|
Tracheoesophageal Puncture for Voice Prosthesis
Following the initial stage of a total laryngectomy, patients routinely need three to six months for optimal wound healing before undergoing the second stage, tracheoesophageal puncture. Tracheoesophageal puncture, which takes about an hour, is performed with the patient under general anesthesia. When you awaken following the procedure, you will notice a temporary prosthesis that is sewn in place. The purpose of this temporary prosthesis is to create the opening for the subsequent functioning voice prosthesis. This initial prosthesis, which will not function for voice production, will remain in place for approximately one week. The patient may stay overnight in the hospital to be observed for airway, bleeding, infection, swallowing and other routine postoperative precautions, but if the procedure goes smoothly you can be discharged the same day.
Following the week of healing, you will be dilated in the office and measured for a final prosthesis. At that time you will also be referred to a speech therapist who will teach you how to use the prosthesis for voice production and answer many of your questions.
Although this second stage procedure is much less involved than the laryngectomy, the same preoperative and postoperative considerations exist. As with any surgical procedure certain risks must be discussed before obtaining surgical consent.
Anesthesia
Complications from anesthesia are known to exist. These complications (anything from nausea to stroke or death) are quite uncommon since patients are usually young and healthy.
Aspiration
Risk of aspiration exists because of the proximity of the surgery to your trachea. Every precaution is made to prevent leakage of saliva into your trachea.
Bleeding
Some bleeding is expected with any surgery, however abnormal postoperative bleeding occurs in about 1% of cases. If it does occur, bleeding usually occurs within the immediate postoperative period but may occur at any time during the first two weeks postoperatively.
Infection
Infection is rare due to the excellent vascularity of the tissues. However, infection involving the mediastinum, which would manifest as fever and sternal chest pain, could require IV antibiotic therapy. A prescription for preventative antibiotics is provided for use in the postoperative period.
Failure of Prosthesis
Although success and compliance with TEP is extremely high (over 80%), failure of the prosthesis due to postoperative scarring and radiation effects is a possibility.
Immediately following your surgery, the sedative medication and/or general anesthesia may make you drowsy for 24 hours. Therefore, do not
- drive or operate machinery for 24 hours
- make major decisions, sign contracts, etc. for 24 hours
- drink alcoholic beverages for 24 hours or at any time when taking prescription medication without your doctor's consent
Pre-Operative Instruction
- Nothing to eat or drink after midnight the evening prior to your surgery. This includes all foods, liquids, water, candy, mints or gum. You may brush your teeth the morning of surgery. Your procedure will be cancelled if you do not follow these instructions.
- Notify us of all routine medications and significant health history. Take medications as directed with just a sip of water.
- Please avoid aspirin, ibuprofen, Vitamin E or any products containing these medications for one week prior to your surgery. If you are on any medications that affect bleeding, please notify the nurse at this time.
- Do not bring valuables (cash, credit cards, jewelry) to the hospital.
- Remove all make-up and nail polish prior to arriving at the Center.
- Please contact the hospital on the business day prior to your surgery to confirm your arrival time.
Post-Operative Instructions
Written postoperative instructions will be provided at the time of hospital discharge.
Wound Care
Keep laryngeal stoma site clear of crusts and apply Polysporin-type ointment twice daily.
Diet
When the procedure is completed and the effects of the anesthesia have worn off, you will be started on clear liquids, advancing to a full diet as tolerated. Take care to avoid extremely hot beverages or food for 24 hours following the procedure.
Medications
Prescriptions, which will be given to you at the time of discharge, may include preventative antibiotics and a pain medication. Patients who have undergone this procedure have stated that any discomfort is well managed by the prescription pain medications provided.
Activity
Please avoid any heavy lifting, bending or straining for two weeks following surgery. You may brush your teeth with care.
After your hospital discharge, please notify the office for any of the following:
- Fever over 102° F
- Difficulty breathing or painful swallowing
- Swelling that increases rather than decreases with time
- Pain not managed by pain medication
If you have any questions, please do not hesitate to contact our office at (716) 256-3550 and ask for our nurse, Louise Muprhy, RN.
For an emergency please call our professional answering service at 585-258-4840.
Please notify the office 585-256-3550 for any concerns. We are here to help in any way we can.
Dr. John U. Coniglio and Staff
|
