Managing Periprosthetic Leakage After Tracheoesophageal Puncture With Carboxymethylcellulose Gel

BACKGROUND: Peripheral leakage around a tracheoesophageal puncture (TEP) voice prosthesis increases patient morbidity. This study describes the use of carboxymethylcellulose (CMC) gel in managing peripheral leakage. METHODS: A single-institution retrospective review was conducted of postlaryngectomy TEP patients who received CMC gel injections for periprosthetic leakage. Data obtained included demographics, comorbidities, and postinjection outcomes. RESULTS: Six male patients (mean age, 58.3 years) underwent 38 CMC injections total. Thirty-six (95%) injections resulted in immediate leak resolution. Four patients (67%) received repeat injections for recurrent leakage. One patient on anticoagulation experienced mild postinjection bleeding; no other adverse events were documented. The median leak-free duration was 2.32 months (range, 0.07-41.33), with an average duration of 4.32 months. Average follow-up period was 11.08 years. CONCLUSIONS: This is the first study reporting the use of CMC gel for TEP tract augmentation. Despite variability in response duration, CMC gel was safe and resulted in immediate leak resolution in almost all cases, highlighting its potential utility in managing peripheral TEP leakage.