Page 85 - Prosthetic voice rehabilitation-5th edition

5.4.3.2.2 VP aspirated? Aspiration of an indwelling Provox VP, as explained in the former paragraph, once properly inserted in the TEP tract, is very unlikely, because the esophageal flange is the thicker/stiffer of the two. However, in case of atrophy of the party wall and widening of the TEP tract (an example right), accidental aspiration of a VP is a potential problem. If a VP (or any other component of the prosthetic voice rehabilitation system) is aspirated, immediate symptoms may include gagging, coughing, choking, or wheezing. As with any other foreign body, complications from aspiration of a component may be caused by an obstruction or infection, and may include pneumonia, atelectasis, bronchitis, lung abscess, broncho-pulmonary fistula and asthma. If the patient can speak or breathe, coughing may dislodge the foreign body without the need for emergency action. Partial airway obstruction or complete airway obstruction requires immediate intervention for removal of the object. In case a reinsertion of the VP is considered, proper measures should be taken to avoid reoccurrence of the aspiration (see Periprosthetic leakage, chapter 5.4.1). And as already mentioned, the chances for VP aspiration are higher with non-indwelling VPs, as shown in the study of Hancock et al., where 21% of the patients had experience with aspiration of their VP.101 101. Hancock K, Houghton B, van As-Brooks CJ, Coman W. First clinical experience with a new non- indwelling voice prosthesis (Provox NID) for voice rehabilitation after total laryngectomy. Acta Otolaryngol 2005; 125:981-990. 5.4.3.3 TEP tract too wide, surgery not an option A rare example of the TEP tract that is too wide to hold a VP and where surgery was not an option anymore, is shown in the left figure. The patient was in an end stage of a second primary cancer (non-small lung carcinoma) and severely cachectic. The solution was blocking the enlarged TEP tract with a nasal septum button, which was cut into shape (middle figure). In the right figure the situation after anterograde insertion of the nasal septum button is shown. In this way the intractable aspiration was stopped and the patient could tolerate liquids again. 85