After Blom and Singer reported the construction of the so-called "duck bill"
prosthesis in 1980, there have been quite a few newer
voice prostheses constructed by other workers and new methods developed to predict the results, such as the insufflation and
lidocaine test. Implanting the
voice prosthesis with the Blom-Singer method has presented some problems and complications related to the
puncture technique, therefore the following simplified esophagotracheal
puncture technique is presented. The pharynx is opened with the
laryngoscope which is then led up to the entrance of the esophagus. Through the
laryngoscope, the distal end of the endo-extralaryngeal needle carrier, developed by the author and modified for mass production by R. Wolf Ltd., Germany, is led into the esophagus. The instrument is pushed forward as long as its distal bent, blunt end is palpable in the upper third of the tracheostoma. The needle with the thread (2/0
prolene) is pushed through from the inside, out in the upper third of the tracheostoma. A double wire forming a loop is led through the pointed
metal cone (containing a built-in needle) and the
catheter and tied behind a counterfixing pierced ball. The 2/0
prolene leading thread is then knotted with the wire. By pulling the thread and the wire, the pointed end of the
metal cone with the needle built-in, perforates the soft parts and pulls the
catheter with it (the same procedure will be used for primary
puncture as well). After this procedure the
voice prosthesis can easily be placed in the
fistula in a conventional manner. Using this technique, 59 patients could be implanted without
puncture-related complications or problems. Problems, not related to the
puncture technique, such as Candida albicans
infection etc., were solved using the well-known treatment modalities. To stop leakage around the
prosthesis, injection of
Bioplastique into the soft tissue surrounding the
fistula was used with success.