SURGICAL CLOSURE OF PERSISTING FAILED TRACHEOESOPHAGEAL VOICE FISTULA

Tracheoesophageal puncture (TEP) is a highly successful procedure for voice restoration. Occasionally, however, patients fail to achieve sat isfactory voice or develop salivary leakage through the fistula into t he trachea. Closure of the TEP is then necessary. In most cases, spont aneous closure occurs once the prosthesis has been removed. When the f istula does not close spontaneously, surgical closure is indicated to prevent aspiration and pulmonary complications. We describe a three-la yer closure technique that employs interposition of dermal graft. The technique was used on 14 patients over a 7-year period. Most patients received irradiation to the neck. Complete closure was achieved in 13 of 14 cases; 1 patient developed partial breakdown of the closure. Our technique is relatively easy to perform and has a high success rate ( 92%). Irradiation did not adversely affect the closure rate.