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Head and Neck Surgery

(002) 3D-Printed Fistula Plug as a Solution for Tracheoesophageal Fistula

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time

    Presenting Author(s)

  • Rachel B. Fenberg

    Medical Student
    Albert Einstein College of Medicine
    Bronx, New York, United States

  • Sarah C. Nyirjesy, MD

    Resident Physician
    Ohio State University Hospital Program
    Columbus, Ohio, United States

    • Senior Author(s)

  • Kyle K. VanKoevering, MD

    Associate Professor
    Ohio State University- Department of Otolaryngology, Head and Neck Cancer
    Columbus, Ohio, United States

Disclosure(s):
Rachel B. Fenberg: No relevant relationships to disclose.
Sarah C. Nyirjesy, MD: No relevant relationships to disclose.
Kyle K. VanKoevering, MD: No relevant relationships to disclose.


Introduction: Tracheoesophageal (TE) fistula is common in laryngectomy patients, occurring in 12 – 34% of patients. Efforts to manage TE fistula focus on wound care and operative intervention for definitive reconstruction. Case report of an 83-year-old patient who underwent total laryngectomy with subsequent recurrence treated with total pharyngectomy and partial esophagectomy who developed a TE fistula that resulted in recurrent aspiration pneumonias. This was successfully managed with a custom 3D printed fistula plug.

Methods: The patient presented to an outside facility with altered mental status, fever, coughing, and hypotension due to aspiration pneumonia, at which time he was transferred to our facility. While under our care his fistula was plugged with a red rubber catheter. On hospital day 3, the patient was afebrile and stable for discharge with the catheter in place. He followed up outpatient to receive his 3D printed plug.

Measurements were taken while the patient was hospitalized. The fistula plugs were designed to have a retaining tip, to keep the plug from coming out with coughing, as well as a safety button to prevent aspiration of the plug. Molds of the plugs were then created digitally and 3D printed. A medical grade silicone was poured into the molds to create the final plugs.

Results: The patient presented in clinic 2 weeks after discharge. At this time, he still had a red rubber catheter in place. The initial fistula plug was too small, so additional measurements were taken. At the second fitting one week later, the plug was a good fit and was left in place to seal the TE fistula.
In the 4 months since fistula plug placement, the patient has had no additional aspiration events or hospitalizations. There are no plans for any definitive closure of the fistula.

Conclusions: 3D printed customized fistula plugs are a viable option for patients who have TE fistulas. These inexpensive and easy to produce plugs prevent potentially fatal aspiration events and pneumonias. They can be used long term, as this patient has used his plug for 4 months, and are good options for patients who are not surgical candidates for closure of their TE fistula.