Page 31 - Prosthetic voice rehabilitation-5th edition

31 The TEP with the disposable Provox Vega Puncture Set (PVPS) is an even more straightforward, and potentially lower traumatic procedure, because all components are always in optimal condition (no maintenance like with the original instruments is needed) and hemostats are not required any longer. The PVPS consist of a sharp 2.5 mm diameter puncture needle, a guide wire, a dilator with the pre-mounted Provox Vega voice prosthesis, and a pharynx protector (only to be used for primary TEP during a total laryngectomy; pharynx protection during secondary TEP should be accomplished with an intraluminal device, e.g. a rigid esophagoscope). The pharynx protector and the needle are used in the same way as in the original TEP. After the puncture with the needle, the guide wire is passed through that, whereby care is taken that the wire is caught into the lumen of the pharynx protector and comes out of that into the pharynx. At this stage, first the needle is removed and then the pharynx protector, leaving the guide wire in the tiny TEP tract thus created. Next, the dilator with the pre-mounted Provox Vega (8 or 10 mm) is attached to the pharyngeal end of the guide wire, which can be secured in a second opening in the top of the dilator. After securing the guide wire to the dilator that can be advanced slowly through the TEP, gradually dilating that and under continued traction pulling the voice prosthesis through the TEP in place, whereby the loop around the voice prosthesis unfolds/delivers the tracheal flange properly into the tracheal lumen. The primary TEP procedure with the PVPS is shown in the figures and the video below.