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Challenging management of an enlarged tracheoesophageal fistula in an irradiated patient
  1. Chiara Bramati,
  2. Andrea Galli,
  3. Emilio Salerno and
  4. Leone Giordano
  1. Otorhinolaryngology - Head& Neck Surgery Department, IRCCS Ospedale San Raffaele, Milano, Lombardia, Italy
  1. Correspondence to Dr Chiara Bramati; bramati.chiara{at}


Speech restoration after total laryngectomy may be achieved in different ways, the gold standard being tracheoesophageal puncture (TPE) with the positioning of a speech prosthesis. TPE is not immune to complications, the most common of which being leakage through or around the prosthesis. When dealing with an enlarged tracheoesophageal fistula, the management can be either conservative or surgical. In the following case report, we present a particularly challenging case, in which every conservative strategies failed and a major surgery was required to close the fistula.

  • Surgery
  • Head and neck surgery
  • Otolaryngology / ENT
  • Plastic and reconstructive surgery
  • Ear, nose and throat/otolaryngology

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  • Contributors The following author was responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: CB. The following authors gave final approval of the manuscript: CB, LG, AG and ES.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.