title: Complications following tracheoesophageal puncture: a tertiary hospital experience.
abstract: BACKGROUND
  In laryngectomised patients, tracheoesophageal speech is the gold standard for voice rehabilitation. This study evaluated complications related to the tracheoesophageal puncture (TEP) and the success rate in voice prosthesis after total laryngectomy at our institution over a 10-year period.
  
  
  METHODS
  A retrospective review of 22 TEPs was performed between January 1998 and December 2008. The timing of TEP, type of voice prosthesis, surgical and prosthesis-related complications, and TEP closure were noted.
  
  
  RESULTS
  Eighteen percent of the patients underwent primary and 82% secondary TEP. Our patients were predominantly males (95.4%) of Chinese descent with a mean age of 62.1 years. The types of voice prostheses used were ProvoxTM (n = 15), Voicemasters (n = 6), and Blom-Singer (n = 1). Prosthesis- related complications occurred in 77.3%. Notable complications were leakage (82.5%), prosthesis displacement (41.2%), intractable aspiration (29.4%), and aspiration of prosthesis (23.5%). The most common surgical-related complication was tracheostomal stenosis. An array of interventions comprising resizing or changing prosthesis type, nasogastric catheter insertion, stomaplasty, purse string suturing, and bronchoscopic removal of bronchial aspirated prosthesis were implemented to address encountered complications. In a mean follow-up of 34.8 months, 68.2% of patients achieved functional tracheoesophageal speech (75% of primary TEP and 67% of secondary TEP). There were 7 TEP closures indicated by persistent leakage, recurrent dislodgement, phonatory failure and, in 1 patient, persistent pain.
  
  
  CONCLUSIONS
  TEP has become an integral part in the rehabilitation of a laryngectomee. However, management of the frequent complications related to TEP requires specific efforts and specialistic commitments in order to treat them.
authors.affiliation: Department of Otorhinolarygology, Head and Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
authors.forename: Pengiran Suhaili
authors.initials: PS
authors.lastname: Dayangku Norsuhazenah
authors.forename: Marina Mat
authors.initials: MM
authors.lastname: Baki
authors.forename: Mohd Razif
authors.initials: MR
authors.lastname: Mohamad Yunus
authors.forename: Primuharsa Putra
authors.initials: PP
authors.lastname: Sabir Husin Athar
authors.forename: Sani
authors.initials: S
authors.lastname: Abdullah
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000328:Adult; D000368:Aged; D003251:Constriction, Pathologic / Q000453:epidemiology / Q000209:etiology; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D015994:Incidence; D007825:Laryngectomy / Q000534:rehabilitation*; D007831:Larynx, Artificial / Q000009:adverse effects*; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011677:Punctures / Q000009:adverse effects*; D012189:Retrospective Studies; D013071:Speech, Alaryngeal; D014132:Trachea / Q000601:surgery