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A tracheo-oesophageal puncture (or tracheoesophageal puncture) is a surgically created hole between the trachea (windpipe) and the esophagus (the tubal pathway between the throat and the stomach) in a person who has had a total laryngectomy, a surgery where the larynx (voice box) is removed. The purpose of the puncture is to restore a person’s ability to speak after the vocal cords have been removed. This involves creation of a fistula between trachea and oesophagus, puncturing the short segment of tissue or “common wall” that typically separates these two structures. A voice prosthesis is inserted into this puncture. The prosthesis keeps food out of the trachea but lets air into the esophagus for oesophageal speech. A laryngectomized person is required to breathe through a permanent breathing hole in the neck, called a tracheostoma. When a laryngectomized person occludes the tracheostoma, completely blocking exhaled air to leave the body through that pathway, exhaled air is directed through the voice prosthesis. This air enters the esophagus and escapes through the mouth. During this process, as the air passes through the upper tissues of the esophagus and lower throat, it allows for vibration of the tissues of the pharyngoesophageal segment (also called PE-segment, neoglottis or pseudoglottis). This vibration creates a sound that serves to replace the sound the vocal cords previously produced. Other methods of alaryngeal speech (i e speech without vocal cords) are esophageal speech, and artificial larynx speech. Studies show that tracheoesophageal speech is found to be closer to normal speech than esophageal speech and is often reported to be better, both in terms of naturalness as well as how well it is understood, when compared to esophageal speech and electrolarynx speech. The first report on a tracheoesophageal puncture dates back to 1932 when a laryngectomized patient was said to use a hot ice pick to create a tracheoesophageal puncture in himself. This enabled him to speak by forcing air through the puncture when closing off the tracheostoma with a finger. ==Puncture procedures== There are two tracheo-esophageal puncture procedure types: Primary and secondary puncture. Initially, the procedure was described as a secondary procedure and later also as a primary procedure. Primary tracheoesophageal puncture: This procedure is performed during the total laryngectomy surgery. After removal of the larynx and creation of the tracheostoma, the puncture is made through the back wall of the trachea into the front wall of the esophagus. The main advantages of a primary puncture are: 1) that a second surgery to create the puncture is avoided (including the related costs and risks) and: 2) that the patient will be able to speak within a few weeks after total laryngectomy.〔 There are cases where a primary procedure cannot be performed. For example, this procedure cannot be used when there is complete separation of the tracheoesophageal wall where the puncture would otherwise be placed (for example, in case a portion of the esophagus is removed requiring an anastomosis, or “reconnection” of structures in the region). In that case, a sufficient period of recovery and wound healing would be required. A secondary puncture could then be placed. Secondary tracheoesophageal puncture: This procedure refers to a puncture that is placed anytime after the total laryngectomy surgery. The decision to use a primary or secondary puncture can vary greatly. Secondary puncture can be performed when: 1) primary puncture was not possible, 2) for re-puncture after closure of a previous tracheoesophageal puncture, 3)because of physician or patient preference, and 4) in case failure of esophageal or electrolarynx speech if this was chosen as the initial speech option. 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Tracheo-oesophageal puncture」の詳細全文を読む スポンサード リンク
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