How we do it: Secondary tracheoesophageal puncture under local anaesthetic, using a trans-nasal flexible laryngo-oesophagoscope (TNFLO)

We describe our technique for the formation of a secondary tracheoesophageal puncture and insertion of a voice prosthesis under local anaesthetic in the out-patient department. We use a trans-nasal flexible laryngo-oesophagoscope (TNFLO) to provide direct visualization of the procedure allowing early detection and rectification of any problems that might arise.