Ripristino delle possibilità vocali nel laringectomatizzato con protesi tracheoesofagea

The experience reported concerning vocal rehabilitation employing tracheoesophageal prostheses (TEP) in laryngectomized subjects at the University of Milan is based upon 149 patients who underwent procedures for total laryngectomy from November 1986 on in nearly all cases (137), a primary procedure was followed in order to insert a Blom Singer prosthesis. Some technical modifications in creating the fistula during the reconstruction phase of laryngectomy reduced the number of postoperative and local complications of the fistula. The men phoniatric rehabilitation time is 38 days from the procedure. The most important aspects affecting the length of rehabilitation are the presence of lower respiratory tract disorders and contemporaneous postoperative radiotherapy. The mean lifetime of the prostheses is 92 days, the main restricting factor being the care taken by the patient. Microbiological studies showed the virtually constant association between fungi and Pseudomonas sp. Nevertheless, infection of the fistula and forced removal of the prosthesis occurred only in 1 patient. Other complications were as follows: granulation tissue at the tracheal side of the fistula into the trachea or oesophagus, 6 and 1 respectively; enlargement of the fistula, 5; others, 15. Fifteen percent of the patients does not succeed in achieving a tracheoesophageal voice because of respiratory insufficiency, difficult neuromuscular control or psychological problems.