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Year : 2014  |  Volume : 34  |  Issue : 1  |  Page : 40-43

A chronic traumatic tracheoesophageal fistula functioning as a respirator and a phonator simultaneously

1 Department of Otolaryngology-Head and Neck Surgery, Buddist Tzu Chi General Hospital, Taipei Branch; Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
2 Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China

Correspondence Address:
Wan-Fu Su
Department of Otolaryngology - Head and Neck Surgery, Buddhist Tzu Chi General Hospital, Taipei Branch, No.289, Jianguo Road, New Taipei City 23142, Taiwan
Republic of China
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1011-4564.129392

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Acquired benign tracheoesophageal fistula (TEF) is an infrequent complication of prolonged intubation or chest blunt injury. Controversy exists as to whether this should be repaired in a single-stage or in a two-stage procedure. To understand the advantage of one-stage surgery on this complicated injury, and vocalization after reconstruction, we will present a case that had a chronic traumatic TEF, compounded with total laryngotracheal obstruction and an existing unilateral vocal fixation. A 28-year-old female sustained a laryngotracheal injury in a car accident eight years ago and underwent a temporary laryngotracheal stent placement after reconstructive surgery, for one year, in another hospital. Relapsing aspiration pneumonia had developed since then. Video laryngoscopy revealed a mobile right vocal fold, a completely obstructed glottic lumen by granulomatous tissue, and a TEF. This chronic fistula functioned as a respirator without any assistance from the ventilator tube placement, as also a phonator, offering a socially acceptable voice simultaneously, as the larynges were totally obstructed by the scarring granulation tissue. This surrogate glottis enabled survival without a tracheostoma and challenged the justification of any further reconstruction in this patient. Eventually, TEF repair and reconstruction of the laryngotracheal airway were conducted in one stage. Subsequently, the insufficient glottis was corrected by medialized laryngoplasty, to complete the entire reconstruction work.

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