title: Primary tracheoesophageal puncture and cricopharyngeal myotomy in stapler-assisted total laryngectomy.
abstract: OBJECTIVE
  To evaluate the utility of the hybrid tracheoesophageal puncture procedure in stapler-assisted laryngectomy.
  
  
  METHODS
  Patients who underwent total laryngectomy at a single institution from 2009 to 2015 were reviewed. The interventions assessed were surgical creation of a tracheoesophageal puncture and placement of a voice prosthesis. The outcomes measured included voicing ability and valve failure.
  
  
  RESULTS
  Thirty-nine patients underwent total laryngectomy or pharyngolaryngectomy. Of these, nine underwent stapler-assisted laryngectomy; seven of the nine patients underwent concurrent stapler-assisted laryngectomy, cricopharyngeal myotomy and a hybrid tracheoesophageal puncture procedure. These seven patients were the focus of this review. Successful voicing and oral alimentation was achieved in all patients. Mean time to phonation was 30 days (range, 7-77 days) and mean time to first valve change was 90 days (range, 35-117 days).
  
  
  CONCLUSIONS
  Primary tracheoesophageal puncture with concurrent voice prosthesis placement and cricopharyngeal myotomy is easily performed with stapler-assisted laryngectomy. The hybrid tracheoesophageal puncture procedure is a simple method that enables a single operator to achieve primary tracheoesophageal puncture and valve placement; in addition, it facilitates concurrent cricopharyngeal myotomy.
authors.affiliation: Department of Otolaryngology / Head and Neck Surgery,Stanford University School of Medicine,California,USA.
authors.forename: D M
authors.initials: DM
authors.lastname: Beswick
authors.affiliation: Department of Otolaryngology / Head and Neck Surgery,Stanford University School of Medicine,California,USA.
authors.forename: E J
authors.initials: EJ
authors.lastname: Damrose
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D002813:Chondrosarcoma / Q000601:surgery; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005870:Giant Cell Tumors / Q000601:surgery; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000601:surgery*; D007825:Laryngectomy / Q000379:methods* / Q000534:rehabilitation; D007831:Larynx, Artificial; D008297:Male; D008875:Middle Aged; D010609:Pharyngeal Muscles / Q000601:surgery*; D010699:Phonation; D019919:Prosthesis Implantation; D011677:Punctures / Q000379:methods; D013071:Speech, Alaryngeal / Q000379:methods*; D000077195:Squamous Cell Carcinoma of Head and Neck; D014132:Trachea / Q000601:surgery*; D016896:Treatment Outcome
keywords: Laryngectomy; Larynx; Neoplasms; Punctures; Surgical Staplers; Voice