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.
What are the major advantages of conservation surgery?
Retain natural airway
May have a better voice than an alaryngeal speaker.
Reduced impact on QOL
What are the major disadvantages of conservation surgery?
Lower cure rate, especially if lymph nodes are involved.
Dysphagia
How is speech intelligibility related to quality of life after surgery for head/neck cancer?
They will be unable to talk…?
How does laryngectomy affect the senses of taste and smell?
Since no air is moving through the nose they have a reduced sense of smell which reduces taste.
How is pulmonary function compromised in laryngectomees?
Coughing Sputum production Dyspnea Chronic diseases Acute infections
Generally, describe how laryngeal cancer is staged?
Location of tumor
Extent of tumor
Metastasis
What are the effects of radiation on alaryngeal communication?
Xerostomia
Dysphagia
Decreased tissue compliance
List the general problems associated with TE shunt/fistula.
Aspiration from leakage
Moving head may crimp shunt
Shunt may change in dimensions
Requires use of one hand or valve
pharyngectomy
Surgical procedure removing some or all of the pharynx
metastasis
Spread of cancer from one part of the body to another.
biopsy
Test used to sample cells for cancer.
Stoma button
Used to keep the stoma open, covered to speak.
xerostomia
Drymouth
neck dissection
Neck skin is scraped free of cancer cells as well as muscle, nerves and blood supply.
QOL
Quality of Life
recurrent laryngeal nerve
Recurs along the tracheoesophageal groove and innervates esophagus.
Usually not resected
Most motor to PE segment area
Not resected due to location
beneficence
Researchers should have the welfare of the research participant as a goal of any clinical trial
microstomia
Small mouth
cardiac sphincter
Lower sphincter keeps the food in the stomach
UES
Upper Esophageal Sphincter
LES
Lower Esophageal Sphincter
Gy (Gray)
GY (Gray)=dose absorbed from ionizing radiation.
in situ
in its place
isolated cancer on vocal fold
chemotherapy
the treatment of cancer with one or more cytotoxic antineoplastic drugs
hypopharynx
Laryngopharynx: behind larynx, lost with laryngectomy
PE segment
Pharyngoesophageal segment
neoglottis
Glottis created after laryngectomee where pharyngeal mucosa is sutured over the end of trachea above the stoma. Essentially, a flap of tissue for vibration needed for phonation (like a fake vocal fold)
apoptosis
Programmed cell death 50-70 billion per day in adults Apoptosis occurs when: Cells receive signal to commit suicide Cell does not receive signal to continue living p53 is a tumor suppressor
subglottic
below the level of the glottis
cricopharyngeus muscle
Only muscle left after laryngectomy
carcinoma
a cancer that begins in a tissue that lines the inner or outer surfaces of the body, and that generally arises from cells originating in the endodermal or ectodermal germ layer during embryogenesis.
Larkle
Laryngeal snorkel.
Vagus
Cranial nerve X which branches off to innervate the neck and torso.
fistula
Hole between two cavities.
carcinogen
cancer causing substance
Dyspnea
Shortness of breath.
Xerostomia
Dry mouth
