10  Imaging the Postoperative Neck	495

10.11\ Tracheoesophageal

Puncture and Voice

Prostheses

10.11.1  Discussion

Voice prostheses (tracheoesophageal puncture devices), such as Provox and Blom-Singer, are used to provide voice restoration following total laryngectomy (Figs. 10.71 and 10.72). These devices are implanted across a surgical tracheoesophageal puncture or fistula created at the superior aspect of the tracheal stoma. Voice prostheses contain a one-way valve that prevents

a

saliva from entering the trachea, but allow air to pass into the esophagus to enable “esophageal speech” (Fig. 10.73). The devices are usually changed after several months due to biofilm accumulation. Complications related to voice prostheses are uncommon, but migration/malposition, leakage around the valve, and valve incompetence can occur. In addition, they can become dislodged and aspirated into the trachea or swallowed, and may appear as a foreign body. CT with multiplanar reformations can be used effectively to evaluate position of the prosthesis, since the cylindrical plastic and metallic components are readily visible (Fig. 10.74).

b

Fig. 10.71  Provox voice prosthesis. Axial (a) and sagittal (b) CT images show the voice prosthesis, the trachea (T), and the esophagus (E) at the level of the stoma (oval)

496	D.T. Ginat et al.

Fig. 10.72  Blom-Singer voice prosthesis. Sagittal CT image shows the prosthesis with its characteristic “duckbill” in the tissue plane between the trachea (T) and esophagus (E)

Fig. 10.73  Illustration depicts a voice prosthesis and relevant anatomy

a

b

Fig. 10.74  Voice prosthesis migration. Oblique axial (a) and sagittal (b) CT images show anterior displacement of the device, which does not attain the esophageal lumen (arrows)