title: Practical management of periprosthetic leakage in patients rehabilitated with a Provox® 2 voice prosthesis after total laryngectomy.
abstract: OBJECTIVE
  Periprosthetic leakage of liquids is a common complication in patients rehabilitated with voice prostheses. Our objective was to describe and review the results of procedures for treating periprosthetic leakage.
  
  
  METHODS
  This was a retrospective analysis of 41 patients rehabilitated with Provox® 2 voice prostheses between 1997 and 2015. We describe 3 techniques: periprosthetic silicon collar placement, injection of hyaluronic acid into the tracheoesophageal wall and the combination of the 2 techniques. We present a method to reduce the diameter of the tracheoesophageal fistula by removing the voice prosthesis and placing a nasogastric tube through the fistula.
  
  
  RESULTS
  In the 3 groups treated with silicone collar (n=5, 13 procedures), hyaluronic acid injection (n=5, 9 procedures) and the combination of both techniques (n=3, 5 procedures), we observed an increase in prosthesis lifespan of an average of 56 days (range 7-118 days), 32 days (range 3-55 days) and 63 days (range 28-136 days), respectively. The tracheoesophageal fistula diameter reduction was performed in 100% (n=6) of patients.
  
  
  CONCLUSIONS
  The use of silicone collars, injection of hyaluronic acid into the tracheoesophageal wall and the combination of both techniques for the treatment of periprosthesis leakage increase the lifespan of the prosthesis. Temporary prosthesis removal and placement of nasogastric tube has also been shown effective in our experience. These techniques are simple, inexpensive and reproducible, thereby reducing healthcare costs.
authors.affiliation: Departamento de Otorrinolaringología, Hospital General Universitario Gregorio Marañón, Madrid, España. Electronic address: eviatarf@gmail.com.
authors.forename: Eviatar
authors.initials: E
authors.lastname: Friedlander
authors.affiliation: Departamento de Otorrinolaringología, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors.forename: Paloma
authors.initials: P
authors.lastname: Pinacho Martínez
authors.affiliation: Departamento de Otorrinolaringología, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors.forename: Daniel
authors.initials: D
authors.lastname: Poletti Serafini
authors.affiliation: Departamento de Otorrinolaringología, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors.forename: Carlos
authors.initials: C
authors.lastname: Martín-Oviedo
authors.affiliation: Departamento de Otorrinolaringología, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors.forename: Tomás
authors.initials: T
authors.lastname: Martínez Guirado
authors.affiliation: Departamento de Otorrinolaringología, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors.forename: Bartolomé
authors.initials: B
authors.lastname: Scola Yurrita
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007825:Laryngectomy / Q000379:methods / Q000534:rehabilitation*; D007831:Larynx, Artificial; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy*; D011474:Prosthesis Design; D012189:Retrospective Studies
keywords: Fuga periprotésica; Laringectomía total; Periprosthetic leakage; Prótesis fonatorias; Rehabilitación fonatoria; Total laryngectomy; Voice prosthesis; Voice rehabilitation