Therapy of periprosthetical leakage with tissue augmentation using Bioplastique around the implanted voice prosthesis.

Having a voice prosthesis provides a good possibility for speech rehabilitation after total laryngectomy has been performed, especially if common complications such as leakage around the valve can be reduced effectively. The early applications of a voice prosthesis-which was originally invented and applied by Mozolewski in 1972, was further developed by Blom and Singer and became an internationally available implantable instrument by 1980- already made clear not only the typical benefits, but also the complications, such as possible leakage around the implanted valve. Remacle proposed the injection of collagen into the surrounding tissues in order to stop leakage. Knowing that collagen is usually resorbed as time goes by, new substances that can be tolerated by human tissues must be found. This article reports the experiences of the authors in the search for such an injectable material that cannot be resorbed and does not migrate. In order to solve the above-mentioned problem, Lichtenberger introduced the injection of Bioplastique into the perivalvular tissues. This delivered the best results ever achieved in this field at our department. During the past 2 years, Bioplastique augmentation was performed for seven laryngectomized and speech-rehabilitated patients in order to reduce periprosthetical leakage. All procedures were successful in terms of either eliminating or reducing the leakage, and also the non-resorbable property of Bioplastique has been proven.

Spasmodic dysphonia combined with insufficient glottic closure by phonation.

The authors describe the case history of a patient who suffered from symptoms deriving from two different origins. The patient's voice was spasmodic dysphonia-like interrupted and pressed. At the same time, his voice was powerless, too. The reason for this was that besides the spasmodic dysphonia caused by hyperkinesis, an incomplete closure of the vocal cords during phonation in the middle third was present. It was caused by the atrophy of the vocal cords. In order to eliminate the symptoms, initially we injected 25 IU Botox into the left vocal cord transcutaneously under the direction of EMG control. It resulted in a fluent, though breathy voice. In order to manage the closing insufficiency during phonation, we performed lipoaugmentation on the left vocal cord under high-frequency jet anaesthesia. The result of the two-step procedure was a fluent and clear voice. The speech without interruption lasted for 5 months, until the drug was eliminated. Of course, to prolong the result, the Botox injection should be repeated.