Page 14 - Prosthetic voice rehabilitation-5th edition

2.6 XtraFlange Peri-prosthetic leakage is one of the more annoying issues patients can have. This is a co- morbidity issue, with reflux and pharyngeal stenosis as the most prominent risk factors for developing TEP enlargement and thus leakage around the prosthesis. When the VP has the right length, a good solution can be to add a washer behind the tracheal flange to increase the cover of the TEP (see picture). The technique for adding a washer, either custom-made (top row of figures), or as the Provox XtraFlange (figure below left), by using two hemostats can be seen on the video below right. A study has shown that this often can be an excellent short-term solution, which gives time for the long-term solution, i.e. proper reflux treatment and/or dilatation of the pharyngeal stenosis.33 33. Hilgers FJ, Soolsma J, Ackerstaff AH, Balm FJ, Tan IB, van den Brekel MW. A thin tracheal silicone washer to solve periprosthetic leakage in laryngectomies: direct results and long-term clinical effects. Laryngoscope 2008; 118:640-645 14