Complications of medical and surgical approaches to voice restoration after total laryngectomy

Experiences with tracheoesophageal puncture are presented that confirm the beneficial experience of others in providing a superior means of voice rehabilitation. As with all surgical procedures, there is a short-term and long-term price to pay in terms of complications. The complications include allergy to tape, esophageal perforation, enlarging fistula, stomal stenosis, fistula migration, cellulitis, esophageal stenosis, pneumonia, and death from aspiration pneumonia. Careful selection of patients lessens the chances for complications and failure. Simultaneous laryngectomy and creation of a speaking fistula have been abandoned because of long-term, serious healing problems. In spite of the complications encountered, the authors feel that the tracheoesophageal voice fistula provides a superior means for vocal rehabilitation in total laryngectomy patients who do not develop esophageal speech.

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