RESUMO
Enlarging tracheoesophageal fistula after tracheoesophageal prosthesis for voice rehabilitation remains a major challenge. The authors analyze the results of treatment of 15 severe enlarging tracheoesophageal fistulas among 28 cases (52%) of tracheoesophageal voice rehabilitation which occurred during a 4 years period of time. Among these 15 cases, a spontaneous closure occurred in 3 cases (20%), a two layers closure was performed in 4 cases (26%) and a closure using a tracheal ascension associated with the design of a new tracheostoma was performed on 8 cases (53%). The authors describe the surgical technique and discussed the advantages of surch technique.
Assuntos
Laringe Artificial , Fístula Traqueoesofágica/cirurgia , Adulto , Idoso , Humanos , Laringectomia/reabilitação , Pessoa de Meia-Idade , Faringectomia/reabilitação , Traqueia/cirurgia , Fístula Traqueoesofágica/etiologia , TraqueostomiaRESUMO
Tumors of the amygdaline region were up until now most often treated by transmandibular buccopharyngectomy (TMBP) with a systematic sacrifice of the mandibular angle. This exercise justified by wide carcinological imperatives, a larger surgical facility and simple immediate postoperative follow-up, in fact systematically shows a substantial esthetic and functional prejudice. This principle was reinforced by the occurrence of osteitis during the first attempts of osseous reconstruction using steel wires opposite the mandibular angle (Dargent, Charachon, 1963). In 1989, Gehanno and Beauvillain published a mandibular conservation technique by vertical paramedian osteotomy, right in front of the mental nerve, shifted from the future field of radiation, with osteosynthesis by titanium plates. This technique appeals to us because it is easy to use, reliable and carcinologically safe. We have currently adopted it with satisfaction for 8 of our patients over an 18-month period, without any case of osteitis and with both good esthetic and functional results.
