At the 4th International Conference of Head and Neck Cancer held in Toronto, Canada, Robert H. Maisel, md, an otolaryngologist at the University of Minnesota Cancer Center, advocated performing tracheoesophageal puncture (TEP) at the time of surgical removal of the voice box due to cancer. While the voice-rehabilitating surgical procedure has been part of the cancer operation since 1985, it has traditionally been performed several months after removal of the larynx.
"The primary TEP (done at time of cancer surgery) should be strongly considered in all laryngectomy patients. Complications have been minimal and the potential benefits in rehabilitating the patient immediately are very high," says Maisel. These benefits include talking within 2 weeks of the surgery and eliminating the need for uncomfortable nasal feeding tubes, as well as obviating the need for a second surgery.
Tracheoesophageal puncture enables air to travel from the lung to the mouth and vibrate off the esophagus, allowing the person to make sounds. Approximately 50% of patients undergoing TEP can resume speaking without requiring an artificial voice box or electrolarynx. Although it cannot completely restore voice quality, TEP provides a more natural-sounding voice than does the electrolarynx. Approximately 5,000 people a year in the United States undergo laryngectomies due to cancer.
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