Tracheoesophageal puncture is frequently being employed for voice restoration after total laryngectomy. Use of a silicone valve prevents aspiration and stenosis commonly experienced with previous speech fistula approaches. Although this method provides rapid acquisition of fluent speech, a variety of problems associated with valve design, materials, and the tracheoesophageal puncture are experienced. In this report, these problems are reviewed and practical solutions suggested. Characteristics are described of an improved valve designed to overcome these problems. HEAD 81 NECK SURGERY lO:S142-S145,1988.
Tracheoesophageal puncture has evolved as an established method for rapid acquisition of voice following total laryngectomy.' Although this approach appears simple, in practice it demands more than surgery and placement of a valve. Our 10-year experience with nearly 600 patients demonstrates that problems attributable to prosthesis design, material, and the tracheoesophageal puncture are not uncommon and may require considerable attention. A silicone valve effectively prevents aspiration and stenosis frequently encountered in previous nonprosthesis