THE INDIAN EXPERIENCE WITH IMMEDIATE TRACHEOESOPHAGEAL PUNCTURE FOR VOICE RESTORATION

A 3-year prospective study on primary tracheoesophageal puncture was c arried out at Nanavati Hospital and Tata Memorial Hospital, Bombay, to assess its feasibility in a developing country and its success in voc al rehabilitation. We report our experience with primary tracheoesopha geal puncture in 64 patients (57 males and 7 females) following surgic al treatment for carcinoma of the pyriform fossa (45 cases) and endola rynx (19 cases). All patients underwent total laryngectomies with or w ithout partial pharyngectomy and primary pharyngeal mucosal closure. F ifty-one patients underwent primary surgery followed by postoperative radiotherapy. At 3 months successful tracheoesophageal speech was achi eved in 84% patients, although this percentage decreased to 67% at 9 m onths. There were no major complications. Successful vocal rehabilitat ion was related more to ''patient factors'' such as delays in seeking medical attention when prosthetic valves dislodged, improper use and c are of the valves and inability to learn speech with the prosthesis. O verall, primary tracheoesophageal puncture was found to be feasible an d should be used more extensively for vocal rehabilitation following l aryngectomy in developing countries.