[Dysphagia] TEP problem - ughh!

[EDolinger at Christianacare.org (Dolinger, Eric)]

Need some collective help here.  Forewarned...long

60ish patient with h/o laryngeal CA, previously irradiated.
Had recurrence and subsequently had TL with primary fistula.  Unfortunately
had healing problems and persistent fistula which subsequntly required
pectoralis flap reconstruction of the neck/stoma.  Miraculously, The
prosthesis I inserted (after he was sitting around for a month with a red
rubber catheter coming out of his stoma)survived 6 weeks of neglect and
reconstructive surgery!!

So...once he was resized and the correct prosthesis inserted (which was
probably 4 sizes smaller than the original size), the spectre of the flaccid
fistula arrived.
Probably went through 4 lost prostheses (don't know where they went?!!
Though I suspect he is sucking them into the esophagus as opposed to losing
them into the lungs CXR has not shown TEP).  We are now using the 6mm 20
french indwelling with the large esophageal flange.  The patient just got a
fat injection to the TEF site last week and he STILL lost a prosthesis over
the weekend...aspirating for 2 days.

Needless to say, we are both frustrated.  Need some further insight

Thanks

eric



Eric Dolinger, MA CCC-SLP
Senior Speech Pathologist
Christiana Care Health System 
Phone 302-733-1015
Fax 302-733-1061

edolinger@christianacare.org