This is an automatically translated article.
The technique of placing a vocal valve has 2 types: valve placement, 1 during laryngectomy or valve placement, 2 after laryngectomy. No matter what type of valve is indicated, the patient should absolutely cooperate with the doctor.
1. What is the technique of placing a sound valve?
Pronunciation valve placement is a procedure to create a catheter and place a vocal valve into the air - oesophagus for patients who have had a total laryngectomy. This technique helps to restore the patient's speech function.
There are 2 types of valve placement:
Valve placement 1: During laryngectomy; Placement of valve 2: After laryngectomy.
2. Indications and contraindications
Indications: Patients with laryngeal cancer, hypopharyngeal cancer have performed total laryngectomy; Contraindications: People with breathing holes too narrow or unable to use and care for valves.
Bệnh nhân ung thư thanh quản cần được đặt van phát âm
3. Technical process of placing the sound valve
3.1 Preparation of Personnel: Ear - Nose - Throat specialist from specialty I and above, trained in head and neck surgery; Technical facilities: Valve set (troca, valve wire, esophagoscope) and Bloom-Singer, Provox type tracheoesophageal valve; Patient: Was explained about the surgical procedure, risk of complications and otolaryngoscopy examination, complete tests (blood count, baseline coagulation, liver-renal function), doctor anesthesia resuscitation examination before surgery; Medical records: Complete according to general regulations. 3.2 Implementation of the technique 1
This is 1 stage in a total laryngectomy, which is performed under general anaesthesia. The procedure is as follows:
Position: The patient lies on his back, with a shoulder pillow and maximum head supine; Insert the throat guard into the patient's esophageal tube to the level of the cut tracheal tip, ensuring that the beveled end of the tube is against the wall of the esophagus-trachea; The troca is punctured from the trachea to the esophagus and about 0.5 - 1cm from the upper end of the trachea in the middle of the tracheoesophageal wall. Direct the troca from front to back, from bottom to top, ensuring that the troca barrel enters the lumen of the throat protection tube; Withdraw the inner tube of the troca, thread the wire through the outer tube from the trachea to the esophagus, then attach the valve to the wire, pull from the esophagus to the trachea so that the two flared ends of the valve are close to the esophageal wall and the trachea wall. Valve placement, 2
This technique is performed after laryngectomy is stable, if the patient has postoperative radiotherapy, it is necessary to wait 6 months to perform valve placement. The procedure is as follows:
Check the records and examine the patient; Anesthesia: General anesthesia, muscle relaxant; Posture: The patient lies on his back, with the shoulder pillow and the head tilted up to the maximum; Using a 30cm esophagoscope to look at the pharynx, check that when the tip of the tube reaches the level of the mouth of the stoma, rotate the bronchoscope 180° so that the bevel side of the tube is pressed against the air-esophageal wall; The troca is punctured from the trachea to the esophagus, about 0.5 - 1cm from the upper end of the trachea in the middle of the tracheoesophageal wall. Direct the troca from front to back, from bottom to top, ensuring that the troca barrel enters the lumen of the throat protection tube; Withdraw the troca tube, thread the wire through the outer tube from the trachea to the esophagus, up to the patient's mouth, attach the valve to the zipper from the esophagus to the trachea so that the two flared ends of the valve are close to the tracheal wall and wall. manage. 3.3 Monitoring and post-operative care Monitoring the fixation of the vocal valve to the tracheo-esophageal wall; Suction and clean the valve to ensure ventilation; Instruct the patient to practice pronunciation from the 2nd day after valve placement. 3.4 Risk of complications and management Bleeding: A rare event, if there is bleeding, it is usually due to tearing of the trachea - esophagus wall. At this time, the doctor needs to intervene according to the standard protocol; Damage to the posterior wall of the esophagus causing esophageal infection: The doctor should give the patient antibiotics, if there is an abscess, it is necessary to open a drainage; Valve drop: Treat by resetting the valve. Pronunciation valve placement is a technique performed in patients with total laryngectomy. After placing the valve, the patient should practice pronunciation early to recover function faster.
To avoid complications after surgery, you should choose reputable medical facilities with a team of highly qualified doctors. Vinmec International General Hospital is a high-quality medical facility in Vietnam with a team of highly qualified medical professionals, well-trained, domestic and foreign, and experienced.
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