Tracheoesophageal Puncture for Voice Prosthesis

After a patient has undergone a total laryngectomy, the second stage is to have a tracheoesophageal puncture. For tracheoesophageal puncture (TEP), the surgeon makes an opening between the trachea and esophagus. A small plastic or silicone valve fits into this opening. The valve keeps food out of the trachea. After TEP, patients can cover their stoma with a finger, and force air into the esophagus through the valve. The air produces sound by making the walls of the throat vibrate. The sound is a lot like natural speech. The TEP is typically done three to six months following the initial total laryngectomy, as this gives the body time to heal before the next phase. The procedure is performed under general anesthesia. A temporary prosthesis will be placed initially, and then it will be replaced with a voice prosthesis in approximately one week. You will be referred to a speech therapist to teach you how to use the voice prosthesis.

Risks

As with any surgical procedure, there are risks and possible complication involved with a tracheoesophageal puncture. The risks and complications involved include:

• Allergic reactions to medicines
• Breathing difficulties
• Infection
• Bleeding
• Aspiration
• Failure of prosthesis
• Injury to the trachea (windpipe) or esophagus
• Complications from anesthesia (The anesthesiologist will discuss the risks involved with you prior to your surgery)

Before the Procedure

1. Nothing to eat or drink after midnight the evening before the procedure. This includes all foods, liquids, candy, mints or chewing gum. You may brush your teeth. You will not be able to undergo the surgery if you do not follow these instructions.
2. Please notify us of all routine medications and significant health history. Take medications as directed with just a sip of water.
3. A week before surgery, please avoid aspirin, aspirin-containing products, ibuprofen (Advil, Motrin, Aleve) or Vitamin E. Please notify our office if you are on any medications that affect bleeding, such as coumadin or warfarin. Please call our office if you have any concerns about any medications. (585-342-2080)
4. If you have diabetes, ask your doctor if you need to adjust your medications.
5. Remove all make-up, jewelry, nail polish, and artificial nails before your surgery.
6. Do not bring valuables to the hospital (cash, credit cards, watches, jewelry, etc.)

After the Procedure

Upon discharge from the hospital, you will be given additional discharge instructions.

Activity: Avoid lifting, bending, and straining for two weeks after surgery. You may brush your teeth with care.

Diet: Advance diet from liquids to soft foods to full diet as tolerated. Avoid hot liquids or food for 24 hours after the surgery.

Wound Care: The hospital staff will educate you on stoma care prior to discharge from the hospital.

Medication: You may be given antibiotics ollowing surgery to prevent infection. If you are having pain, you may need to take pain medication as prescribed and as needed.

Follow-Up: Our office will notify you of the date and time of your follow up appointment.

Please call our office at 585-342-2080 for any of the following:

1. Difficulty breathing or painful swallowing
2. Swelling that increases rather than decreases with time
3. Fever above 102° F
4. Pain not relieved by pain medication as prescribed
5. Difficulty with persistent hearing loss or dizziness
6. Cough, shortness of breath, or chest pain.
7. Any other worrisome symptoms