Method of placing an esophageal voice prosthesis in a laryngectomized person

• US 5,078,743 A
• Filed: 04/19/1990
• Issued: 01/07/1992
• Est. Priority Date: 04/19/1990
• Status: Expired due to Fees

• Current Assignee: Abraham Mikalov, Jamie S. Barkin
• Original Assignee: Abraham Mikalov, Jamie S. Barkin
• Inventors: Barkin, Jamie S., Mikalov, Abraham
• Primary Examiner(s): Pellegrino, Stephen C.
• Assistant Examiner(s): Dawson, Glenn K.
• Application Number:
  US07/511,484
• Time in Patent Office: 628 Days
• Field of Search: 606/108, 128/898, 623/9, 623/11, 604/164
• US Class Current: 623/9
• CPC Class Codes: A61F 2/203 comprising an air passage from trachea to oesophagus or to pharynx; Artificial epiglottis
• CPC Class Codes: A61M 16/0472 Devices for performing a tracheostomy

Abstract

A method of placing an esophageal voice prosthesis in a patient who has undergone a laryngectomy to be performed by a surgeon to permit the patient to restore speech patterns. The method comprises the steps of sedating the patient under local anesthesia, introducing a flexible endoscope into the patient'"'"'s mouth so that it reaches the patient'"'"'s esophagus, introducing a Seldinger needle into the patient to puncture the tracheostoma and enter the esophagus and create a passageway therethrough. The surgeon measures the tracheostoma length to determine the proper sized prosthesis to use by threading a measuring catheter and length of gastrostomy tubing about a guide wire to the prosthesis implantment site. The measuring catheter is removed with the guide wire in place, and a voice prosthesis is attached to the gastronomy tubing and threaded over the guide wire so that the prosthesis is in place at the implantment site. The gastronomy tubing is then removed and the prosthesis is ready for use.

Claims

1. A method of restoring speech in a patient who has undergone a surgical removal of the voice box to be performed by a surgeon or other person to provide the patient with a voice restorative prosthesis, said patient having a esophagus, mouth and tracheostoma, said method comprising the steps of:

a. sedating said patient under local anesthesia;

b. providing a flexible endoscope and introducing said flexible endoscope into the patient'"'"'s mouth until the flexible endoscope reaches the patient'"'"'s esophagus;

c. providing a Seldinger needle having an outer cannula and introducing said Seldinger needle into the patient so that the Seldinger needle punctures the tracheostoma and enters said patient'"'"'s esophagus to create a passageway therethrough, while the surgeon visualizes the introduction of the Seldinger needle through the flexible endoscope;

d. providing a guide wire and threading said guide wire through the outer canula of the Seldinger needle directly into the patient'"'"'s esophagus and out through the patient'"'"'s mouth;

e. providing a measuring catheter having a distal end with graduated, pre-measured lines, and a proximal end, and threading said guide wire through said distal end and out through said proximal end of the measuring catheter;

f. guiding the measuring catheter directly over the guide wire, and through patient'"'"'s mouth and esophagus until the measuring catheter extends through said passageway in a retrograde fashion so that said proximal end abuts said esophagus at the site of the passageway and the surgeon can see the pre-measured lines extending through and out said passageway;

g. measuring the length of the tracheostoma using the measuring catheter;

h. removing the measuring catheter from the patient through the patient'"'"'s mouth;

i. providing a length of catheter tubing having a voice restorative prosthesis attached to the catheter tubing, said voice restorative prosthesis having a length appropriate for the patient'"'"'s tracheostoma, a distal end having a one-way valve and a flexible retaining flap, and a proximal end having a flange;

j. threading said guide wire through said catheter tubing and through the distal end of the prosthesis and out through said proximal end of said prosthesis;

guiding said catheter tubing and said prosthesis directly over the guide wire through the patient'"'"'s mouth and esophagus until the prosthesis extends through said passageway in a retrograde fashion so that the flange abuts the anterior of the patient'"'"'s esophagus and the flexible retaining flap is located outside of the patient; and

l. severing said distal end of said catheter tubing.

2. The method of claim 1 additionally comprising the step of:

a. advancing said flexible endoscope to the patient'"'"'s stomach to remove any contents therein and withdrawing the flexible endoscope to the tracheostoma prior to providing the Seldinger needle.

3. The method of claim 1 additionally comprising the step of removing said flexible endoscope from said patient prior to providing said measuring catheter.

4. The method of claim 1 wherein the step of sedating said patient under local anesthesia additionally comprises the steps of:

a. providing a 1% Xylocaine or Cetacaine topical anesthetic to said patient and administering the topical anesthetic at the tracheostoma and surrounding areas; and

b. providing an intravenous solution of approximately 10 milligrams of Valium administering the intravenous solution to the patient.