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In: Business and Management

Submitted By ehtesham90000
Words 6352
Pages 26
Literature Review: Enlarged Tracheoesophageal Puncture after Total Laryngectomy: A Systematic Review and Meta-Analysis

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ABSTRACT
Objectives: Enlargement of the tracheoesophageal puncture (TEP) is a challenging complication after laryngectomy with TEP. We sought to estimate the rate of enlarged puncture, associated pneumonia rates, potential risk factors, and conservative treatments excluding complete surgical TEP closure.
Methods: A systematic review was conducted (1978–2008). A summary risk estimate was calculated using a random-effects meta-analysis model.
Results: Twenty-seven peer-reviewed manuscripts were included. The rate of enlarged puncture and/or leakage around the prosthesis was reported in 23 articles (range, 1% to 29%; summary risk estimate, 7.2%; 95% confidence interval [CI], 4.8% to 9.6%). Temporary removal of the prosthesis and TEP- site injections were the most commonly reported conservative treatments. Prosthetic diameter (p =.076) and timing of TEP (p = .297) were analyzed as risk factors; however, radiotherapy variables were inconsistently reported.
Conclusions: The overall risk of enlarged puncture seems relatively low, but it remains a rehabilitative challenge. Future research should clearly establish risk factors for enlarged puncture and optimal conservative management.
Keywords: tracheoesophageal puncture, total laryngectomy, enlarged tracheoesophageal puncture, complications, leakage

Enlarged Tracheoesophageal Puncture after Total Laryngectomy: A Systematic Review and Meta-Analysis
Introduction:
The gold standard for voice restoration after total laryngectomy is tracheoesophageal puncture (TEP). The TEP is a small surgically created fistula in the tracheoeosphageal (TE) wall that may be created at the time of the total laryngectomy (primary TEP) or later after the patient has healed from surgery (secondary TEP). A…...

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