Proposal for a new nomenclature of tracheo-oesophageal puncture: a different perspective
Dear Editor, The management of laryngeal cancer is focused on improvingsurvival while preserving function; nevertheless, total laryngectomy is often required for primary and recurrent disease. While total laryngectomy is undoubtedly an effective oncologicalsurgery, it profoundly alters speech, respiration and sense of smell and taste. Specifically, the loss of voicehas the impact on the psychosocial and economic consequencesfollowing laryngectomy.There are three methods of voice rehabilitation after totallaryngectomy: electrolarynx, oesophageal speech andtracheo-oesophageal (TE) speech. Historically, oesophagealspeech was the method of choice by which all otherswere compared, and patients who could not master oesophagealspeech used the electrolarynx. In 1969, Staffieri introduced a surgical voice restoration techniquecalled “phonatory neoglottis surgery”: this was a personaltechnique that allowed one-way air transit from the lungsto the hypopharynx or oesophagus through a fistula betweenthe trachea and the hypopharynx or oesophagus.In 1977, Amatsu with a different surgical technique thatincluded a posterior tracheal wall flap, namely the “Amatsutracheo-oesophageal shunt”, achieved similar results.Both authors addressed the issue of frequently occurringaspiration and the use of a trachea-oesophageal prosthesisplacement to manage failures. In 1972, Mozolewski firstdescribed a TE shunt prosthesis with a valve function. In1980, Singer and Blom proposed a simplified endoscopicmethod for voice restoration. They addressed the problemsof aspiration and stenosis (of the fistula) by meansof a valved prostheses placed inside the TE fistula. Thisprocedure was initially proposed as a secondary salvagetechnique for patients who failed oesophageal speech orthose who were displeased with the electrolarynx voice.Maves and Lingeman and Hamaker et al. were the firstto introduce TE puncture with voice prosthesis as a primarytechnique, performed at the time of laryngectomy.Nowadays, TEP with voice prosthesis is the gold standardfor voice rehabilitation after total laryngectomy.