The challenging therapy of tracheoesophageal fistulas following laryngectomy and radiotherapy

Persisting tracheoesophageal fistulas following laryngectomy represent a therapeutic challenge. We present two cases of customized prosthetic fistula closure after failed surgical approaches of plastic reconstruction.

Both patients were initially treated with a combination of salivary bypass tube and attached silicon foil to obtain a fistula sealing. To gain a complete sealing customized prostheses were applied in the course of disease. Close cooperation between otolaryngologists and prostheses specialist during repeated interventions under general anesthesia were required to manufacture a precisely fitting model that sealed the fistula completely allowing swallowing fluids orally without leakage. A pharyngeal stenosis cranial to the stenosis in one case could be stented by applying a combination of a prostheses and a salivary bypass tube. One of the first prosthetic models dislocated into the esophagus and had to be removed endoscopically. 2 month after final prostheses-fitting one patient died due to unexplained fatal erosion bleeding of a neck vessel. Mechanical alterations caused by the epithesis itself have to be taken into consideration. The combination stent (salivary bypass tube and prostheses) is in place for 3 month, up to now without any side effects.

A sufficient reconstruction of persisting tracheoesophageal fistulas can be reached by customized prosthesis alone or in combination with a salivary bypass tube. Prosthetic fitting requires a close cooperation between otolaryngologists and prosthetic specialists as well as patient's compliance for repeated interventions under general anesthesia. Patients have to get informed about potential and possibly fatal complications. A close outpatient follow up is mandatory.

Publication History

Publication Date:
23 May 2018 (online)