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. 2019 Mar;41(3):623-631.
doi: 10.1002/hed.25364. Epub 2019 Jan 7.

Postlaryngectomy prosthetic voice rehabilitation outcomes in a consecutive cohort of 232 patients over a 13-year period

Japke F Petersen  1 , Liset Lansaat  1 , Adriana J Timmermans  1 , Vincent van der Noort  2 , Frans J M Hilgers  1   3 , Michiel W M van den Brekel  1   3   4
Affiliations

Postlaryngectomy prosthetic voice rehabilitation outcomes in a consecutive cohort of 232 patients over a 13-year period

Japke F Petersen et al. Head Neck. 2019 Mar.

Abstract

Background: With the increasing necessity for total laryngectomy (TL) after prior (chemo)radiotherapy, prosthetic vocal rehabilitation outcomes might have changed.

Methods: Retrospective cohort study including all patients laryngectomized between 2000 and 2012 with a voice prosthesis (VP) in the Netherlands Cancer Institute.

Results: Median device lifetimes of the standard Provox2 and Vega VPs are 63 and 66 days, respectively, and for the problem-solving ActiValve Light and Strong VPs 143 and 186 days, respectively. In multivariable analysis, salvage TL and TL for a dysfunctional larynx (compared to primary TL) were associated with a shorter device lifetime. Almost half of the patients (48%) experienced tracheoesophageal puncture tract-related problems, and this concerned 12% of all VP replacements.

Conclusions: Compared to historical cohorts, device lifetimes of regular Provox2 and Vega voice prostheses have decreased. Complications are not occurring more frequently but affect more patients. Nevertheless, the clinical reliability and validity of prosthetic voice rehabilitation is still sound.

Keywords: complication management; device lifetime; total laryngectomy; voice prosthesis; voice rehabilitation.

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Figures

Figure 1
Figure 1
A) Kaplan Meier curve of device lifetime analyzed separately for the different VPs. B) The device lifetime for the standard VPs (Provox2 and Vega) grouped by whether or not these patients have ever had an ActiValve VP during follow‐up and the device lifetime of the ActiValve VPs together [Color figure can be viewed at wileyonlinelibrary.com]
Figure 2
Figure 2
This figure illustrates the complex pathways of VP problem solving, in this case, periprosthetic leakage. As can be seen in this figure, 204 VPs were replaced with either the same or a smaller size, which was effective in 154 and not effective in 34 replacements. The result was undocumented for 16 VPs. The 34 VPs entered the flowchart again. Finally, it resulted in three surgical closures [Color figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

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