Ar. Mehta et al., THE INDIAN EXPERIENCE WITH IMMEDIATE TRACHEOESOPHAGEAL PUNCTURE FOR VOICE RESTORATION, European archives of oto-rhino-laryngology, 252(4), 1995, pp. 209-214
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.