Page 13 - Prosthetic voice rehabilitation-5th edition

2.5 ProvoxVegaXtraSeal The Provox Vega XtraSeal is a voice prosthesis with an second, extended (18mm), and thin (0.5 mm) esophageal flange for the treatment of periprosthetic leakage. The extended flange is only attached to the center portion of the standard esophageal flange and is angling downwards to enhance the contact of the esophageal mucosa and TEP tract, and thus the effectiveness of the sealing. The Vega XtraSeal can be inserted with the standard Smart Inserter, but overshooting is recommended to ensure complete extension of the extended flange in the esophageal lumen (see animations of insertion with overshooting and voice prosthesis reloading below). Removal of the voice prosthesis is uneventful, despite its extended flange, which only slightly increases the pullout resistance, also keeping in mind that the XtraSeal is used in TEPs that show peripheral leakage and thus are not tight. An advantage of the slightly higher pullout resistance is that the risk for dislodgment towards the trachea is also lower. This principle of extended esophageal flange successfully has been explored in the literature,31,32 and the initial clinical experiences are favorable. 13 31. Kress P, Schafer P, Schwerdtfeger FP. [The custom-fit voice prosthesis, for treatment of periprosthetic leakage after tracheoesophageal voice restoration]. Laryngorhinootologie 2006; 85:496-500. 32. Lewin JS, Hutcheson KA, Barringer DA, Croegaert LE, Lisec A, Chambers MS. Customization of the voice prosthesis to prevent leakage from the enlarged tracheoesophageal puncture: results of a prospective trial. Laryngoscope 2012; 122:1767-1772.