Provoxweb
  • Provoxweb
  • Voice--Speech Rehab
    • Speech Therapy >
      • Introduction
      • Preoperative counseling
      • Outline of voice therapy
      • Important basic principles in voice rehabilitation in prosthetic speech
      • Some points of attention for the 'finishing touch'
      • General aspects of patient instruction
      • Problem solving
      • Conclusion
  • Pulmonary Rehab
    • Introduction
    • Heat and Moisture Exchangers (HME's) >
      • Treatment aspects
      • Prevention aspects
    • Provox HME >
      • Compliance aspects
      • Improvements in compliance
      • Improvements in voicing
      • Early post-operative pulmonary hygiene
      • Breathing resistance
      • Newest Provox HMEs
    • Treatment with inhalation medication
    • Conclusions
    • References

Prosthesis extruding from the fisula tract

Problem: the prosthesis is extruding from the fistula tract.

Protrusion of the prosthesis and subsequent spontaneous extrusion is sometimes observed during an infection of the TE-fistula. This phenomenon has been also observed sometimes after (too) rapid downsizing of the prosthesis. Removal of the prosthesis is mandatory to avoid dislodgment into the trachea. Often the fistula tract is still patent and it is possible to ‘salvage’ the fistula and thus the voice by inserting a proper length device, either anterograde or retrograde. The figures show such a situation, in which the TEP could be salvaged: Figure 1.  spontaneous extrusion; Figure 2. fistula tract after removal of prosthesis; Figure 3.  insertion of a longer device; Figure 4.  the well-healed fistula after 10 months, when the patient came for his next replacement for leakage through the device. If this is not possible, the fistula tract may close spontaneously secondary to the removal of the prosthesis and resolution of the infection, for which antibiotic treatment might be needed. Secondary re-puncturing is then necessary in order to re-establish the prosthetic voice.

Picture
Picture
Picture
Picture
© The Netherlands Cancer Institute - 2003-18; ISBN 90-75575-05-X