The objectives of this study were to determine (1) the rates of complications, admissions to hospital and requirements for further surgery in patients fitted with tracheoesophageal fistula speech valves, and (2) whether any factors were predictive of complications. A case note review was undertaken of all patients undergoing a laryngectomy at Gartnavel General and Stobhill Hospitals over a 10-year period. One hundred patients were identified.

Forty-five patients had complications from their valves, most commonly granulation tissue formation. Thirty-five had a least one admission related to complications and 34 required further surgery. Sixty-seven were vocalizing with the valve.

Radiotherapy and valve type were not statistically significant in predicting complications in this study. Primary puncture was associated with a higher rate of complications, although the numbers undergoing secondary puncture were small.

Insertion of a voice prosthesis through the tracheoesophageal puncture (TEP) is one way to restore the voice after total laryngectomy. The second generation Provox® voice prosthesis is presently one of the most popular devices. Although TEP can be done primarily, there are many centres that prefer it to be done at a second stage for various reasons. However, secondary TEP for retrograde replacement of prosthesis can be difficult and general anaesthesia is very often necessary. Moreover, the presence of neck stiffness and fibrosis from the surgery or previous radiotherapy could affect the neck extension for proper positioning of the trocar. Similarly, it is difficult to insert the prosthesis if there is stenosis at the pharyngoesophageal segment. We describe a technique in which creation of secondary TEP and insertion of Provox®2 is done with local anaesthesia under the same setting. The procedure is well tolerated and can be safely performed on an out-patient basis.

The Groningen voice prosthesis can be successfully replaced using the back-loading system. We have attempted to minimize patient stress by developing a front-loading system that does not require insertion of the introducer via the tracheo-oesophageal shunt to the oral cavity or the mesopharyngeal anaesthetization regularly used with the back-loading system. Using our front-loading system, the existing prosthesis is removed, then the posterior portion of the replacement Groningen prosthesis is grasped by a pair of nasal forceps with a small jaw to make an acute angle and inserted into the oesophageal cavity through the shunt at a stroke. All 20 patients who underwent forward-loading replacement of a Groningen (n=17) or Blom-Singer (n=3) valve with a Groningen valve tolerated the procedure well and experienced no complications except, in some cases, for minor bleeding just after insertion of the prosthesis.The procedure was completed within 30 seconds.

Congenital posterior laryngeal clefts are rare anomalies, being first described by Richter in 1792, and first operated upon successfully by Pettersson in 1955. Most clefts present within the first few months of life, with only a few cases being documented as presenting in adulthood. We present the case of a 50-year-old lady presenting with a previously undiagnosed posterior laryngeal cleft with an associated tracheoesophageal fistula. The defect was graded as 2 on the Benjamin and Inglis classification system of posterior laryngeal clefts. Following a literature review, we believe that our patient is the oldest to present with this congenital defect.

Successful communication following laryngectomy usually involves an electrolarynx or oesophageal speech. Only within the past decade has tracheoesophageal puncture been advocated for alaryngeal speech and evolved into the procedure of choice. Successful production of speech after total laryngectomy using tracheoesophageal speech may be impaired secondary to anatomical and functional difficulties. The primary limitation of tracheoesophageal speech is pharyngoesophageal spasm occurring in the upper oesophageal sphincter impeding airflow through this segment. Our report presents four patients who underwent a pharyngeal myotomy with the potassium-titanyl-phosphate (KTP) laser. Post-operatively, each patient was able to communicate with functional alaryngeal speech. A transmucosal pharyngeal myotomy may represent an alternative for patients with speech failure after tracheoesophageal puncture.

Tracheoesophageal puncture is an established procedure for voice restoration following laryngectomy. A method using a flexible gastroscope and a percutaneous endoscopic gastrostomy (PEG) set is described. This overcomes a number of problems and complications which may be encountered when using a rigid endoscope.