الفهرس 
Acknowledgment
Preoperative Planning and PreparationOnly 14 pages are availabe for public view
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Abstract
Summary
The past three decades have a significant progress in the rehabilitation of patients after total laryngectomy. (11) Now TEP is the gold standard for voice rehabilitation after TL. It is done by creating a surgical fistula between the trachea and the oesophagus and maintaining it by inserting a silicon prosthesis. It can be performed at the time of TL (primary TEP) or afterwards (secondary TEP). (20)
The advantages of these devices are numerous and include immediate voice production, high success rates and the possibility of sustained speech with high quality than that with esophageal speech. (20)
Minor complications usually occur with the prosthesis e.g. leakage, fungal colonization, granulation tissue formation, cervical cellulitis, tracheostomal stenosis, and swallowing the device. Severe complications are very rare.(79)
For evaluating speech rehabilitation outcomes, multidimensional assessment is recommended as acoustic analysis, perceptual evaluation, and self-assessment. Acoustic voice analysis includes obtaining information about the pitch, quality and MPT. Perceptual outcomes include overall impression of voice quality and intelligibility assessed by speech pathologist and phoniatricians. The self-assessment protocols are those based on the patient’s own opinion in his or her voice quality. (62)
This study aimed to evaluate the outcomes of Provox®2 voice prosthesis in vocal rehabilitation after total laryngectomy. It was performed on the patients demanding vocal rehabilitation by the insertion of Provox®2 voice prosthesis after total laryngectomy (secondary rehabilitation).
The study was conducted in ENT department of the main Assiut University Hospital during the period from 27th of Sept 2015 to 31st of Dec 2016. It included 16 patients. Their ages ranged from 45 to 82 years. According to the TNM staging, all the patients had an advanced disease. Seven patients received adjuvant postoperative chemo or/and radiotherapy. Four patients (25%) needed stomal dilatation (size less than two cm).
Provox®2 voice prosthesis was inserted following total laryngectomy (secondary TEP) under general anesthesia and Atos Medical 7203 Provox® Trocar with Cannula was used for TE fistula creation. Replacement of the Provox®2 voice prosthesis was carried out by anterograde insertion.
All the patients were followed up for training and education and determining of functional outcomes and development of complications for a period that ranged from four months to 12 months.
Fifteen patients were able to produce voice shortly after recovery from anesthesia.
This study showed that in the fifteen satisfied patients, the production of 100% intelligible voice with a good MPT and quality of voice (assessed by GRBAS scale) using a device with an average life of 375 days would be considered as favorable. Its main drawback in our locality would be its coast augmented by its native nature to be expired.