Page 60 - Prosthetic voice rehabilitation-5th edition

4.2.2 Provox Although rarely used at present, for completion the original retrograde Provox replacement3 is described here. The video right shows an animation of this procedure. 1) Obtain satisfactory local anesthesia of the trachea and oropharynx with lidocaine 10% spray. Some experienced patients might prefer replacement of the prosthesis without local anesthesia, since the lidocaine spray causes the same or sometimes even more irritation than a rapid replacement procedure itself. Introduce the guide-wire through the old prosthesis and push it upward through the pharynx and out of the mouth. Often it is easy to grab the guide-wire in the pharynx with a finger. Sometimes the introduction of the guide-wire needs special attention. This is particularly true for the low positioned prosthesis. Grasping the tracheal flange with a non-toothed hemostat and changing the position of the prosthesis in a more upright direction, can facilitate the proper movement of the wire into the pharynx. In the rare event that the wire is trapped at the base of the tongue or tonsil, a tongue depressor and hemostat are useful in freeing the guide-wire. 1 2) Grasp the tracheal flange of the prosthesis with a curved non- toothed hemostat, cut this off from the prosthesis with the disposable scalpel, included in the package, and remove it over the guide-wire 3) Remove the esophageal remnant of the prosthesis transorally with a push and pull action of the disposable guide wire that has a 8 mm halfway stop for this purpose. 4) Attach the new Provox voice prosthesis to the connector of the guide-wire and secure it in its slid with a gentle pull of the introduction string of the prosthesis (figure below right). Pull the wire the prosthesis towards the existing TEP tract and ask the patient to swallow the new prosthesis. 5) Introduce the prosthesis into the TEP tract. Because of the oval shape and flexibility of the tracheal flange the prosthesis can be introduced easily into the tract, mostly with the help of the curved non-toothed hemostat. Finally, the introduction string is cut off with the disposable scalpel. 6) The prosthesis in situ after removal of the introduction string, ready for speech. Preferably, the long end of the tracheal flange points downward in the trachea. 60