Alaryngeal Midterm Flashcards
What are some important points to discuss in preoperative and postoperative laryngectomy counseling?
Ask them what they already know. Speech rehab Determine patient's communication needs What medical concerns do they have? They will have no voice post-op
5 stages of grief
DABDA Denial Anger Bargaining Depression Acceptance
Early history of laryngectomy
First one in 1866 1829 first one on a dog 1925 accepted procedure 5,000-7,000 per year 5 males: 1 female Prevalence: 60,000 Incidence: 12,000 new cases per year
Three ways of increasing humidity of inhaled air
Move to a humid place Humidifier Showers, hot tubs Covering stoma HME Heat moisture exchanger
How are eating habits affected by laryngectomy?
Loss of sense of smell
Eating slower
Take more time because they have to chew more thoroughly.
Have to swallow smaller amounts
What causes cancer?
Mutation of cells
Carcinogens damage genes responsible for reproduction
List the risk factors for laryngeal cancer.
Tobacco Alcohol Poor nutrition GERD/LPR Papilloma virus Weakened immune system
List the general symptoms of laryngeal cancer
Persistent cough Persistent hoarseness Prolonged sore throat/ear pain Dysphagia Dyspnea/stridor Unexplained weight loss Lump in throat/neck
How does hearing loss affect the communication ability of both laryngectomees and their spouses?
Laryngectomees have reduced volume so spouses (who may be older and hard of hearing already) cannot hear them as well.
Articulation may be affected if there is already a hearing loss.
What is surgically removed in a typical laryngectomy?
Arytenoids Thyroid Cricoid and two tracheal rings True and false vocal cords Epilottis Hyoid All intrinsic muscles of the larynx except for cricopharyngeus. May have neck dissection
In general, how is laryngeal cancer treated?
Radiation with partial or total laryngectomy chemotherapy
Describe the anatomy of the esophagus.
The esophagus is posterior to the trachea and extends from C5-6 ro T11.
At the pharynx it is 1/2 inch in diameter and widens to 1 inch at the stomach.
The upper esophageal sphincter is the upper 1 inch and the lower esophageal sphincter is the lower 1 inch.
Between the sphincters is the thoracic segment.
The fibers on the outside are longitudinal.
The fibers on the inside are circular.
The fibers in the top inch are striated.
The fibers in the next three inches are mixed.
The fibers in the bottom six inches are unstriated.
How is the PE segment innervated in normals?
Superior and recurrent laryngeal nerves
How is the PE segment innervated in laryngectomees?
Some of the superior laryngeal nerve.
How would a Stage 1 laryngeal cancer usually be treated?
? Radiation
What is the cure rate for stage 1 laryngeal cancer?
Over 90%
What is a hemilaryngectomy?
Partial vertical laryngectomy where half of the thyroid lamina and sometimes part of the cricoid is removed along with the true and false vocal fold and vocal process of the arytenoid. The entire arytenoid may be taken but the epiglottis remains.
What is a supraglottal laryngectomy?
Horizontal removal of structures above the vocal folds including the thyroid cartilage, epiglottis, aryepiglottic folds and hyoid bone. Carries swallowing risk.
Generally, what activities are precluded by laryngectomy and why?
Swimming, blowing nose, fishing
How do cancer cells differ from normal cells?
They function poorly or not at all.
They reproduce faster or the rate of reproduction exceeds the rate of death.
Discuss some important points with regard to management of a tracheostomy tube.
Trach tube= stoma tube (outer canula, inner canula, introducer, use konola oil for inducer, clean once/day w/ water and brush, occasionally clean cannulas of mucus
What advice would you give a laryngectomee about wearing a stoma cover?
That it’s essential. ?
Describe the functions of the esophageal and cardiac sphincters.
Upper is to keep air out
Lower is to keep food in
What is a “near-total” laryngectomy?
Essentially a total with intent to leave some tissue behind to vibrate for esophageal voice. Not a good surgery since airway isn’t protected since there is only half an epiglottis and person looks/sounds just like a person who had an older type TE shunt surgery.
