Cardiothoracic Surgery: Cardiology and Cardiothoracic Surgery |

Bronchotomy for Extraction of Voice Prosthesis After Total Laryngectomy: A Case Report and Review of the Literature FREE TO VIEW

Jonathan Ratcliff, MD; Steven Lorch, MD; Bharat Pancholy, MD; Ernesto Jimenez, MD
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James A Haley Tampa VA, Tampa, FL

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A46. doi:10.1016/j.chest.2016.02.049
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SESSION TITLE: Cardiology and Cardiothoracic Surgery

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM

INTRODUCTION: Foreign body aspiration after laryngectomy in the adult population is reported up to 6.7%. In most instances, these foreign bodies can be successfully treated with bronchoscopic intervention only. We present a patient with a previous total laryngectomy whom aspirated his voice prosthesis 12 months prior with multiple unsuccessful bronchoscopic attempts at extraction necessitating surgical intervention.

CASE PRESENTATION: A 57 year-old patient with a total laryngectomy for squamous cell carcinoma presented with recurrent pneumonias. One year prior, a CT scan identified a foreign body lodged in his bronchus intermedius with an occluded and partially collapsed middle and lower lobe. Bronchoscopic attempts were performed but unsuccessful in removing this object. Patient underwent a right posterolateral thoracotomy, and after palpation of the foreign body in the bronchus intermedius, a transverse bronchotomy was performed with successful extraction of the foreign body. The bronchotomy was closed with interrupted 4-0 PDS and covered with an intercostal muscle flap.

DISCUSSION: Post-operatively, the patient did well with resolution of his pneumonia symptoms and improved ventilation and oxygenation. He was discharged home on post-operative day 8 on oral antibiotics for his culture positive right sided pneumonia. Radiographic confirmation of a patent bronchus intermedius and inflated right middle and lower lobe was performed immediately post operatively and at the 3 month follow up by CT scan. Both CT scans identified successful and complete extraction of the foreign body with a patent bronchus and no signs of stenosis. Patient returned to normal activities with improved oxygenation.

CONCLUSIONS: In adult laryngectomized patients, the aspiration risk of foreign body prosthesis is known with only 10 cases of voice specific prosthesis aspiration being published. All previous cases were treated successfully with bronchoscopic extraction. In those patients that bronchoscopy is unsuccessful, surgical bronchotomy continues to be a viable option.

Reference #1: 1. Rao Kadam V, et al. ‘Speaking valve' aspiration in a laryngectomy patient. Anaesth Intensive Care 2010, 38:197-200.

Reference #2: 2. Kerr Al et al. Blom-Singer prostheses - an 11 year experience of primary and secondary procedures. Clin Otolaryngol Allied Sci 13, 18:184-187.

Reference #3: 3. Conte Sergio et al. Aspiration of tracheoesophageal prosthesis in a laryngectomized patient. Multidisciplication Respiratory Medicine 2012, 7:25.

DISCLOSURE: The following authors have nothing to disclose: Jonathan Ratcliff, Steven Lorch, Bharat Pancholy, Ernesto Jimenez

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