Head and Neck Cancer

TEP Emergency Protocol

What should I tell the Emergency Room or Ambulance if I need to go to the hospital?

I am a neck breather, which means I breathe through a stoma or opening in my neck. Please give me CPR to my neck stoma, not to my nose or mouth. Place the oxygen over the opening (stoma) in my neck. If I am having trouble breathing or shortness of breath I may have a mucus plug in my stoma or lungs. Please assess my pulmonary status for this problem.
I have a tracheoesophageal puncture (TEP) between my esophagus and my trachea. My voice prosthesis sits in this puncture (opening) to allow me to voice. It has a one-way valve that allows air to pass so I can speak and it should close and not allow liquids to come back through to my trachea.

What do I do if my TEP/prosthesis is completely missing?

If the TEP/prosthesis is completely missing (has fallen out), please put my dilator in to keep the puncture patent for a future replacement prosthesis to be inserted by my SLP. If I do not have my dilator, insert a 16 or 20Fr red-rubber catheter as a last resort to keep the puncture patent. Feed the catheter into the tracheoesophageal puncture about 10-12 inches. Tie off the end of the catheter on the end sticking out of the stoma so stomach fluids do not leak out. The catheter can be securely taped to one side of the stoma, please make sure it will allow for airflow around the catheter so that the stoma is not completely blocked by it. If the puncture has completely closed by the time I get to the ER, there is nothing that can be done at this time to save the puncture. I will need to follow-up with my head and neck surgeon to schedule another puncture surgery. I will also need to notify my SLP.
If you completely coughed out your prosthesis and it fell into your stoma and you cannot cough it out, you will need to have the ER physician or ENT retrieve it. Many prosthesis have an opaque ring that will allow it to show up on a chest X-ray.

What do I do if my prosthesis is leaking when I drink, making me cough?

If my prosthesis is leaking liquid through the middle of the prosthesis or I have a strained voice, it is not a life threatening emergency. I just need to schedule an appointment with my SLP and drink thicker liquids for a few days until I can see him/her. Place your Plug into your TEP to stop the leakage and allow you to eat and drink safely. PLEASE do not pull the currently placed prosthesis. My TEP should only be removed by an SLP or ENT that works with laryngectomy patients and has a replacement prosthesis or dilator to stent the puncture.
Please make an appointment with your UMMC SLP as soon as possible: Call 601-815-6064 and ask for a TEP Evaluation. Let them know if your prosthesis is leaking or completely missing.