Modified Technique for Difficult Secondary Tracheoesophageal Puncture

Head Neck. 2025 Jan 10. doi: 10.1002/hed.28068. Online ahead of print.

Abstract

Tracheoesophageal puncture (TEP) with voice prosthesis (VP) placement is commonly used to restore voice in laryngectomy patients. The conventional procedure utilizes a rigid esophagoscope to open and visualize the pharyngeal inlet. However, this approach is challenging in patients with postradiation changes, reduced neck extension, or trismus. Here, we demonstrate a modified technique involving flexible endoscopy and endotracheal tube placement to reestablish the TEP tract in a patient with a challenging anatomic profile. This step-by-step video demonstrates retrieval of a dislodged prosthesis and TEP/VP placement under general anesthesia, which results in effective voice restoration. This modified technique can safely and effectively restore voice in patients with difficult exposure.

Keywords: endotracheal tube; tracheoesophageal puncture; voice prosthesis.