Page 3 - Prosthetic voice rehabilitation-5th edition

4 3.5.2.2 Category 1................................................................................................... 50 3.5.2.3 Category 2................................................................................................... 50 3.5.2.4 Category 3................................................................................................... 51 3.5.3 Comments and Conclusions.............................................................................. 52 3.5.4 References ........................................................................................................ 53 3.6 Pharynx reconstruction and prosthetic voice rehabilitation........................55 3.6.1 References pharynx reconstruction: .................................................................. 57 Voice prosthesis replacement ......................................................................... 58 4.1 Indications for replacement.............................................................................58 4.1.1 Prosthesis related indications ............................................................................ 58 4.1.2 TEP tract related indications.............................................................................. 58 4.2 Replacement procedures.................................................................................59 4.2.1 Choosing the right length.................................................................................... 59 4.2.2 Provox ................................................................................................................ 60 4.2.3 Provox 2 and Provox ActiValve ......................................................................... 61 4.2.4 Provox Vega and Vega XtraSeal ....................................................................... 64 4.3 Additional remarks in conjunction with prosthesis replacement................66 Troubleshooting surgical voice restoration................................................... 67 5.1 Schematic overview of troubleshoot issues..................................................67 5.2 Introduction.......................................................................................................68 5.2.1 Basic principles.................................................................................................. 68 5.2.2 Definition problems/adverse events................................................................... 69 5.3 Device issues....................................................................................................70 5.3.1 Transprosthetic leakage .................................................................................... 70 5.3.2 Biofilm fouling/candida overgrowth .................................................................... 70 5.3.3 Frequent/early transprosthetic leakage ............................................................. 71 5.4 TEP tract issues................................................................................................73 5.4.1 Periprosthetic leakage ....................................................................................... 73 5.4.1.1 Treatment algorithm .................................................................................... 74 5.4.1.2 Prosthetic solutions ..................................................................................... 74 5 5.4.1.2.1 5.4.1.2.2 5.4.1.2.3 Tracheal washer ................................................................................... 74 Extended esophageal flange ................................................................ 75 Larger VP diameter .............................................................................. 75 5.4.1.3 Surgical solutions ........................................................................................ 77 5.4.1.3.1 5.4.1.3.2 5.4.1.3.3 Purse string suture ............................................................................... 77 Tissue augmentation ............................................................................ 78 Surgical closure .................................................................................... 79 5.4.2 TEP tract infection/hypertrophy ......................................................................... 80 5.4.2.1 Local infection ............................................................................................. 80 5.4.2.1.1 5.4.2.1.2 5.4.2.1.3 5.4.2.1.4 VP still OK ............................................................................................ 80 VP displaced......................................................................................... 80 VP extruded .......................................................................................... 81 Difficult anterograde VP insertion ......................................................... 82 5.4.2.2 Tissue interfering with VP ........................................................................... 82 5.4.2.2.1 Granulation tissue................................................................................. 82 5.4.2.2.2 Hypertrophic tissue............................................................................... 83 3