A report of four cases of acute mediastinitis occurring following tracheoesophageal puncture in laryngectomees.

Tracheoesophageal puncture is a simple procedure for speech rehabilitation of total laryngectomy patients. Despite its relative simplicity this is not an innocent technique without complications. The goal of this study was to determine the incidence of acute mediastinitis as an early postoperative complication related to this procedure and to present outcomes of non-surgical conservative management in this complication. Blom-Singer voice prosthesis was used for 51 secondary tracheoesophageal puncture procedures in 45 patients between 1994 and 2002 according to the technique described by Blom and Singer. In the postoperative period, four patients (7.8%) developed mediastinitis related to this procedure. Of these, one patient had iatrogenic perforation of the posterior esophageal wall. A false dissection plane occurred in the tracheo-esophageal party wall in three patients which subsequently resulted in mediastinitis. Mediastinitis was diagnosed by clinical and radiological findings. All of these patients required prolonged hospitalization, intravenous antibiotics, and chest tube insertion. Only one patient underwent major surgical procedure to treat this complication. In conclusion, tracheoesophageal puncture for voice restoration is now regarded as a routine procedure usually performed in outpatient conditions. However, our experience demonstrates that this technique may be associated with significant complications such as mediastinitis. If mediastinitis is recognised earlier, it may be treated with conservative measures in most of the cases.