Page 26 - Prosthetic voice rehabilitation-5th edition

Application of a HME and/or ASV also can be achieved with an intrastomal device, the LaryButton.41 It is made of a soft silicone rubber material, which can be folded inwards to ease its insertion into the stoma. The dimensions of the external retainer are optimized for the retention of the FreeHands/FlexiVoice ASVs. The conical shield provides a proper anatomical transition between the retainer and the intratracheal part with smooth edges in the peristomal area to improve airtight sealing. The conical shield also helps to accommodate different stoma sizes, as the exact length of the button is of less importance in achieving an airtight seal, compared to a straight shield (like in the Barton-Mayo Button). The edges of the tracheal rim are smooth and it is possible to attach a neckband to improve the intrastomal retention (Figure below left). To optimize retention, it would be easier if, contrary to the upward traction neckbands exert, the extrastomal fixation exerted a downward traction towards the stoma and trachea lumen. Therefore, the attachment system was renewed as well. This now consists of Velcro clips and adhesives, the LaryClips and adhesives: see images above right and middle). This novel fixation system provides safe anchoring of the button and limits its inadvertent loss, e.g. during coughing. It also diminishes intratracheal movements of the button (compare Figure next page middle (no speech), and right (patient speaking), limiting trauma to and widening of the stoma and thus reducing the need to replace the button with one of a larger diameter during the day. It has turned out to prolong ASV wearing time and comfortable hands-free speech in more patients without making the system too complicated. 41. Hilgers FJ, Ackerstaff AH. Development and evaluation of a novel tracheostoma button and fixation system (Provox LaryButton and LaryClip adhesive) to facilitate hands-free tracheoesophageal speech. Acta Otolaryngol 2006; 126:1218-1224. 26