Major complications following tracheoesophageal puncture for voice rehabilitation.

The successful use of the tracheoesophageal voice prosthesis for speech rehabilitation of the total laryngectomy patient has lead to common application of this device. Although the creation of a tracheoesophageal fistula is a simple procedure, it is not without complications. A review of 104 patients who underwent this procedure indicated a complication rate of 25%. Complications were related primarily to the fistula and included migration and progressive enlargement of the puncture, persistent or recurring infection of the fistula site, aspiration pneumonia, and death. Other problems included aspiration of the prosthesis, vertebral osteomyelitis, and tracheal stomal and esophageal stenosis. Many of these patients required hospitalization, intravenous antibiotics, and major surgical procedures to treat these complications. Guidelines for early identification and management of these problems as well as methods to prevent complications are discussed.