Treatment of periprothetic leakage in laryngectomized patients- first experience with the Provox Xtraseal

Introduction:

Tracheoesophageal prosthetic voice rehabilitation is the gold standard after total laryngectomy. Success rates of around 90% are described in the recent literature. For the treatment of even advanced laryngeal or hypopharyngeal cancer the TLE is still an indispensable surgical procedure. Even with regards tot he increasing number of salvage laryngectomies maintenance of prothetic problems is necessary for satisfying rehabilitation results.

Beside transprothetic leakage as a result of material fatigue the periprothetic leakage impairs the quality of patients life. Moderate leakage might be managed by using silicon washers at the tracheal side, but a washer on the esophageal side could be more effective, thus special protheses with enlarged esophageal flanges (Provox© Xtraseal) had been developed.

We performed a prospective evaluation on the efficacy, satisfaction and ease of placement of the Provox© Xtraseal among 21 patients seen in the outpatient clinic suffering from periprosthetic leakage.

Results:

The median diameter of the leaking voicefistula was 9.7 mm. In 26 cases the exchange workes in the first attempt. In four cases a second attempt and in two cases three attempts were necassary. A sufficient sealing could be achieved in 29 cases, two patients needed an additional tracheal esophageal washer.

The duration of effectivness showed a median of 9.2 weeks. The application was described as easy, only the needed overshooting procedure was unfamiliar in the first attempts.

Discussion:

For moderate periprothetic leakage the Provox xtraseal is an easy to use and effective option with an exellent success rate, however, this means replacement of the voice prothesis and thus higher costs.

Publication History

Publication Date:
23 April 2019 (online)