title: Placement of a 16-French voice prosthesis at the time of secondary tracheoesophageal voice restoration.
abstract: OBJECTIVE
  Tracheoesophageal voice restoration (TEVR) has traditionally been described with fistula tract creation, catheter placement, and prosthesis placement. Prosthesis placement at the time of tracheoesophageal puncture (TEP) utilizing 20-French prostheses has been previously described. Smaller initial prostheses may allow fluent speech with reduced long-term complications, such as widening of the fistula and peri-prosthesis leakage. This study evaluates the safety and efficacy of the 16-French prostheses placement at the time of secondary TEP.
  
  
  METHODS
  All cases of 16-French tracheoesophageal voice prosthesis (TEVP) placement at the time of secondary TEP were reviewed from 1/2011 through 12/2013 at a large academic medical center. Perioperative complications attributable to device placement were recorded, including inability to place prosthesis, intraoperative complications, post-operative infection, prosthesis dislodgement, prosthesis leakage, and inability to obtain voice.
  
  
  RESULTS
  Twenty-one patients received placement of a 16-French TEVP at the time of secondary TEP. All prostheses were placed without intraoperative complications. The proportion of patients who had minor complications within the first postoperative month was 23.8%, including leakage through the prosthesis (3 of 21), granulation tissue near the prosthesis (1 of 21), retained sheath (1 of 21) and prosthesis displacement (1 of 21). Leakage and displacement were addressed with change and replacement, respectively. Fluent voicing was achieved in 85.7% patients, with a median time to voicing of 18.5days.
  
  
  CONCLUSIONS
  Placement of 16-French TEVPs is effective and safe, with an acceptable rate of minor complications attributable to the prosthesis. Therefore, a smaller prosthesis may be primarily placed at the time of secondary TEP and is our preference.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, United States; Department of Otology and Laryngology, Harvard Medical School, 25 Shattuck Street, Boston, MA, United States. Electronic address: Matthew_Naunheim@meei.harvard.edu.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Naunheim
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, United States; Department of Otology and Laryngology, Harvard Medical School, 25 Shattuck Street, Boston, MA, United States. Electronic address: Aaron_Remenschneider@meei.harvard.edu.
authors.forename: Aaron K
authors.initials: AK
authors.lastname: Remenschneider
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, United States; Department of Otology and Laryngology, Harvard Medical School, 25 Shattuck Street, Boston, MA, United States. Electronic address: Glenn_Bunting@meei.harvard.edu.
authors.forename: Glenn W
authors.initials: GW
authors.lastname: Bunting
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, United States; Department of Otology and Laryngology, Harvard Medical School, 25 Shattuck Street, Boston, MA, United States. Electronic address: Daniel_Deschler@meei.harvard.edu.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Deschler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004947:Esophagus / Q000601:surgery*; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000601:surgery; D007825:Laryngectomy; D007831:Larynx, Artificial; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000379:methods*; D011677:Punctures; D012189:Retrospective Studies; D014132:Trachea / Q000601:surgery*; D016896:Treatment Outcome