Skip to main content
SpringerLink
Log in

Therapie der tracheoösophagealen und tracheopharyngealen Fisteln nach Laryngektomie

Treatment of tracheoesophageal and tracheopharyngeal fistulas after laryngectomy

  • CME Weiterbildung · Zertifizierte Fortbildung
  • Published:
HNO Aims and scope Submit manuscript

Zusammenfassung

Tracheoösophageale (TÖF) und tracheopharyngeale Fisteln (TPF) nach Laryngektomie können in 5 Typen eingeteilt werden: „hohe TÖF bei defekter Stimmprothese“ (Typ Ia), „hohe TÖF mit Leckage neben der Stimmprothese“ (Typ Ib), „erweiterte hohe TÖF“ (Typ II), „tiefe TÖF“ (Typ III), „TPF“ (Typ IV) und „TPF assoziert mit einer Pharynxstenose“ (Typ V). TÖF-Leckagen nach prothetischer Stimmrehabilitation können gut konservativ behandelt werden. Bei allen TPF und in Fällen, in denen die konservative Behandlung versagt, ist ein chirurgisches Vorgehen mit einem transtracheostomalen oder transzervikalen mehrschichtigen Fistelverschluss erforderlich. Eine Trachea- bzw. Tracheostomaverlagerung zur Distanzierung der kranialen Trachea von den pharyngealen und ösophagealen Fistelnähten ist eine effektive Maßnahme für einen erfolgreichen Verschluss. In seltenen Fällen ist eine TPF mit einer narbigen Verengung des Pharynx kombiniert. Eine komplette Resektion des stenotischen pharyngoösophagealen Segments mit nachfolgender Rekonstruktion durch ein revaskularisiertes tubuläres Radialistransplantat kann in diesen Fällen indiziert sein.

Abstract

Tracheoesophageal (TEF) and tracheopharyngeal fistulas (TPF) after laryngectomy can mainly be divided into five types: “high TEF with leakage through the voice prosthesis (VP)” (Type Ia), “high TEF with leakage around the VP” (Type Ib), “enlarged high TEF” (Type II), “deep TEF” (Type III), “TPF” (Type IV) and “TPF associated with pharynx stenosis” (Type V). Leakage of TEF in prosthetic voice restoration usually responds well to conservative measures. If these measures fail, as well as in all cases of TPF, surgical intervention is necessary for transtracheostomal or transcervical closure with multi-layer sutures of the esophagus and trachea. In persisting TEF/TPF after unsuccessful surgical attempts revision surgery remains challenging. Tracheostoma transposition for dissociation of the cranial end of the trachea and the hypopharynx and esophagus is essential for effective closure. In rare cases of TPF combined with pharyngoesophageal stricture formation a resection and immediate reconstruction of the stenotic pharyngoesophageal segment with a tube-shaped fasciocutaneous radial forearm flap must be considered.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. Akin I, Torkut A, Ustunsoy E et al (1997) Results of reconstruction with free forearm flap following laryngopharyngo-oesophageal resection. J Laryngol Otol 111:48–53

    Article  CAS  PubMed  Google Scholar 

  2. Brasnu D, Pages JC, Laccourreye O et al (1994) Results of the treatment of spontaneous widening of tracheo-esophageal punctures after laryngeal implant. Ann Otolaryngol Chir Cervicofac 111:456–460

    CAS  PubMed  Google Scholar 

  3. Cho BC, Kim M, Lee JH et al (1998) Pharyngoesophageal reconstruction with a tubed free radial forearm flap. J Reconstr Microsurg 14:535–540

    Article  CAS  PubMed  Google Scholar 

  4. Delaere PR, Delsupehe KG (1994) Closure of persistent tracheoesophageal fistulas after removal of the voice prosthesis. Laryngoscope 104:494–496

    CAS  PubMed  Google Scholar 

  5. Duarah S, Thankappan K, Sharan R, Kekatpure V (2008) In reference to classification and management of tracheoesophageal and tracheopharyngeal fistulas after laryngectomy. Laryngoscope 118:944; author reply 944. Comment on: Laryngoscope 2007 117:1943–1951

  6. Ehrenberger K, Wicke W, Piza H et al (1985) Jejunal grafts for reconstructing a phonatory neoglottis in laryngectomized patients. Arch Otorhinolaryngol 242:217–223

    Article  CAS  PubMed  Google Scholar 

  7. Gehrking E, Raap M, Sommer KD (2007) Classification and management of tracheoesophageal and tracheopharyngeal fistulas after laryngectomy. Laryngoscope 117:1943–1951

    Article  PubMed  Google Scholar 

  8. Harii K, Ebihara S, Ono I et al (1985) Pharyngoesophageal reconstruction using a fabricated forearm free flap. Plast Reconstr Surg 75:463–476

    CAS  PubMed  Google Scholar 

  9. Hosal SA, Myers EN (2001) How I do it: closure of tracheoesophageal puncture site. Head Neck 23:214–216

    Article  CAS  PubMed  Google Scholar 

  10. Jakubowicz DM, Smith RV (2005) Use of becaplermin in the closure of pharyngocutaneous fistulas. Head Neck 27:433–438

    Article  PubMed  Google Scholar 

  11. Laccourreye O, Papon JF, Brasnu D, Hans S (2002) Autogenous fat injection for the incontinent tracheoesophageal puncture site. Laryngoscope 112:1512–1514

    Article  PubMed  Google Scholar 

  12. Leder SB, Acton LM, Kmiecik J et al (2005) Voice restoration with the advantage tracheoesophageal voice prosthesis. Otolaryngol Head Neck Surg 133:681–684

    Article  PubMed  Google Scholar 

  13. Lee LM, Razi A (2004) Three-layer technique to close a persistent tracheo-oesophageal fistula. Asian J Surg 27:336–338

    Article  PubMed  Google Scholar 

  14. Lorincz BB, Lichtenberger G, Bihari A, Falvai J (2005) Therapy of periprosthetical leakage with tissue augmentation using Bioplastique around the implanted voice prosthesis. Eur Arch Otorhinolaryngol 262:32–34

    Article  CAS  PubMed  Google Scholar 

  15. Luff DA, Izzat S, Farrington WT (1999) Viscoaugmentation as a treatment for leakage around the Provox 2 voice rehabilitation system. J Laryngol Otol 113:847–848

    Article  CAS  PubMed  Google Scholar 

  16. Manni JJ, Van den Broek P (1990) Surgical and prosthesis-related complications using the Groningen button voice prosthesis. Clin Otolaryngol Allied Sci 15:515–523

    Article  CAS  PubMed  Google Scholar 

  17. Margolin G, Masucci G, Kuylenstierna R et al (2001) Leakage around voice prosthesis in laryngectomees: treatment with local GM-CSF. Head Neck 23:1006–1010

    Article  CAS  PubMed  Google Scholar 

  18. Moerman M, Vermeersch H, Heylbroeck P (1999) A simple surgical technique for tracheoesophageal fistula closure. Head Neck 21:131–138

    Article  Google Scholar 

  19. Mozolewski E (1972) Surgical rehabilitation of voice and speech following laryngectomy. Otolaryngol Pol 26:653–661

    CAS  PubMed  Google Scholar 

  20. Neumann A, Schultz-Coulon HJ (2000) Management von Komplikationen nach prothetischer Stimmrehabilitation. HNO 48:508–516

    Article  CAS  PubMed  Google Scholar 

  21. Perie S, Ming X, Dewolf E, St Guily JL (2002) Autologous fat injection to treat leakage around tracheoesophageal puncture. Am J Otolaryngol 23:345–350

    Article  PubMed  Google Scholar 

  22. Remacle MJ, Declaye XJ (1988) Gax-collagen injection to correct an enlarged tracheoesophageal fistula for a vocal prosthesis. Laryngoscope 98:1350–1352

    Article  CAS  PubMed  Google Scholar 

  23. Remmert S, Ahrens KH, Sommer K et al (1994) Die Stimmrehabilitation mit dem Jejunumsprechsiphon: Der Biventerzügel, eine Modifikation zur Vermeidung von Aspirationen. Laryngorhinootologie 73:84–87

    Article  CAS  PubMed  Google Scholar 

  24. Remmert S, Majocco A, Gehrking E (1995) Der neurovaskuläre infrahyoidale Muskelfaszienlappen: Anatomisch-topographische Untersuchung der Innervation und Gefässversorgung. HNO 43:182–187

    CAS  PubMed  Google Scholar 

  25. Rosen A, Scher N, Panje WR (1997) Surgical closure of persisting failed tracheoesophageal voice fistula. Ann Otol Rhinol Laryngol 106:775–778

    CAS  PubMed  Google Scholar 

  26. Seidenberg B, Hurwitt ES (1958) Immediate reconstruction of the cervical esophagus by a revascularized isolated jejunal segment. Surg Forum 9:413–416

    CAS  PubMed  Google Scholar 

  27. Singer MI, Blom ED (1980) An endoscopic technique for restoration of voice after laryngectomy. Ann Otol Rhinol Laryngol 89:529–533

    CAS  PubMed  Google Scholar 

  28. Singer MI, Hamaker RC, Blom ED (1989) Revision procedure for the tracheoesophageal puncture. Laryngoscope 99:761–763

    Article  CAS  PubMed  Google Scholar 

  29. Soylu L, Kiroglu M, Aydogan B et al (1998) Pharyngocutaneous fistula following laryngectomy. Head Neck 20:22–25

    Article  CAS  PubMed  Google Scholar 

  30. Staffieri M, Procaccini A, Steiner W, Staffieri A (1978) Chirurgische Rehabilitation der Stimme nach Laryngektomie. Operationsmethode nach Staffieri. Laryngol Rhinol Otol 57:477–488

    CAS  Google Scholar 

  31. Ward PH, Andrews BC, Mickel RA et al (1988) Complications of medical and surgical approaches to voice restoration after total laryngectomy. Head Neck 10(Suppl II):124–128

    Article  Google Scholar 

  32. Yu P, Robb GL (2005) Pharyngoesophageal reconstruction with the anterolateral thigh flap: a clinical and functional outcomes study. Plast Reconstr Surg 116:1845–1855

    Article  CAS  PubMed  Google Scholar 

  33. Yu P (2005) One-stage reconstruction of complex pharyngoesophageal, tracheal, and anterior neck defects. Plast Reconstr Surg 116:949–956

    Article  CAS  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    E. Gehrking

Authors
  1. E. Gehrking
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E. Gehrking.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gehrking, E. Therapie der tracheoösophagealen und tracheopharyngealen Fisteln nach Laryngektomie. HNO 58, 497–505 (2010). https://doi.org/10.1007/s00106-010-2085-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00106-010-2085-y

Schlüsselwörter

Keywords

Search

Navigation