Management of Total Laryngectomy with Tracheoesophageal Prosthesis in a School Teacher: A 10-Year Case Report

Abstract Voice rehabilitation following total laryngectomy is essential for restoring communication and improving long-term quality of life. Tracheoesophageal puncture (TEP) with voice prosthesis is considered the gold standard method for post-laryngectomy voice restoration. A 54-year-old male school teacher from Uttar Pradesh presented to Tata Memorial Hospital, Mumbai, in 2014 with voice change and was diagnosed with squamous cell carcinoma of the larynx. He underwent total laryngectomy with primary TEP insertion in June 2015, followed by adjuvant radiotherapy. From 2020, the patient continued follow-up at MPMMCC, Varanasi. Over ten years, 14 prosthesis changes were performed, with careful selection based on fistula size and presence of granulation. Despite persistent peri-TEP leakage, granulation tissue, and financial barriers, the patient maintained functional voice with Provox Vega prosthesis. Patient-reported outcome measures (EORTC QLQ-C30, QLQ-H&N43, VHI, V-RQOL, Voice Prosthesis Questionnaire) and clinician-rated SToPS scale indicated moderate handicap but adequate speech for daily and occupational functioning. Financial support was arranged in 7 out of 13 prosthesis replacements. This case demonstrates that long-term, multidisciplinary rehabilitation with individualized prosthesis management can yield functionally successful outcomes even in resource-constrained settings. Consistent follow-up and financial support are critical for sustaining quality of life post-laryngectomy.