Preoperative preparation for tracheoesophageal puncture

Tracheoesophageal puncture is a traumatic operation performed to restore the pronunciation function of patients who have undergone total laryngectomy for laryngeal cancer. In order to minimize the surgical damage, adequate preparation should be done before the operation.

1. Barium angiography

The patient first undergoes esophageal barium contrast to observe whether there is stenosis of the hypopharyngeal esophagus.

2. Esophageal inflation test

A special latex catheter with a three-way function is used, with the round-tipped end inserted through the nasal cavity to the bottom of the entrance of the esophagus, and stopped at 25 cm from the nostril according to the pre-marked scale. There is a sealing cover on the other end, which is covered on the tracheostomy opening and connected to a manometer. During the test, the airflow exhaled from the lungs is used to reach the esophagus through the catheter. When blowing, if the pharyngeal mucosa can make a sound when the airflow vibrates, the inflation test is positive; if no sound is made, it is negative.

Under normal air pressure, those who test positive have a high success rate in installing a voice machine; those who test negative should be considered to have cricopharyngeal atony. After pharyngeal plexus anesthesia, if the inflation test can produce sound, it is considered to be cricopharyngeal atony, and it will be difficult to produce sound successfully even if a voice machine is installed.

3. Tracheostomy stenosis

For patients with a tracheostomy stoma diameter of less than 1.5 cm, stoma enlargement should be performed first, and a special large-sized cannula should be placed for dilation after the operation. The tracheal cannula should be removed after 6 months, and then tracheoesophageal puncture should be performed.

4. Psychological preparation

Patients and their families should understand the application methods of the sound device, relax and be mentally prepared before the operation.

Tips: Indications for tracheoesophageal puncture

1. Patients who have undergone total laryngectomy;

2. People without larynx who cannot master esophageal phonation;

3. People without larynx who cannot use electronic larynx or other assisted pronunciation and speech;

4. Those who have failed other voice surgeries or pronunciation methods;

5. Patients who have undergone radiotherapy or neck lymph node dissection.