A Study of Primary and Secondary Tracheoesophageal Voice Prostheses in Total Laryngectomy

BACKGROUND: Tracheoesophageal puncture and placement of voice prosthesis have become the effective method of choice to achieve voice rehabilitation after total laryngectomy. A study has been conducted in post laryngectomized patient who undergone either primary and secondary tracheoesophageal puncture with insertion of voice prosthesis and speech therapy. These patients are followed up to our institution for every 3 months or longer to compare the complications of tracheoesophageal puncture and success rate in functional outcome of voice rehabilitation. AIMS AND OBJECTIVES: 1. To study the complications in primary and secondary tracheoesophageal puncture following total laryngectomy 2. To determinate the success rate of functional voice outcome in primary and secondary tracheoesophageal voice prostheses. STUDY PLACE : Rajiv Gandhi Government General Hospital, Chennai – 600 003 COLLABORATING DEPARTMENT : Upgraded Institute of Otorhinolaryngology. STUDY DESIGN : Retrospective and Prospective study. STUDY PERIOD : November 2020 to December 2021. SAMPLE SIZE : 20. INCLUSION CRITERIA: ◙ Age group : 40 to 75 years. ◙ Both sex male and female. ◙ Patient undergoing total laryngectomy for the treatment of laryngeal malignancy. ◙ Adequate pulmonary reserve. ◙ Post laryngectomy stoma healthy. EXCLUSION CRITERIA : ◙ Age group < 40 years. ◙ Recurrence carcinoma. ◙ Multiple metastasis in head and neck. ◙ Inadequate pulmonary reserve. ◙ Extensive surgery involving pharynx and larynx with separation of tracheoesophageal party wall. ◙ Impaired hand dexterity. MATERIALS AND METHODS : A Prospective and Retrospective study was carried out with 20 patients who underwent total laryngectomy subjected to voice rehabilitation by the placement of voice prostheses by means of tracheoesophageal puncture at Upgraded Institute of Otorhinolaryngology, Rajiv Gandhi Government General Hospital, Chennai. Patients were divided into two groups according to the type of tracheoesophageal puncture received, who were implanted with blom singer duckbill voice prostheses immediately (primary TEP) or after (secondary TEP) the surgery. CONCLUSION: Tracheoesophageal puncture is an effective method of choice for voice rehabilitation in laryngectomized patient. The percentage of successful voice rehabilitation, device lifetime and surgical and prosthetic complications between primary and secondary TEP are comparable . The rate of surgical complications are slightly high in primary TEP than secondary TEP which was statistically significant . The increase in rate of voice prosthesis lifetime was seen in secondary TEP because of second surgery after salvage surgery with postoperative radiotherapy and decrease in surgical and prosthetic complications and also increase in rate of complications diminish the voice prosthesis life time in primary TEP but the rate of percentage of successful functional voice outcome are comparatively more in primary TEP. Effective surgical restoration with prosthetic valve by TEP and careful selection of patients with good hand dexterity, motivation effective speech therapy with capacity to learn quick leads to satisfactory functional voice outcome for a high rate of successful voice rehabilitation in most laryngectomized patients