Page 62 - Prosthetic voice rehabilitation-5th edition

the flange, which is still protruding from the slit of the loading tube (figure below right). This flange has to be kept down firmly within the tube, while pushing the inserter pin forward until mark-line 1 is reached. Now the prosthesis is in the correct position for insertion (figure below left). The only difference with the Provox ActiValve is that, because of its slightly longer/bulkier valve seat, there is a little more resistance felt during its insertion into the loading tube, especially when holding the thumb down to squeeze the esophageal flange into the tube and when pushing the inserter pin forward. To prevent accidental loss during its insertion, both the Provox2 and the ActiValve have a security string that extends in the axis of the flange and also can serve as the introduction string, if the voice prosthesis is inserted in the traditional retrograde manner through the pharynx (see animation above right). The possibility to replace these devices both in an anterograde and in a retrograde manner makes the Provox prostheses the most versatile prosthetic devices presently available. The anterograde replacement procedure can be accomplished easily by any trained clinician (Otolaryngologist/resident, Speech Language Pathologist, and Oncology Nurse). Local anesthesia is seldom needed. In some patients, the procedure may exert some coughing that can be suppressed with 10% lidocaine spray into the trachea. Local anesthesia in the pharynx is not needed. Replacement of the Provox2 and ActiValve prosthesis: the old prosthesis is removed by pulling it out from the TEP tract with a non-toothed hemostat (see video next page). Alternatively, up to the clinician's discretion, the tracheal flange can be grabbed with a hemostat and cut off, and the remainder of the device is then pushed into the esophagus, allowing for natural passage through the intestinal tract. The patient's clinical history of abdominal diseases should hereby be taken into account. 62