Further experience with modification of an intraluminal button for hands-free tracheoesophageal speech after laryngectomy

Abstract

Tracheoesophageal (TE) speech using a voice prosthesis and hands-free speaking valve with an intraluminal attachment is the gold standard for voice restoration after total laryngectomy. Modification of a standard self-retaining silicone cannula or laryngectomy button often aids in the attachment of a speaking valve within the tracheal lumen for hands-free TE speech production. An increased number of laryngectomized individuals are able to achieve hands-free TE speech when the standard length, flange, and diameter of a silicone button is customized to accommodate individual tracheostomal contours. A technique is presented for modification of a standard silicone laryngectomy button to facilitate hands-free TE speech after total laryngectomy.

Fig. 1

Lateral view of TE voice prosthesis stenting TEP with ideal position of LaryButton within stoma to allow pulmonary airflow through prosthesis for speech production.

Fig. 2

LaryButton compromised of external retainer, wings, conical shield, shaft, and tracheal end.

Fig. 3

Metal piston within shaft of bisected button with 2 mm cut-out from shaft to be added to tracheal end (flange).

Fig. 4

Metal piston inserted and 2 mm cut-out from shaft added to tracheal end (flange).

Fig. 5

Dental stone injected onto tracheal end of button.

Fig. 6

Button components in flask.

Fig. 7

Button components retrieved from flask while piston remains embedded in stone during dewaxing.

Fig. 8

Spatulated and vacuumed silicone injected into cope/drag flasking assembly.

Fig 9

Final modified button after cleaning and polishing.

Fig 10

Final modified button fit securely within the tracheostoma. Wings allow for use of LaryClip system for greater retention within stoma.