Treatment of large pharyngotracheal fistulas after laryngectomy by a novel customized pharyngeal stent

Persisting tracheoesophageal (TEF) and/or tracheopharyngeal (TPF) fistulas after laryngectomy are incessant problems that can lead to a tremendous loss of quality of life among patients. As soon as surgical options for closing fistulas become impractical, then alternative approaches to stent the fistulas gain significant value. Conventional stents seldom seal the entire fistula, might dislocate and tend to induce tissue proliferation and cause discomfort to the patient. On the basis of these side effects a novel customized pharyngeal stent has been developed to completely seal the fistula without dislocation and discomfort. The anatomic dimensions of the neopharynx in two patients were obtained by a silicone cast of the respective neopharynx and the stent was manufactured according to this anatomical model. The soft silicone edges of the stent match the pharyngeal anatomic structures and follow the changes of the base of the tongue during the process of swallowing. Nevertheless, the stents are rigid enough to remain in place. The reported two patients were able to subsist by themselves orally most of the time without any signs of leakage at all. One stent had to be explanted after 7 months due to an enlargement of the fistula. The second stent is still in place for 10 months up to now without any side effects.