Laryngectomy Flashcards
Three purposes of larynx
- Valve for respiration
- Valve for swallowing
- Phonation
Reasons for a laryngectomy (3)
- Laryngeal cancer
- Trauma to larynx
- Stenosis
Occurrence of Laryngeal cancer
Mostly in males 50-70; death rate ~30%; early dx leads to better outcomes
Etiology of laryngeal cancer
Smoking; smoking+alcohol; exposure to environmental pollution
Forms of laryngeal cancer
Squamous cell carcinoma (most common, originates in epithelial tissues)
Chondrocardinoma
Chondrosarcoma (these originate in the laryngeal cartilages)
Three general locations for malignant neoplasms
- Supraglottic
- Glottic (true VFs or anterior/posterior commisures)
- Subglottic
Three ways cancer can spread
- Enlargement
- Spread via blood
- Metastasis (spread via lymph fluid)
Tumor staging T
Tumor–Tx-T4
Tumor staging N
Nodal involvement–Nx-N3
Tumor staging M
Metastasis–Mx-M1
Tumor staging R
Residual tumor–R0-R2
Microflap surgery
Elevates the flap of the epithelium to remove cancer
Cordectomy
Removes VF through the neck
Parital Laryngectomy
Can be hemilaryngectomy or vertical partial laryngectomy
Removes at least half of the thyroid, arytenoids, VFs, and tissue on involved side
Supraglottic laryngectomy
For tumors confined to the epiglottis and false VFs only. True VFs not affected, so voice quality ok.
Near total laryngectomy
Removes entire larynx except for one strip on the contralateral side to connect the trachea and the pharynx. speaking shunt is created for voice
Total laryngectomy
Removal of the entire larynx. Requires tracheostoma for breathing and outside device for speech
Effects of laryngectomy on nose
Lose sense of smell, can’t sniff or blow nose, air is not warmed through the nasal passage
Effects of laryngectomy on mouth
Taste is often affected, eating/swallowing problems reported in over 50%, base of tongue may be shortened due to excision of fibers
Effects of laryngectomy on respiration
Ability to cough/clear throat is lost, lifting and bearing down are impaired, air is no longer filtered and humidified, causing mucous plugs, crusting, stoma sensitivity, and decreased oxygenation
Ways to improve hydration (5)
- Increased fluid intake
- Stoma covers
- Air filters
- Suctioning
- Decrease caffeine, alcohol, salt, etc…
Preoperative counselling includes (6)
- Building rapport
- Explaining the surgery
- Explaining changes
- Providing written material
- Discussing speech options
- Indirect assessment and oral mech
Postoperative counselling includes (5)
- Answering questions
- Reviewing speech options
- Assessment and oral mech
- Review changes
- Help with issues that arise
Pneumatic device
Non-electronic hand-held device that vents air from the stoma to the mouth. Good for cost and ease of use, bad for aesthetics and hand-use
Artificial Larynx
Electronic vibrating device that acts as a larynx, providing a source for sound. Good for the phone, can be hand-held or oral, bad because batteries and finding sweet spot may be difficult. Needs to be switched on/off with voicing.
Esophageal speech
Pt. pushes air through the esophagus to substitute vibration to VFs. Very hard to learn, but nice because it needs no equipment. Pt. must have functioning PE segment. Encouragement and education are huge with this approach.
TEP
Puncture goes through the PE segment to insert a one-way valve with a reed for vibration. Requires good healing of stoma, emotional stability, and good coordination. Works quickly and uses pulmonary air drive, however TEP can become dislodged, can leak, etc.
