title: Technique to Improve Tracheostomy Speaking Valve Tolerance after Head and Neck Free Flap Reconstruction.
abstract: Increased upper airway resistance from postoperative changes after major head and neck surgery may cause elevated transtracheal pressures and result in tracheostomy speaking valve intolerance. This may be particularly true among patients with baseline pulmonary disease. We describe a patient recovering from oral cancer resection and flap reconstruction who demonstrated prolonged ventilator dependence and tracheostomy speaking valve intolerance with abnormal tracheal manometry. We attempted to improve speaking valve tolerance through the adaptation of a valve modification intended to reduce transtracheal pressures. Drilling holes into the 1-way speaking valve allowed for excess air egress and resulted in normalization of transtracheal pressures with improved speaking valve tolerance. This 1-way speaking valve modification may serve as a simple method to allow for earlier restoration of voicing and potentially reduce the number of ventilator- dependent days in this patient population.
authors.affiliation: Hansjorg Wyss Department of Plastic Surgery, NYU Langone Medical Center, New York, N.Y.; Department of Speech & Language Pathology, Rusk Rehabilitation, NYU Langone Medical Center, New York, N.Y.; and Department of Oral Maxillofacial Surgery, Lenox Hill Hospital, New York, N.Y.
authors.forename: John T
authors.initials: JT
authors.lastname: Stranix
authors.affiliation: Hansjorg Wyss Department of Plastic Surgery, NYU Langone Medical Center, New York, N.Y.; Department of Speech & Language Pathology, Rusk Rehabilitation, NYU Langone Medical Center, New York, N.Y.; and Department of Oral Maxillofacial Surgery, Lenox Hill Hospital, New York, N.Y.
authors.forename: Keri M
authors.initials: KM
authors.lastname: Danziger
authors.affiliation: Hansjorg Wyss Department of Plastic Surgery, NYU Langone Medical Center, New York, N.Y.; Department of Speech & Language Pathology, Rusk Rehabilitation, NYU Langone Medical Center, New York, N.Y.; and Department of Oral Maxillofacial Surgery, Lenox Hill Hospital, New York, N.Y.
authors.forename: Veturia L
authors.initials: VL
authors.lastname: Dumbrava
authors.affiliation: Hansjorg Wyss Department of Plastic Surgery, NYU Langone Medical Center, New York, N.Y.; Department of Speech & Language Pathology, Rusk Rehabilitation, NYU Langone Medical Center, New York, N.Y.; and Department of Oral Maxillofacial Surgery, Lenox Hill Hospital, New York, N.Y.
authors.forename: Ginger
authors.initials: G
authors.lastname: Mars
authors.affiliation: Hansjorg Wyss Department of Plastic Surgery, NYU Langone Medical Center, New York, N.Y.; Department of Speech & Language Pathology, Rusk Rehabilitation, NYU Langone Medical Center, New York, N.Y.; and Department of Oral Maxillofacial Surgery, Lenox Hill Hospital, New York, N.Y.
authors.forename: David L
authors.initials: DL
authors.lastname: Hirsch
authors.affiliation: Hansjorg Wyss Department of Plastic Surgery, NYU Langone Medical Center, New York, N.Y.; Department of Speech & Language Pathology, Rusk Rehabilitation, NYU Langone Medical Center, New York, N.Y.; and Department of Oral Maxillofacial Surgery, Lenox Hill Hospital, New York, N.Y.
authors.forename: Jamie P
authors.initials: JP
authors.lastname: Levine