création d'une fistule trachéo-œsophagienne

OBS: Renseignement obtenu d'une spécialiste du Centre de l'ouïe et de la parole de l'hôpital Notre-Dame, Montréal.

CONT: A tracheo-esophageal puncture technique for voice restoration after laryngectomy.
CONT: Tracheoesophageal puncture. Stoma is occluded with finger to shunt air, through silicone bivalved tube, into the esophagus. The air causes vibration at the level of the P-E segment and enables production of sound.
OBS: Tracheoesophageal fistulas, which are created by a puncture technique and maintained by a plastic prosthesis, are useful in the restoration of speech after a total laryngectomy. On the other hand, I have not found total laryngectomy with tracheoesophageal puncture to be an acceptable substitute for near-total laryngectomy if the patients' cancer did not actually require a total laryngectomy ... Furthermore, puncture methods direct the bolus of pulmonary air into the esophagus. Sometimes this induces a cricopharyngeal spasm, which must be corrected before the air can be brought up into the pharynx as sound ... On the other hand, excellent results in a co-operative patient are certainly possible with the puncture and prosthesis technique.