Technique to Improve Tracheostomy Speaking Valve Tolerance after Head and Neck Free Flap Reconstruction.

Autor:	Stranix JT; Hansjorg Wyss Department of Plastic Surgery, NYU Langone Medical Center, New York, N.Y.; Department of Speech & Language Pathology, Rusk Rehabilitation, NYU Langone Medical Center, New York, N.Y.; and Department of Oral Maxillofacial Surgery, Lenox Hill Hospital, New York, N.Y., Danziger KM; Hansjorg Wyss Department of Plastic Surgery, NYU Langone Medical Center, New York, N.Y.; Department of Speech & Language Pathology, Rusk Rehabilitation, NYU Langone Medical Center, New York, N.Y.; and Department of Oral Maxillofacial Surgery, Lenox Hill Hospital, New York, N.Y., Dumbrava VL; Hansjorg Wyss Department of Plastic Surgery, NYU Langone Medical Center, New York, N.Y.; Department of Speech & Language Pathology, Rusk Rehabilitation, NYU Langone Medical Center, New York, N.Y.; and Department of Oral Maxillofacial Surgery, Lenox Hill Hospital, New York, N.Y., Mars G; Hansjorg Wyss Department of Plastic Surgery, NYU Langone Medical Center, New York, N.Y.; Department of Speech & Language Pathology, Rusk Rehabilitation, NYU Langone Medical Center, New York, N.Y.; and Department of Oral Maxillofacial Surgery, Lenox Hill Hospital, New York, N.Y., Hirsch DL; Hansjorg Wyss Department of Plastic Surgery, NYU Langone Medical Center, New York, N.Y.; Department of Speech & Language Pathology, Rusk Rehabilitation, NYU Langone Medical Center, New York, N.Y.; and Department of Oral Maxillofacial Surgery, Lenox Hill Hospital, New York, N.Y., Levine JP; Hansjorg Wyss Department of Plastic Surgery, NYU Langone Medical Center, New York, N.Y.; Department of Speech & Language Pathology, Rusk Rehabilitation, NYU Langone Medical Center, New York, N.Y.; and Department of Oral Maxillofacial Surgery, Lenox Hill Hospital, New York, N.Y.
Jazyk:	angličtina
Zdroj:	Plastic and reconstructive surgery. Global open [Plast Reconstr Surg Glob Open] 2016 Dec 07; Vol. 4 (12), pp. e1082. Date of Electronic Publication: 2016 Dec 07 (Print Publication: 2016).
DOI:	10.1097/GOX.0000000000001082
Abstrakt:	Increased upper airway resistance from postoperative changes after major head and neck surgery may cause elevated transtracheal pressures and result in tracheostomy speaking valve intolerance. This may be particularly true among patients with baseline pulmonary disease. We describe a patient recovering from oral cancer resection and flap reconstruction who demonstrated prolonged ventilator dependence and tracheostomy speaking valve intolerance with abnormal tracheal manometry. We attempted to improve speaking valve tolerance through the adaptation of a valve modification intended to reduce transtracheal pressures. Drilling holes into the 1-way speaking valve allowed for excess air egress and resulted in normalization of transtracheal pressures with improved speaking valve tolerance. This 1-way speaking valve modification may serve as a simple method to allow for earlier restoration of voicing and potentially reduce the number of ventilator- dependent days in this patient population.
Databáze:	MEDLINE
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