwelling Blom-Singer prosthesis. No complications were noted with intraoperative prosthesis placement. No prostheses were dislodged in the postoperative period. Twenty-nine of 30 subjects had initial success with tracheoesophageal voice production. At 1-year follow-up, 23/30 subjects (77%) had successful voice restoration. Five failed because of recurrent disease, one subject never achieved successful voice, and one subject wanted the prosthesis removed although successful voice was achieved. Twenty-three of 25 (92%) disease-free subjects had functional voice restoration at 1-year post-total laryngectomy and primary prosthesis placement.
  
  
  CONCLUSIONS
  This study demonstrates that the voice prosthesis can be safely and effectively placed intraoperatively at the time of primary TEP and laryngectomy. Initial voice acquisition rates were high and long-term success was well within the acceptable range.
authors.affiliation: Massachusetts Eye and Ear Infirmary, Division of Head and Neck Surgery, Department of Otology and Laryngology, Harvard Medical School, Boston 02114, Massachusetts, USA. daniel_deschler@meei.harvard.edu
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Deschler
authors.forename: Glenn W
authors.initials: GW
authors.lastname: Bunting
authors.forename: Derrick T
authors.initials: DT
authors.lastname: Lin
authors.forename: Kevin
authors.initials: K
authors.lastname: Emerick
authors.forename: James
authors.initials: J
authors.lastname: Rocco
mesh_terms: D003131:Combined Modality Therapy; D004947:Esophagus / Q000601:surgery*; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D007825:Laryngectomy; D007831:Larynx, Artificial; D008297:Male; D011183:Postoperative Complications; D011474:Prosthesis Design; D011475:Prosthesis Failure; D019919:Prosthesis Implantation / Q000379:methods*; D011677:Punctures; D012189:Retrospective Studies; D014132:Trachea / Q000601:surgery*; D016896:Treatment Outcome