Stricture associated with primary tracheoesophageal puncture after pharyngolaryngectomy and free jejunal interposition
✍ Scribed by Gurston G. Nyquist; Michael P. Hier; Tassos Dionisopoulos; Martin J. Black
- Book ID
- 102230584
- Publisher
- John Wiley and Sons
- Year
- 2006
- Tongue
- English
- Weight
- 73 KB
- Volume
- 28
- Category
- Article
- ISSN
- 1043-3074
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✦ Synopsis
Background. Free jejunal interposition has been one of the standard reconstructive options for patients undergoing total laryngopharyngoesophagectomy. Tracheoesophageal puncture (TEP) done primarily is a well-accepted means of voice restoration. The rapid recovery of swallowing and communication in patients who have advanced cancer of the upper aerodigestive tract is a valid goal. The objective of this study was to evaluate the functionality and complications of primary TEP in patients with a free jejunal interposition graft.
Methods. Twenty-four consecutive patients who had free jejunal interposition were studied. Thirteen of these patients had a primary TEP. Stricture was assessed through barium swallow, laryngoscopy, and CT scan.
Results. A statistically significant greater number of patients had stricture develop after primary TEP (p < .0325). All these patients had stricture develop at the distal anastomosis. These patients also tended to have a poorer quality of diet. Moreover, speech with a TEP prosthesis in patients with a free jejunal interposition was less intelligible and functional than speech with a TEP prosthesis after simple laryngectomy.
Conclusions. This article recognizes an increased incidence of stricture formation after primary TEP as compared with non-TEP in patients undergoing pharyngolaryngectomy with free jejunal interposition. The morbidity and possible etiology of this complication are discussed. This clinical data have been translated into a change in clinical practice.