Page 39 - Prosthetic voice rehabilitation-5th edition

Finally, the introduction string is cut off, and the prosthesis can be turned in its proper position with the oval side of the flange pointing downwards in the trachea (Figure right). After the patient is awake, the impermeability for liquids of the prosthesis and the TE tract is checked, by letting the patient drink some water. If there is no leakage, oral feeding can be resumed right away. Speech therapy usually also can start the same day. Reminder: It is important to place the Provox voice prosthesis at the correct position in the tracheal back-wall, i.e. the puncture should be carried out in the midline 5-10 mm below the upper tracheal rim, causing the upper border of the tracheal flange of the prosthesis almost to reach the muco-cutaneous junction. A too low position of the prosthesis leads more easily to leakage, makes cleaning and replacement more difficult, and might result in less optimal speech. To the right a video of the traditional secondary TEP with Trocar and Cannula, and below an animation and a video of the PVPS secondary TEP , 39