Page 63 - Prosthetic voice rehabilitation-5th edition

The loading tube is inserted into the TEP tract (left figure below) until the back wall of the esophagus is slightly touched. Then, with the loading tube kept in this position with one hand, the inserter pin, held between thumb and index finger of the other hand, is pushed forward until mark-line 2 is reached. The thumb should be used as stopper, to avoid the tracheal flange to prematurely slide out of the loading tube. In this position the forward folded esophageal flange has been unfolded in the lumen of the esophagus. Next, the complete insertion tool, thus loading tube and inserter pin together, is pulled backwards, anchoring the unfolded esophageal flange on the anterior esophageal wall. Then, the loading tube can be slid backwards, keeping the inserter pin in place, allowing the tracheal flange of the voice prosthesis to unfold properly in the trachea (middle figure above). Most of the times this happens immediately. Sometimes, the tracheal flange has to be unfolded intentionally, either by turning the inserter with the prosthesis around its axis, or by turning and pulling this flange into position with a non-toothed hemostat. The proper position of the voice prosthesis can be checked easily by rotating and exerting slight traction on the tracheal flange, after which the safety string of the prosthesis can be cut off with a small pair of scissors, or a scalpel (right figure above). The Provox2/ActiValve voice prosthesis is then ready for use. 63 Provox 2 loading Removal old VP Insertion examples 8. Hilgers FJ, Ackerstaff AH, Balm AJ, Tan IB, Aaronson NK, Persson JO. Development and clinical evaluation of a second-generation voice prosthesis (Provox 2), designed for anterograde and retrograde insertion. Acta Otolaryngol 1997; 117:889-896. 27. Hilgers FJ, Ackerstaff AH, Balm AJ, Van den Brekel MW, Bing Tan I, Persson JO. A new problem- solving indwelling voice prosthesis, eliminating the need for frequent Candida- and under-pressure- related replacements: Provox ActiValve. Acta Otolaryngol 2003; 123:972-979.