TE fistula migrated upwards outside the trachea, voicing problematic

Problem: the TE fistula is migrated upwards outside the trachea, making voicing problematic

This is an extremely rare problem in an indwelling voice prostheis system like Provox. This is probably due to the lack of any tension upwards, unlike non-indwelling prostheses. If any ‘migration’ occurs, this is most probably downward migration, an example of which is shown on the previous page. The top figure is only one of two cases of upward migration we have ever seen with indwelling prostheses. In this case, the patient underwent a gastric pull-up procedure with reconstruction of the neck skin with a PM flap with split skin coverage. Although everything healed well, over a course of more than 5 years the situation shown developed. The patient was still able to achieve airtight stoma occlusion by using the Provox HME adhesive to cover the voice prosthesis area together with the tracheostoma. However, at a certain point this became too problematic and, therefore, the fistual tract was closed with a local skin rotation flap. After 6 weeks, a new secondary TEP was carried out with the result shown in the lower figure. At “11 o’ clock” the closed TEP scar still can be noticed.