• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.12 no.2
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• pp.152-157
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• 2001

Background : Electrolarynx, Esophageal voice, and Silicone voice prosthesis with tracheoesophageal(T-E) fistula have been used as vocal rehabilitating methods for the post-laryngectomized patients. Prosthetic rehabilitation of voice after total laryngectomy has gained wide acceptance and has become a common practice in many clinics since the pioneering works of Singer and Blom In 1979. Since the introduction of tracheo-esophageal puncture and application of Blom Singer$\circledR$ voice prosthesis in 1980, several reliable voice prostheses have been developed and are successfully being used. Objectives : Even though quality of voice produced by Silicone voice prosthesis with T-E fistula is superior to other modalities, it still has some disadvantages. We devised a new cannulatyped silicone voice prosthesis. Methods : 1) Devising a new prototype of cannula-typed silicone voice prosthesis. 2) Application of the prototype using canine animal model(laryngectormized dog) and fitting trial on human patient whose previously inserted Silicone voice prosthesis is not functioning due to presumed fungal infection. Discussion : Final form of prototype was made after several times of major and minor modifications. Insertion of the newly developed Cannula-typed Silicone voice prosthesis on canine animal model and human trial were done without any difficulty. There were no serious leakage of saliva or food during swallowing. Conclusion : The newly developed Cannula-typed Silicone voice prosthesis(So-Mang$\circledR$) and the modified replacement method will further improve the results of post-laryngectomized prosthetic voice rehabilitation. Long-term animal study and human trial are planned in the near future.

• Proceedings of the KSLP Conference
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• 2001.11a
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• pp.167-167
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• 2001

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.13 no.2
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• pp.155-163
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• 2002

Background and Objectives : Esophageal voice, Silicone voice Prosthesis with tracheo-esophageal (T-E) puncture have been used as vocal rehabilitation methods for postlaryngectomy. However, long-term follow-up in the voice rehabilitation in the total laryngectomees has not been reported. The purpose of this study is to analyze practice of postlaryngectomy voice rehabilitation and to find the effective voice rehabilitation. Materials and Methods : From Jan 1992 until June 2002, 75 patients underwent a total laryngectomy at Yongdong Severance Hospital. We retrospectively studied voice rehabilitation methods commonly used, acquisition levels of esophageal speech, patients satisfaction scale (5 rating scale) according to the methods in 33 of them (40 died, 2 unavailable) by using charts review, telephone interview. Results : T-E speech is most commonly used by 14 patients (42.4%) : A tracheo-esophageal procedure (primary or secondary puncture) by 21 : and 8 patients removed Provox. 1 patient had no voice rehabilitation. 7 patients (21.2%) have used esophageal speech : 4 patients of them have used it after removing Provox. Electrolarynx has been used with other voice rehabilitation methods : 4 patients have only used this method and 3 patients with T-E speech, 1 patient with esophageal speech. However, 6 patients (18%) remained without a substitute voice rehabilitation. In the satisfaction with speech and management of voice rehabilitation methods, patients using esophageal speech were most satisfied (4.1), patients with T-E speech were unsatisfied (2.3). Regarding with the acquisition level of esophageal speech in 33 patients, 22 patients (66.6%) failed without functional speech. Conclusion : To increase patients satisfaction and to achieve successful voice rehabilitation after total laryngectomy, preoperative counseling, pretesting, appropriate patient selection of each method and team decision-making and postoperative voice therapy must be considered.

• Archives of Plastic Surgery
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• v.49 no.5
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• pp.617-632
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• 2022

Tracheoesophageal puncture (TEP) and voice prosthesis insertion following laryngectomy may fail to form an adequate seal. When spontaneous closure of the fistula tract does not occur after conservative measures, surgical closure is required. The purpose of this study was to summarize the available evidence on surgical methods for TEP site closure. A comprehensive search across PubMed, Web of Science, SCOPUS, and Cochrane was performed to identify studies describing surgical techniques, outcomes, and complications for TEP closure. We evaluated the rate of unsuccessful TEP closure after surgical management. A meta-analysis with a random-effect method was performed. Thirty-four studies reporting on 144 patients satisfied inclusion criteria. The overall incidence of an unsuccessful TEP surgical closure was 6% (95% confidence interval [CI] 1-13%). Subgroup analysis showed an unsuccessful TEP closure rate for silicone button of 8% (95% CI < 1-43%), 7% (95% CI < 1-34%) for dermal graft interposition, < 1% (95% CI < 1-37%) for radial forearm free flap, < 1% (95% CI < 1-52%) for ligation of the fistula, 17% (95% CI < 1-64%) for interposition of a deltopectoral flap, 9% (95% CI < 1-28%) for primary closure, and 2% (95% CI < 1-20%) for interposition of a sternocleidomastoid muscle flap. Critical assessment of the reconstructive modality should take into consideration previous history of surgery or radiotherapy. Nonirradiated fields and small defects may benefit from fistula excision and tracheal and esophageal multilayer closure. In cases of previous radiotherapy, local flaps or free tissue transfer yield high successful TEP closure rates. Depending on the defect size, sternocleidomastoid muscle flap or fasciocutaneous free flaps are optimal alternatives.