Page 74 - Prosthetic voice rehabilitation-5th edition

5.4.1.1 Treatment algorithm First try one of the conservative prosthetic options and only if those are not sufficiently effective, consider one of the surgical options, but in any case, never forget to address the comorbidities involved, i.e. reflux and pharyngeal stenosis! 1. First try one or a combination of the available prosthetic options: a. Application of thin (0.5 mm) silicon washer behind tracheal flange b. VP with an extended esophageal flange, or c. In case of a 17 or 20Fr device, a larger diameter VP 2. In case the options under 1 are insufficient, try one of the surgical options: a. Submucosal purse string suture b. Tissue augmentation c. Surgical closure of the TEP tract 5.4.1.2 Prosthetic solutions 5.4.1.2.1 Tracheal washer The traditional solution of periprosthetic leakage is temporary (often several days) removal of the VP and insertion of a nasogastric feeding tube (and often a cuffed trachea cannula) to allow for shrinkage of the TEP tract. Obviously, this is uncomfortable for the patient, and may require hospitalization. Therefore, we prefer an instant and for the patient more comfortable solution, which is the application of a thin (0.5 mm) silicon washer (either custom-made with a punch (figure right) or the commercially available Provox XtraFlange (figure middle below; see also chapter 2.6 XtraFlange) behind the tracheal flange (see picture and video below). This washer has proven to be an effective short-term and quite often also a long-term solution.33 74