Case Report

3D Silicone Prosthesis in the Management of a Large and Late Tracheoesophageal Fistula Following Primary Puncture in a Laryngectomee

by Omar Al Saraireh1*, Muhanad M Hatamleh2

1Consultant Otolaryngology-Head and Neck Surgery, King Husain Cancer Center, Jordan

2Assistant Professor, Department of Applied Dental Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Jordan.

*Corresponding author: Omar Al Saraireh, Consultant Otolaryngology-Head and Neck Surgery, King Husain Cancer Center, Jordan

Received Date: 20 December 2023

Accepted Date: 26 December 2023

Published Date: 28 December 2023

Citation: Al Saraireh O, Hatamleh MM (2023) 3D Silicone Prosthesis in the Management of a Large and Late Tracheoesophageal Fistula Following Primary Puncture in a Laryngectomee. Ann Case Report 8: 1569.


We are describing a case of a large tracheoesophageal fistula that occurred six years following primary tracheoesophageal puncture and total laryngectomy. The patient has been admitted many times to ICU due to aspiration pneumonia. He was managed by 3D printed silicone prosthesis. The prosthesis did not allow him to eat through the mouth, however it decreased the frequency of ICU admissions.

Keywords: Tracheoesophageal; 3D Printed Silicone Prosthesis; laryngectomy; Hyperbaric Oxygen Therapy; Fistula.


Voice restoration following total laryngectomy with tracheoesophageal puncture and voice prosthesis is the procedure of choice since it’s simple, cost-effective, and easy to learn good quality voice. Several studies have demonstrated its superiority to alternative methods of voice restoration, such as esophageal speech and electrolarynx [1, 2]. However, it is not free of problems which are reported by various authors including leakage around or through the prosthesis, prosthesis displacement, intractable aspiration of secretions or oral intake, bronchial aspiration of the prosthesis, granulation tissue formation, tracheostomal stenosis and widening of the tracheoesophageal fistula [3]. Speech and language specialists are well trained to take care of most of these complications with surgical referral for intractable cases mostly widened TEF after the failure of conservative measures.

Case Report

A 65-year-old male patient, who underwent total laryngectomy and bilateral neck dissection for T4aN1M0 squamous cell carcinoma of supraglottis with adjuvant radiotherapy, also had neck radiotherapy as part of treatment of lymphoma 16 years prior to the diagnosis of laryngeal cancer. The patient was exhibiting swallowing and was able to produce voice very efficiently for about five years post total laryngectomy, then a leak around the voice prosthesis started which was managed by increasing the size of the voice prosthesis, then by using an extra flange then NG tube was inserted and workup to rule out recurrence was done including neck MRI, PET CT scan, which showed no cancer recurrence. The patient ended with a huge tracheoesophageal fistula (Figure 1). The patient was admitted 5 times to ICU with aspiration pneumonia. A gastrostomy tube was inserted, hyperbaric oxygen therapy (HBO) was given and this resulted in stopping the enlargement of the fistula. A Delto pectoral flap was used to close the fistula but unfortunately failed. Thus, a silicone prosthesis was constructed to maintain the natural separation between trachea and the oesophagus.


Figure 1: Left cross-sectional radiological view of the fistula (A) and top view (B).

The patient CT scan of Tracheo-Oesophageal area was processed using specialized biomedical software (CMF Pro Plan, Materialise, Leuven, Belgium) to produce a three-dimensional (3D) virtual model of the patient’s trachea and then was cut into two parts. The two parts were exported as standard triangular language files (STL) and were 3D printed using a 3D printer. The 3D models were marked with the design of the medical device (Figure 2).