Page 9 - Prosthetic voice rehabilitation-5th edition

The Provox voice prosthesis is inserted in the TEP tract and remains in situ without replacement by the patient. Primary introduction at the time of TL is the method of choice, but secondary introduction at a later stage is also easily accomplished. For the introduction and replacement of the prosthesis a special Guide Wire is available. This disposable instrument has a connector for easy attachment of the introduction string of the new prosthesis and an 8 mm stop for transoral removal of the remnant of the old prosthesis. It has a flexible tip, which facilitates its retrograde introduction through the esophagus and pharynx. If the guide wire becomes entrapped in the pharyngeal mucosa wall, the wire will bend near the tip and can still slide upwards through the pharynx. 3. Hilgers FJM, Schouwenburg PF. A new low-resistance, self-retaining prosthesis (Provox) for voice rehabilitation after total laryngectomy. Laryngoscope 1990; 100:1202-1207. 4. Hilgers FJ, Cornelissen MW, Balm AJ. Aerodynamic characteristics of the Provox low-resistance indwelling voice prosthesis. Eur Arch Otorhinolaryngol 1993; 250:375-378. 5. Hilgers FJM, Balm AJM. Long-term results of vocal rehabilitation after total laryngectomy with the low- resistance, indwelling Provox voice prosthesis system. Clin Otolaryngol 1993; 18:517-523. 2.2 Provox2 In 1996-1997 a second generation Provox voice prosthesis, intended for anterograde and retrograde use, Provox2, has been developed.8,9 This adapted prosthesis can be inserted during primary TEP at the time of laryngectomy, or during a secondary procedure at a later date, in the same manner as the original Provox prosthesis, using the separately available guide wire. Replacement in the outpatients office, however, can be carried out now in an anterograde manner directly through the tracheostoma. For this replacement a simple disposable tool, consisting of a loading tube and an inserter, is used. The Provox2 is available not only in 4.5, 6, 8, and 10 mm shaft lengths, but also in two additional lengths, i.e. 12.5 and 15 mm. The dimensions of the Provox2 prosthesis are comparable with those of the original Provox device, but the flanges have been adapted. The flanges are thinner: the esophageal flange is 1.5 mm instead of 1.6 mm to enable easier removal from the tracheoesophageal puncture (TEP) tract, and the tracheal flange is 1.3 mm instead of 1.6 mm, to make the resistance towards the esophagus lower than that towards the trachea, to decrease the possibility of inadvertent dislodgment into the trachea. Furthermore, the valve construction has been improved and the tracheal flange contains the size number, allowing in vivo identification of the length of the prosthesis. 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. 9. Ackerstaff AH, Hilgers FJ, Meeuwis CA et al. Multi-institutional assessment of the Provox 2 voice prosthesis. Arch Otolaryngol Head Neck Surg 1999; 125:167-173. 9