Fabrication of a custom recessed tracheostoma valve retainer for the total laryngectomy patient

Total laryngectomy patients who depend on a prosthesis for the production of alaryngeal speech often have irregular peristomal anatomy. The standard tracheostoma (speech) valve retainer cannot be intimately adapted to uneven and highly mobile tissue. Fabrication of a custom speech valve retainer is indicated under such circumstances but may be complicated by restricted access to the surgically created stoma. This article describes the clinical and laboratory techniques for the fabrication of a custom tracheostoma valve retainer that displaces the peristomal soft tissues and musculature. This technique permits access for placement of the speech valve and valve retainer in close proximity to the speech button prosthesis. Enclosure of the custom retainer in the recess underlying the peristomal musculature also provides a plug that enhances retention and increases patient confidence during alaryngeal speech. The coordinated efforts of the speech specialist and the prosthodontist in the fabrication of this prosthesis enhances the quality of life for the total laryngectomy patient.