Partial Laryngectomy Flashcards
The goal of a __________ is to effectively remove the cancer while maintaining physiological breathing, swallowing and voice production.
Partial laryngectomy
What are three potential problems of a partial laryngectomy:
- airway breathing and safety
- swallowing safety
- voice quality and quantity
Describe a Cordectomy:
Stripping or removal of a vocal fold. The arytenoids are usually left in place to preserve laryngeal function. Use activating or relaxing voice techniques depending.
What are problems with cordecomty:
- usually relatively minor changes of voice quality and effort
- Hyperfunctional compensation
- postoperative soft and insufficient voice.
The goal of therapy after a cordecomty is to identify ______ and _______ problems and identify _________
anatomical and physiological problems and identify vicious cycles of maladaptive behaviours.
Describe techniques of reducing hyperfunctional compensation (pressed/ forced phonation):
Relaxation:
- smooth, easy phonation
- increase utterance length
- control speech rate via phrasing tasks
Describe techniques of reducing postoperative soft and insufficient voice:
Activating:
- careful pushing
- other activating exercises
Describe a Hemilaryngectomy:
If a tumour has spread along the VF as well as vertically the surgeon may resect half of the larynx including the arytenoid.
Describe a vertical partial laryngectomy:
A more confined vertical resection where the arytenoid is left in place.
Problems of a vertical partial or hemilaryngectomy:
- variable depending on the operative technique used
- higher F0s and shorter durations for sustained vowels
- ventricular fold phonation if VF can’t approximate
A therapy goal for a vertical partial or hemi-laryngectomy is to:
- identify the predominant source of voicing (glottal vs ventricular)
- identify point of easiest phonation from subsequent vowel phonation tasks
- Decrease utterance length to manage pulmonary support
Describe the supraglottic subtotal laryngectomy:
- All laryngeal structures above the VF are removed.
- Leave the vocal folds and arytenoid for voice and airway protection.
- Patient may require a tracheostoma
- Voice quality and quantity are often poor. Tracheo-esophageal voice may actually be a better option.
What structures are removed in the supraglottic subtotal laryngectomy:
Epiglottis, ventricular folds, hyoid and thyroid cartilage.
Problems of supraglottic subtotal laryngectomy:
- high risk of aspiration which can lead to overadduction of the VF and hyperfunctional voice problems.
The treatment goal in supraglottic subtotal laryngectomy is to ___________ and ______
eliminate aspiration and re-establish phonation
Describe Supracricoid partial laryngectomy with cricohyoidoepiglottopexy:
A variation of the supraglottic laryngectomy
- Hyoid and the epiglottis are preserved. Surgical pull-up of the cricoid to the hyoid results in better swalllowing safety and voice quality.
T or F: The supracricoid partial laryngectomy with cricohoidoepiglottopexy provides more structure and provides patients with slightly better voice quality and slightly safer swallowing than the supraglottic laryngectomy.
True
A compromised airway can be managed with a __________ in total laryngectomy or a ___________
Permanent tracheostoma in total laryngectomy or a temporary tracheotomy.
Describe the difference between a permanent tracheostoma and temporary tracheotomy:
In permanent tracheostoma the trachea is bent forward into the stoma and the stoma is scarred to prevent shrinkage and closure. In temporary a silver tube is inserted to keep the airway open.
The tracheotomy tube __________
keeps the airway open
The fenestrations allow________
airflow to the larynx so that the patient can phonate more easily.
The one-way speech valve _________
is open during normal respiration. It closes when the phonation threshold is reached allowing the patient to phonate.
Describe the cuffed tracheostomy tube:
- the inflated cuff fills the space between the tracheostoma tube and the tracheal walls.
- the purpose of the cuff is to close off the airway in a ventilated patient to prevent air leakage.
T or F: Cuffed treachostomy tubes prevent aspiration
False - ineffective
The _________ speech valve protects the airway while the _________ in the tube allow the patient to phonate.
cuffed one-way
fenestrations
Cuff-inflation increased aspiration by a factor of ____
2.7
Cuffs resulted in problems like ______, ________ and ________
leakage, tracheal irritation and trauma and esophageal trauma (pressure can reduce esophageal motility)
After speech therapy the goal for someone with unilateral partial cordectomy would be_________
glottal phonation
Voice rehabilitation after unilateral partial cordectomy involves working on _______ and ________
respiration and glottal phonation
After speech therapy someone with bilateral partial cordectomy would use _______
glottal phonation
Describe the 2 goals of therapy in partial laryngectomy:
1) to phonate at any cost, reducing the airflow and promoting an acceptable voice quality
2) to improve global communication in which strategies involving over articulation, modulation and projection may help
In Partial laryngectomy the goal is to restore _______ depending on the voice quality, quanity and ease of production ______________ may constitute acceptable alternatives
glottal phonation
mixed or ventricular
T or F: Endoscopy or ears can be used to identify the phonation type (glottal, mixed or ventricular)
True
List the 3 levels of a rehabilitation program in partial laryngectomy:
1) Sonorization level
2) Speech level
3) Vocal plasticity level
What is the goal of the sonorization level:
Promote phonation at any cost
List the techniques used at the sonorization level:
- humming
- vocal fry (strohbass)
- half-swallow ‘boom’
- hard vocal attack
- bilabial lip-trill /B/
- gentle pushing
What is the goal of the Speech level:
Improve vocal quality
List 2 techniques to improve vocal quality at the speech level:
- identify optimum head and neck posture for phonation
- improve speech intelligibility through over articulation
The goal of the vocal plasticity level is to:
expand dynamic and frequency range
List techniques to expand dynamic and frequency range:
- practice prosodic patterns
- singing and reading
List strategies to rehabilitate swallowing in partial laryngectomy:
- supra and super glottic swallow
- mendelson maneuver
- increase laryngeal protrusion
- tongue protrusion to elevate the larynx
- head and neck postural changes
For a hypofunctional voice you would use________ exercises.
activating voice exercises
For a hyperfunctional voice you would use ________
voice relaxation exercises
