Selection: Patient, Surgical Techniques, and Timing

Tracheoesophageal puncture (TEP) with voice prosthesis placement is the end point of voice rehabilitation of patients undergoing total laryngectomy. Voice prosthesis placement depends on both specialist (otolaryngologist) and multidisciplinary assessment of patient in terms of performance status, family contest, availability to the supplementary devices essential for the maintenance of the voice prosthesis, and self-reliance in the management of the voice prosthesis. TEP timing depends almost exclusively on the choice of the surgeon in relation to the possible need for adjuvant therapy or possible comorbidity of patients, such as diabetes mellitus.