Tracheo-oesophageal Puncture - Placement of The Voice Prosthesis

Placement of The Voice Prosthesis

There are two different methods that can be used to place the voice prosthesis: Primary placement: A voice prosthesis is placed into the puncture immediately after it is created. During the immediate postoperative period, the patient is fed through a feeding tube, either inserted directly into the stomach or through a more temporary version than extends from the nose into the stomach. This tube is removed when the patient is able to eat enough by mouth to maintain nutritional needs; this can be as early as the second day following surgery. Speech production with the voice prosthesis is initiated when the surgical area has healed, after clearance by the surgeon. The advantages of this method are: 1) the voice prosthesis stabilizes the TE wall, 2) the flanges of the device protect the puncture against leakage of fluids, stomach acids and other stomach contents, 3) there is no irritation or pressure from a stenting catheter, used to maintain the puncture opening until a voice prosthesis can be placed, 4) patients become quickly familiar with their prosthesis care as they receive instructions while hospitalized, 5) the patient will not have to undergo an outpatient procedure during which the voice prosthesis needs to be fitted, 6) many patients can learn to speak before the start of any post-operative radiation therapy (if indicated) 7) the patient can focus on voice production immediately, as wound healing allows.

Another advantage is that generally, the voice prosthesis placed at the time of surgery lasts relatively long and requires no early frequent replacements. The only disadvantage is that the patient will need to use a feeding tube for a few days.

Delayed placement: Instead of the voice prosthesis, a catheter (red rubber, Silastic Foley catheter, Ryle's tube) is introduced through the puncture into esophagus. The tube is sometimes utilized for feeding the patient during the immediate post operative period, or the patient has a standard feeding tube for feeding. The voice prosthesis is placed after the patient is able to eat sufficiently by mouth and speech production is initiated when healing has completed, after clearance by the surgeon. The advantage of this method is that the patient may be fed through the catheter, not requiring standard tube feeding. The primary disadvantage is that the patient will have to undergo an outpatient procedure to have the voice prosthesis placed. Another disadvantage can be the need for more frequent replacements early after fitting of the voice prosthesis due to changes in the length of the puncture.