TE fistula deep down in trachea, making replacement troublesome

Problem: the TE fistula is positioned deep down in the trachea, making the replacement more troublesome

The correct position of the TE-fistula is of great importance. The center of the fistula should be approximately 5 mm below the mucocutaneous junction of the trachea. The figure to the right shows such an ideally situated prosthesis. A much lower position (as shown in the lower figure) can induce problems for the patient in cleaning of the prosthesis, might make replacement more cumbersome and could be the cause for easy leakage of fluids through the prosthesis. If any of these problems interfere with optimal function of the prosthetic voice rehabilitation, closure of the fistula and secondary puncture at a later date could be beneficial.