{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T16:11:01Z","timestamp":1772640661431,"version":"3.50.1"},"reference-count":34,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,6,27]],"date-time":"2023-06-27T00:00:00Z","timestamp":1687824000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:sec><jats:label\/><jats:p>Management of Enlarging tracheoesophageal fistula (TEF) with Voice Prosthesis in Laryngectomized Head and Neck Cancer Patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>An enlarging TEF following voice prosthesis placement impacts patient quality of life, risks airway compromise, and can lead to aspiration pneumonia. Pharyngoesophageal strictures have previously been reported to be associated with TEF enlargement and leakage. We describe a series of patients with enlarging TEFs after Tracheoesophageal puncture (TEP) for voice prosthesis who required pharyngoesophageal reconstruction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective case series of laryngectomized H&amp;N cancer patients with primary or secondary TEP who underwent surgical management for enlarging TEF site between 6\/2016\u201311\/2022.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Eight patients were included. The mean age was 62.8\u2009years old. Seven patients had a history of hypothyroidism. Of seven with prior H&amp;N radiation history, two had both historical and adjuvant radiation. Two of the eight TEPs were placed secondarily. Mean time from TEP to enlarging TEF diagnosis was 891.3\u2009days. Radial forearm\u2010free flaps were used in five patients. Six had stenosis proximal to the TEF whereas one had distal stenosis and one had no evidence of stenosis. Mean length of stay was 12.3\u2009days. Mean follow\u2010up was 400.4\u2009days. Two required a second free flap for persistent fistula.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Surgical reconstruction of enlarging TEFs due to TEP\/VP placement is effective in combination with addressing underlying pharyngeal\/esophageal stenosis contributing to TEF enlargement and leakage. Radial forearm\u2010free flaps have the additional benefit of a long vascular pedicle to access more distant and less\u2010irradiated recipient vessels. Many fistulae are resolved after the first flap reconstruction, but some may require subsequent reconstruction in case of failure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>4 <jats:italic>Laryngoscope<\/jats:italic>, 134:198\u2013206, 2024<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.30857","type":"journal-article","created":{"date-parts":[[2023,6,27]],"date-time":"2023-06-27T10:59:56Z","timestamp":1687863596000},"page":"198-206","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Management of Enlarging Tracheoesophageal Fistula with Voice Prosthesis in Laryngectomized Patients"],"prefix":"10.1002","volume":"134","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3396-0115","authenticated-orcid":false,"given":"Arman","family":"Saeedi","sequence":"first","affiliation":[{"name":"Otolaryngology\u2014Head and Neck Surgery NYU Grossman School of Medicine  New York New York U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David P.","family":"Strum","sequence":"additional","affiliation":[{"name":"Otolaryngology\u2014Head and Neck Surgery NYU Langone Health  New York New York U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ghayoour","family":"Mir","sequence":"additional","affiliation":[{"name":"Otolaryngology\u2014Head and Neck Surgery NYU Langone Health  New York New York U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael S.","family":"Chow","sequence":"additional","affiliation":[{"name":"Otolaryngology\u2014Head and Neck Surgery NYU Langone Health  New York New York U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nupur","family":"Bhatt","sequence":"additional","affiliation":[{"name":"Otolaryngology\u2014Head and Neck Surgery NYU Langone Health  New York New York U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam S.","family":"Jacobson","sequence":"additional","affiliation":[{"name":"Otolaryngology\u2014Head and Neck Surgery NYU Langone Health  New York New York U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,6,27]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/014556130608500417"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-009-1138-x"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215117002390"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.24529"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.28517"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.21399.Enlarged"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjoto.2019.08.003"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.21201"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.2310\/7070.2008.0044"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.11236"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1159\/000130870.Proximal"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.21842"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.21777"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/coa.13138"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLG.0b013e31813544ce"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599817722938"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-011-1558-2"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2007.02.014"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/(ISSN)1097-0347"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.22401"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLG.0b013e31816067d5"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.21807"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nutres.2017.08.007"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/HED"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6815-9-10"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1080\/01635581.2017.1285406"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-017-6278-4.Hypothyroidism"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjoto.2021.103003"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599818815164"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1055\/a-1270-6704"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anorl.2021.09.002"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1002\/HED"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.26507"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599820920829"}],"container-title":["The Laryngoscope"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lary.30857","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,2]],"date-time":"2024-07-02T12:58:11Z","timestamp":1719925091000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/lary.30857"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,27]]},"references-count":34,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2024,1]]}},"alternative-id":["10.1002\/lary.30857"],"URL":"https:\/\/doi.org\/10.1002\/lary.30857","archive":["Portico"],"relation":{},"ISSN":["0023-852X","1531-4995"],"issn-type":[{"value":"0023-852X","type":"print"},{"value":"1531-4995","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,27]]},"assertion":[{"value":"2023-03-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-06-13","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-06-27","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}