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Submental abscess: an unusual delayed complication of primary Blom–Singer valve insertion

  • S. W. Denholm (a1) and C. P. Fielder (a1)

Abstract

Voice restoration following laryngectomy can be achieved by the now well accepted technique of inserting a ’Blom–Singer‘ prosthesis through a tracheo-oesophageal fistula created either primarily or secondarily. Recognized complications of primary puncture and valve insertion include haemorrhage, oesophageal perforation, peristomal cellulitis and aspiration of saliva. We describe the previously unreported complication of a submental abscess developing probably as a result of air being forced from the fistula up between the trachea and the pharynx, this plane not having fully healed as a result of previous radiotherapy. The problem was compounded by the patient's over-zealous attempts to phonate. To prevent this problem arising in future we recommend leaving the fistula at least six weeks to mature before inserting the valve, when the patient has had previous radiotherapy, and encouraging relaxation when learning to phonate with this technique.

Copyright

Corresponding author

Mr S. W. Denholm, F.R.C.S., Department of Otolaryngology, Singleton Hospital, Sketty, Swansea SA2 8QA.

References

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Baugh, R. F., Lewin, J. S., Baker, S. R. (1990) Vocal rehabilitation of tracheo-oesophageal speech failures. Head and Neck 12: 6973.
Garth, R. J. H., McRae, A., Rhŷs-Evans, P. H. (1991) Tracheooesophageal puncture: a review of problems and complications. Journal of Laryngology and Otology 105: 750754.
Kerr, A. I. G., Denholm, S. W., Anderson, S., Sanderson, R. J. (1993) Blom–Singer prosthesis: an 11-year experience of primary and secondary procedures. Clinical Otolaryngology 18: 184187.
Maniglia, A. J., Lundy, D. S., Casiano, R. C, Swim, S. C. (1989) Speech restoration and complications of primary versus secondary tracheo-oesophageal puncture following total laryngectomy. Laryngoscope 99: 489491.
Silver, F. M, Gluckman, J. L., Donegan, J. O. (1985) Operative complications of tracheo-oesophageal puncture. Laryngoscope 95: 13601362.

Keywords

Submental abscess: an unusual delayed complication of primary Blom–Singer valve insertion

  • S. W. Denholm (a1) and C. P. Fielder (a1)

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