COMPS: Laryngeal Surgery (O10)

Question 1

What is an “exofittic tumor”?

Answer 1

A tumor you can feel externally.

Question 2

What is a lumpectomy?

Answer 2

Removal of the lump only, with the rest of the laryngeal tissue staying intact. (However if you remove a lump from one side of the larynx, it will no longer function correctly bc it can’t protect the airway)

Question 3

Choose one:

If the pt had radiation before surgery, he WILL/WILL NOT be able to have post-surgery radiation.

Answer 3

will NOT

Question 4

Once the laryngectomy surgery is in progress, decisions about the amount to take (partial vs. full laryngectomy) may change. Why?

Answer 4

The surgeon might discover more tumor than they initially thought was present.

Question 5

What shape is the initial incision typically?

Answer 5

T-shaped

Question 6

What does a total laryngectomy consist of (remove)?

Answer 6

A total laryngectomy removes everything from the hyoid bone down to the trachea. (hyoid bone, larynx, and possibly the thyroid gland and top 2-4 tracheal rings)

Removal of thyroid gland: thyroidectomy

The tongue may also be removed (glossectomy). :(

*A permanent hole (stoma) is created during a total laryngectomy surgery. (AKA, tracheostomy)

Question 7

After the larynx is removed, the _____ ______ muscle will be cut from the thyroid cartilage and tied to itself to make a ring for ______ (swallowing).

Answer 7

inferior constrictor muscle

peristalsis

Question 8

What will happen if the cancer has penetrated the thyroid cartilage and into the inferior constrictor muscle (in the pharynx)?

Answer 8

The pharynx cannot be saved and the pt will have to tube-feed for the rest of his or her life.

Question 9

Name the 5 types of partial laryngectomies.

Answer 9

1. cordectomy: removal of vocal folds only
2. supraglottic laryngectomy: remove supraglottis only
3. hemilaryngectomy: remove half of the larynx
4. partial laryngectomy: remove only part of larynx
5. combinations of the above

Question 10

What vibrates during esophageal speech?

Answer 10

the upper esophageal sphincter (UES)

Question 11

What is the muscle of the UES?

Answer 11

cricopharyngeus

Question 12

If the cricopharyngeus muscle is removed during the laryngectomy surgery, what impact will this have on speech?

Answer 12

The pt will have to use an electrolarynx since he/she will not be able to use esophageal speech.

Question 13

the esophagus is ___ cm in length for EVERYONE.

Answer 13

30 cm

Question 14

You CAN/CANNOT see the esophagus through an endoscopic evaluation through the mouth.

Answer 14

CANNOT- the esophagus is just posterior to the arytenoids.

Question 15

what is the permanent hole that the surgeon creates in the lower part of the neck in which the traches is sewn through??

Answer 15

the stoma

Question 16

What should an SLP look for when assessing a Lary’s speech?

Answer 16

1. tissue compliance - has radiation affected the tissues of the mouth and throat?
2. hearing - laryngeal speech is quieter than normal speech (may assess Lary’s spouse too)
3. Pulmonary function (esp. if Lary was a smoker) - can he/she produce enough air pressure for esophageal speech?

Question 17

What is a neck dissection?

Answer 17

Removal of the lymph nodes by which
cancer spreads throughout the body; surgery may
affect neck or shoulder muscles.

Question 18

After a total laryngectomy, there is NO connection between the ______ system and the ________ system.

Answer 18

respiratory and digestive systems