SUBMENTAL ABSCESS - AN UNUSUAL DELAYED COMPLICATION OF PRIMARY BLOM-SINGER VALVE INSERTION

Voice restoration following laryngectomy can be achieved by the now we ll accepted technique of inserting a 'Blom-Singer' prosthesis through a tracheo-oesophageal fistula created either primarily or secondarily. Recognized complications of primary puncture and valve insertion incl ude haemorrhage, oesophageal perforation, peristomal cellulitis and as piration of saliva. We describe the previously unreported complication of a submental abscess developing probably as a result of air being f orced from the fistula up between the trachea and the pharynx, this pl ane not having fully healed as a result of previous radiotherapy. The problem was compounded by the patient's over-zealous attempts to phona te. To prevent this problem arising in future we recommend leaving the fistula at least six weeks to mature before inserting the valve, when the patient has had previous radiotherapy, and encouraging relaxation when learning to phonate with this technique.