title: Video laryngoscopy-assisted secondary tracheoesophageal puncture placement for the patient with severely limited neck extension.
abstract: Secondary tracheoesophageal puncture (TEP) placement in patients with severe limitations in neck extension is challenging. Visualization of the hypopharynx with traditional rigid endoscopy may not be possible. We report using the C-MAC (Karl Storz, Tuttlingen, Germany) video laryngoscope to successfully place a secondary TEP in patient with severe radiation fibrosis at a tertiary referral center. A 59-year-old male with severe radiation fibrosis of the neck underwent total laryngectomy for a nonfunctioning larynx. His primary TEP dislodged in the early postoperative period and the patient requested secondary TEP and voice prosthesis. The result was a successful, properly positioned, placement of a secondary TEP. Videolaryngoscopy should be included in the surgeon's armamentarium of techniques to effectively and safely perform secondary TEP in anatomically difficult patients.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390-9035, USA.
authors.forename: Emily E
authors.initials: EE
authors.lastname: Crozier
authors.forename: Kevin
authors.initials: K
authors.lastname: Klein
authors.forename: Janis
authors.initials: J
authors.lastname: Deane
authors.forename: Laura E
authors.initials: LE
authors.lastname: Toles
authors.forename: Larry L
authors.initials: LL
authors.lastname: Myers
mesh_terms: D004947:Esophagus / Q000601:surgery*; D005355:Fibrosis / Q000209:etiology; D006801:Humans; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000473:pathology; D011677:Punctures / Q000379:methods*; D011832:Radiation Injuries / Q000150:complications; D014132:Trachea / Q000601:surgery*; D020535:Video-Assisted Surgery