Calcium Hydroxyapatite Injection for Management of Periprosthesis Tracheoesophageal Puncture Leakage
Thomas M. Kaffenberger*, Ryan M. Stephenson, Danielle Columbe and Jonas T. Johnson
Abstract:
Objective: Among patients who undergo tracheoesophageal puncture (TEP) after total laryngectomy (TL) a subset develop leakage around their voice prosthesis (VP). This can be difficult to manage and leads to surgical closure of TEP in some cases due to aspiration risk. TEP-injection (TEP-I) is a practical method of resolving low volume leaks. Our study reviewed the outcomes of 22 patients at our institution who underwent TEP-I.
Study Design: Case series of 22 patients.
Methods: Chart review of 22 patients who underwent TEP-I with calcium Hydroxyapatite after leakage around the VP due to an enlarged TEP. Data was gathered regarding demographics, leakage resolution, tumor stage, and radiotherapy history.
Results: 22 patients had undergone TEP-I procedures and 8 of these had multiple injections. TEP-I provided durable (>90 days) leakage resolution in 20 (91%) patients and the mean duration of leakage resolution in these successful patients was 462 days. When leakage resolution was controlled for the length of therapy, patients on average spent 81% of the time in durable resolution.19patients had a history of radiotherapy. No complications were experienced due to TEP-I.
Conclusion: This study found that TEP-I is an effective and safe intervention for patients who experience low volume leakage around the VP. It is important to develop management strategies, including TEP-I, for these difficult to manage cases.
Thomas M. Kaffenberger*, Ryan M. Stephenson, Danielle Columbe and Jonas T. Johnson
Abstract:
Objective: Among patients who undergo tracheoesophageal puncture (TEP) after total laryngectomy (TL) a subset develop leakage around their voice prosthesis (VP). This can be difficult to manage and leads to surgical closure of TEP in some cases due to aspiration risk. TEP-injection (TEP-I) is a practical method of resolving low volume leaks. Our study reviewed the outcomes of 22 patients at our institution who underwent TEP-I.
Study Design: Case series of 22 patients.
Methods: Chart review of 22 patients who underwent TEP-I with calcium Hydroxyapatite after leakage around the VP due to an enlarged TEP. Data was gathered regarding demographics, leakage resolution, tumor stage, and radiotherapy history.
Results: 22 patients had undergone TEP-I procedures and 8 of these had multiple injections. TEP-I provided durable (>90 days) leakage resolution in 20 (91%) patients and the mean duration of leakage resolution in these successful patients was 462 days. When leakage resolution was controlled for the length of therapy, patients on average spent 81% of the time in durable resolution.19patients had a history of radiotherapy. No complications were experienced due to TEP-I.
Conclusion: This study found that TEP-I is an effective and safe intervention for patients who experience low volume leakage around the VP. It is important to develop management strategies, including TEP-I, for these difficult to manage cases.
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