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Original Article
December 21, 2009

Secondary Tracheoesophageal Puncture With In-Office Transnasal Esophagoscopy

Author Affiliations

Author Affiliations: Department of Otolaryngology–Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans (Drs LeBert, McWhorter, Kunduk, and Walvekar); and Department of Head Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston (Drs Lewin, Hessel, and Holsinger and Mss Hutcheson and Barringer).

Arch Otolaryngol Head Neck Surg. 2009;135(12):1190-1194. doi:10.1001/archoto.2009.166
Abstract

Objective  To evaluate the outcomes of voice restoration using office-based transnasal esophagoscopy (TNE) to guide placement of the secondary tracheoesophageal puncture (TEP).

Design  Retrospective chart review.

Setting  Two tertiary care medical centers.

Patients  The study included 39 patients who underwent the TNE-TEP procedure from January 2004 to December 2008.

Main Outcome Measures  Clinical, demographic, and TE speech–related data were recorded to examine the ease, efficiency, complications, and speech-related outcomes.

Results  Among 39 patients identified, the average age was 65 years (age range, 47-83 years), with 32 male (82%) and 7 female (16%) patients. Twenty-five patients (64%) underwent total laryngectomy; 8 (21%) underwent total laryngectomy with partial pharyngectomy; and 14 (36%) underwent microvascular flap reconstruction. The overall success rate of secondary TNE-assisted TEP placement was 97% (n = 38), with 1 unsuccessful attempt. There was no statistically significant correlation found between patients having undergone radiation therapy (either before or after oncologic resection) or a cricopharyngeal myotomy and successful TEP placement, type of reconstruction used to close the pharyngeal defect when compared with the difficulty in the placement of the TEP, development of complications associated with TEP placement, use of the TEP prosthesis, or speech intelligibility at the last follow-up visit. Thirty-one patients (79%) were still using their TEP prosthesis for speech at the last follow-up visit. Of the patients reviewed, 28 (72%) had understandable TE speech.

Conclusions  In-office TNE-assisted TEP placement can safely be performed, with excellent speech outcomes. Reconstruction with musculocutaneous or microvascular free-tissue transfer did not limit our ability to place secondary TEPs with TNE.

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