Management of aphonic patients following total laryngectomy and trachea esophageal puncture.

Abstract

BACKGROUND:

Trachea esophageal puncture (TEP) is performed following total laryngectomy to allow speech and communication. The most common reason for long-term speech failure in this population is hypertonicity of the constrictor muscle.

OBJECTIVES:

To present our experience with the treatment of aphonic patients after total laryngectomy and TEP and suggest a protocol for treatment.

METHODS:

Of 50 patients who underwent total laryngectomy and TEP, 6 suffered from aphonia after surgery. All patients underwent radiotherapy with or without chemotherapy. Delay in speech continued for more than 6 months after surgery. The patients received percutaneous lidocaine injection to the neopharynx in different locations around the stoma in order to map the hypertonic segments in the neopharynx.

RESULTS:

Lidocaine injection immediately enabled free speech in five patients. One patient (patient 6) suffered from aphonia and from severe dysphagia and required a feeding tube. This patient succeeded to pronounce abbreviations after lidocaine injection. Another (patient 4) gained permanent ability to speak following a single lidocaine injection; this patient was not injected with botolinium toxin (BTX). For the other five, lidocaine had a transient effect on speech. These patients received BTX percutaneous injections. After BTX injections four regained free speech within 14 days. The fifth patient (patient 6) gained a conversational voice and his swallowing improved only after additional intensive speech therapy.

CONCLUSIONS:

Percutaneous lidocaine and BTX injections represent first-line treatment in this population, with good success and minimal complications.

• Authors: Limor Benyamini, Ziv Gil, Jacob T Cohen
• Journal: The Israel Medical Association journal : IMAJ (Isr Med Assoc J) Vol. 16 Issue 12 Pg. 768-70 (Dec 2014) ISSN: 1565-1088 [Print] Israel
• PMID: 25630206 (Publication Type: Journal Article)

Chemical References

• Anesthetics, Local
• Neuromuscular Agents
• Lidocaine
• Botulinum Toxins, Type A

Topics

• Adult
• Aged
• Anesthetics, Local (administration & dosage)
• Aphonia (etiology, physiopathology, therapy)
• Botulinum Toxins, Type A (administration & dosage)
• Esophagus (drug effects)
• Female
• Humans
• Injections
• Laryngeal Neoplasms (pathology, surgery)
• Laryngectomy (adverse effects, methods, rehabilitation)
• Lidocaine (administration & dosage)
• Male
• Middle Aged
• Neoplasm Staging
• Neuromuscular Agents (administration & dosage)
• Postoperative Complications (physiopathology, therapy)
• Speech Therapy (methods)
• Speech, Alaryngeal (methods)
• Trachea (drug effects)
• Treatment Outcome