[Results of the treatment of spontaneous widening of tracheo-esophageal punctures after laryngeal implant].

Vocal rehabilitation by tracheosophageal puncture procedure and voice prosthesis was employed in a series of 68 patients (64 men and 4 women). The mean age was 68.4 years and ranged from 39 to 78 years. Enlarging tracheoesophageal fistula and leakage occurred in 31 patients. One or several conservative treatments were employed in 23 patients. Surgical closure of the tracheoesophageal fistula was performed in 5 patients (closure without muscular interposition: 3 patients, closure with sternomastoid muscle interposition: 2 patients). Leakage around the prosthesis was noted 8 days to 39 months postoperatively (mean: 11 months). Successful rates of conservative treatments were as following: prosthesis replacement with a small gauge catheter for several days followed by a prosthesis replacement: 9/17 (52.9%), replacement of prosthesis: 4/12 (33%), Gax Collagen injection: 3/9 (33%), cauterization of the tracheoesophageal tract: 0/1. Surgical closure was successful in all cases. Repuncture and prosthesis replacement was successful in one patient. Conservative treatment is initially recommended including prosthesis replacement with a small gauge catheter for several days and followed by a prosthesis replacement. Surgical treatment with muscular interposition is recommended in case of failure of conservative treatments.