Die epithetische Versorgung des dysmorphen Tracheostomas nach Laryngektomie

Abstract After laryngectomy, the tracheostoma forms a functional center for breathing and phonation. Form, size and position of the tracheostoma affect the quality of the tracheoesophageal voice. A rare but absolutely typical problem arises from a large and irregularly formed tracheostoma making a sufficient mechanical closing difficult or rather impossible. As an alternative to surgical correction of such a dysmorphic tracheostoma we inserted individually adjusted tracheostoma silicon prosthesis. In this study comprising 21 patients, the subjective assessment of voice quality and breathing function was monitored by a standardized interview as well as the Voice Handicap Index (VHI). Additionally, 7 patients were evaluated clinically. Compared to the standard speech silicon canula a significant improvement of voice function (prolonged voice production and less peristomal noise) was achieved using the tracheostoma prosthesis without increasing airway resistance during breathing. Besides, there was a close correlation between self-evaluation and total VHI score. Light local skin reactions were described by 1/4 of the patients caused by the applied medical adhesive. In general the prosthesis was used 20 hours by the patients, its durability (loss of elasticity, discoloration) was estimated to 2 years. According to our experience, the tracheostoma silicon prosthesis represents an effective alternative to a surgical revision of a dysmorphic tracheostoma after laryngectomy.