Stylet-Guided Secondary Tracheo-esophageal Puncture: A Safe and Simple Method

Prior to the 1970s, rehabilitation of aphonia following a total laryngectomy was accomplished using esophageal speech or through the use of mechanical or electrical devices. First described in 1980 by Singer and Blom, tracheoesophageal puncture (TEP) with prosthesis placement affords the clarity of esophageal speech without the volitional need to ingest and expel air. Deciding between a primary or secondary tracheoesophageal puncture (TEP) can depend on multiple factors. Pou describes that a primary TEP is absolutely contraindicated if the party wall between the trachea and esophagus have been separated, either as a consequence of surgeon technique or secondary to the degree of oncologic resection. Relative contraindications include conditions precluding adequate use of the prosthesis such as poor pulmonary function, poor manual dexterity, or bilateral hearing loss. Pou notes that preoperative or the need for postoperative radiation are not contraindications to primary TEP When comparing primary TEP to secondary TEP, the literature shows no significant difference in outcomes initially or at later follow-up, with success rates in the 75-90% range after 2 years.