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Authors:
Luigi Sivero, Donato Alessandro Telesca, Cesare Formisano, Teresa Russo, Stefania Sivero, Grazia Salerno, Italy
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Abstract:
Background and Aims:
In our study, we have analyzed the use of flexible video endoscopy in patients undergoing total laryngectomy and candidates for the placement of a voice prosthesis, with the creation of a tracheo-esophageal fistula in which the prosthesis is positioned, which acts as a valve one-way, which allows the passage of air from the trachea to the oesophagus and prevents the passage of liquids in the opposite direction, allowing the pulmonary air to vibrate a segment of the cervical oesophagus. The use of flexible video endoscopy for the positioning of the prosthesis can be both primary and secondary to the intervention of total laryngectomy. Endoscopy has also been used in the ontological follow-up for the assessment of the hypo pharyngeal-oesophageal-gastric district in the search for relapses or secondary tumors, which may develop in this district in more than 10% of patients with pathological neoplasia. Higher aero-digestive.
Methods:
We performed a complete esophagogastroduodenoscopy on 36 patients who had total laryngectomy divided into two groups of 18 patients, in group A there were patients who had already been prosthetic for at least one year, and in the B group the patients underwent for the first time creation of a tracheo-esophageal fistula.
Results:
At endoscopy we found three neoplastic recurrences in group A that did not allow the placement of a new prosthesis, in group B we excluded 3 patients who had a grade B esophagitis according to the classification of Los Angeles, in the remaining 15 patients there were minor complications, in particular two patients presented intense inflammatory reaction after the creation of the fistula, one patient had phonatory difficulties, one patient had a progressive deterioration of the phonatory function, which endoscopic control showed was determined by a too short prosthesis.
Conclusions:
Without a doubt the flexible video endoscopy in recent years has been very widespread, we believe that our experience has confirmed the interesting and beneficial use in patients undergoing total laryngectomy and candidates for the placement of a tracheo-esophageal voice prosthesis, in the evaluation contraindications such as recurrences or secondary neoplasm's of the oesophagus, and in the presence of reflux esophagitis in patients with hiatal hernia and / or cardiac incontinence.
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