Off-Label Use of a Tracheoesophageal Prosthesis for Occlusion of an Oronasal Fistula.

Abstract

An oronasal fistula is an abnormal communication between the oral and nasal cavities, which can arise as a result of radiation therapy for head and neck cancer, resulting in significant speech and swallowing challenges. We present a case in which a transesophageal prosthesis (TEP) was used as an alternative to existing treatment options for oronasal fistulas, which include surgical repair or a palatal obturator prosthesis. A 59-year-old female with a history of poorly differentiated squamous cell carcinoma of the nasopharynx with metastatic neck disease, treated with radiation therapy over 20 years ago, presented with an oronasal fistula resulting in significant weight loss and hypernasal speech. Due to the discomfort caused by a palatal obturator, a TEP device was offered as an alternative treatment option for the patient's oronasal fistula. Post-procedure videofluoroscopic swallow study and speech analysis demonstrated markedly improved nasal regurgitation and speech intelligibility. This case demonstrates the use of a TEP device as an effective, non-surgical treatment option for oronasal fistula.