Background/Aims: The tracheoesophageal prothesis (TEP) has become the primary modality for laryngeal communication after total laryngectomy due to high success rates, minimal morbidity, and more natural pulmonary driven speech. Fibrosis, kyphosis, and post-radiation contracture may preclude TEP placement through rigid esophagoscopy, and certain patients may not tolerate an in-office awake procedure. For such patients, a technique for flexible esophageal stenting and TEP placement is necessary. Methods: We performed a retrospective review of 3 patients who underwent TEP placement through endotracheal-tube esophageal stenting at the Massachusetts Eye and Ear Infirmary. Results: All 3 patients underwent laryngectomy after prior chemoradiotherapy for laryngeal cancer with resulting neck contracture and fibrosis preventing rigid esophagoscopy. All patients underwent successful TEP placement through endotracheal stenting without complication and developed excellent tracheoesophageal speech. Specific technical details are highlighted. Conclusions: In patients with anatomical constraints preventing traditional TEP placement through rigid esophagoscopy, fiberoptic guidance through an endotracheal tube stent provides a safe and efficient approach for TEP placement.

1.
Singer MI, Blom ED: An endoscopic technique for restoration of voice after laryngectomy. Ann Otol Rhinol Laryngol 1980; 89: 529–533.
2.
Finizia C, Bergman B: Health-related quality of life in patients with laryngeal cancer: a post-treatment comparison of different modes of communication. Laryngoscope 2001; 111: 918–923.
3.
Clements KS, Rassekh CH, Seikaly H, Hokanson JA, Calhoun KH: Communication after laryngectomy. An assessment of patient satisfaction. Arch Otolaryngol Head Neck Surg 1997; 123: 493–496.
4.
Glazer TA, Meraj T, Lyden TH, Spector ME: In-office secondary tracheoesophageal puncture with immediate prosthesis placement. Otolaryngol Head Neck Surg 2016; 155: 360–363.
5.
Deschler DG, Emerick KS, Lin DT, Bunting GW: Simplified technique of tracheoesophageal prosthesis placement at the time of secondary tracheoesophageal puncture (TEP). Laryngoscope 2011; 121: 1855–1859.
6.
Morrison MP, Chheda NN, Postma GN: The tough tracheoesophageal puncture. Am J Otolaryngol 2012; 33: 113–115.
7.
Doctor VS, Enepekides DJ, Farwell DG, Belafsky PC: Transnasal oesophagoscopy-guided in-office secondary tracheoesophageal puncture. J Laryngol Otol 2008; 122: 303–306.
8.
Britt CJ, Lippert D, Kammer R, Ford CN, Dailey SH, McCulloch T, Hartig G: Secondary tracheoesophageal puncture in-office using Seldinger technique. Otolaryngol Head Neck Surg 2014; 150: 808–812.
9.
Maniglia AJ: Vocal rehabilitation after total laryngectomy: a flexible fiberoptic endoscopic technique for tracheoesophageal fistula. Laryngoscope 1982; 92: 1437–1439.
10.
Sharma SD, Abed T, Philpott J: Secondary tracheo-oesophageal puncture using an endotracheal tube. Ann R Coll Surg Engl 2014; 96: 558–559.
11.
Cannon CR: Using an endotracheal tube in difficult secondary tracheoesophageal puncture: a novel technique. Otolaryngol Head Neck Surg 2001; 125: 117–119.
12.
Padhya TA, Athavale SM, Morgan JM, McCaffrey TV: An alternative approach for secondary tracheoesophageal puncture in the difficult laryngectomy neck. Laryngoscope 2008; 118: 266–269.
13.
Crozier EE, Klein K, Deane J, Toles LE, Myers LL: Video laryngoscopy-assisted secondary tracheoesophageal puncture placement for the patient with severely limited neck extension. Laryngoscope 2012; 122: 134–136.
14.
Trivedi NP, Kekatpure V, Kuriakose MA, Iyer S: Safe and simple method for secondary tracheoesophageal puncture using curved forceps. J Laryngol Otol 2009; 123:e19.
15.
Tkaczuk AT, Taylor RJ, Wolf JS: A novel device for placement of a secondary tracheoesophageal voice prosthesis: a preliminary feasibility study. ORL J Otorhinolaryngol Relat Spec 2018; 80: 36–40.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.