Partial Laryngectomy

Question 1

The goal of a __________ is to effectively remove the cancer while maintaining physiological breathing, swallowing and voice production.

Answer 1

Partial laryngectomy

Question 2

What are three potential problems of a partial laryngectomy:

Answer 2

• airway breathing and safety
• swallowing safety
• voice quality and quantity

Question 3

Describe a Cordectomy:

Answer 3

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.

Question 4

What are problems with cordecomty:

Answer 4

• usually relatively minor changes of voice quality and effort
• Hyperfunctional compensation
• postoperative soft and insufficient voice.

Question 5

The goal of therapy after a cordecomty is to identify ______ and _______ problems and identify _________

Answer 5

anatomical and physiological problems and identify vicious cycles of maladaptive behaviours.

Question 6

Describe techniques of reducing hyperfunctional compensation (pressed/ forced phonation):

Answer 6

Relaxation:

• smooth, easy phonation
• increase utterance length
• control speech rate via phrasing tasks

Question 7

Describe techniques of reducing postoperative soft and insufficient voice:

Answer 7

Activating:

• careful pushing
• other activating exercises

Question 8

Describe a Hemilaryngectomy:

Answer 8

If a tumour has spread along the VF as well as vertically the surgeon may resect half of the larynx including the arytenoid.

Question 9

Describe a vertical partial laryngectomy:

Answer 9

A more confined vertical resection where the arytenoid is left in place.

Question 10

Problems of a vertical partial or hemilaryngectomy:

Answer 10

• variable depending on the operative technique used
• higher F0s and shorter durations for sustained vowels
• ventricular fold phonation if VF can’t approximate

Question 11

A therapy goal for a vertical partial or hemi-laryngectomy is to:

Answer 11

• 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

Question 12

Describe the supraglottic subtotal laryngectomy:

Answer 12

• 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.

Question 13

What structures are removed in the supraglottic subtotal laryngectomy:

Answer 13

Epiglottis, ventricular folds, hyoid and thyroid cartilage.

Question 14

Problems of supraglottic subtotal laryngectomy:

Answer 14

• high risk of aspiration which can lead to overadduction of the VF and hyperfunctional voice problems.

Question 15

The treatment goal in supraglottic subtotal laryngectomy is to ___________ and ______

Answer 15

eliminate aspiration and re-establish phonation

Question 16

Describe Supracricoid partial laryngectomy with cricohyoidoepiglottopexy:

Answer 16

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.

Question 17

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.

Answer 17

True

Question 18

A compromised airway can be managed with a __________ in total laryngectomy or a ___________

Answer 18

Permanent tracheostoma in total laryngectomy or a temporary tracheotomy.

Question 19

Describe the difference between a permanent tracheostoma and temporary tracheotomy:

Answer 19

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.

Question 20

The tracheotomy tube __________

Answer 20

keeps the airway open

Question 21

The fenestrations allow________

Answer 21

airflow to the larynx so that the patient can phonate more easily.

Question 22

The one-way speech valve _________

Answer 22

is open during normal respiration. It closes when the phonation threshold is reached allowing the patient to phonate.

Question 23

Describe the cuffed tracheostomy tube:

Answer 23

• 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.

Question 24

T or F: Cuffed treachostomy tubes prevent aspiration

Answer 24

False - ineffective

Question 25

The _________ speech valve protects the airway while the _________ in the tube allow the patient to phonate.

Answer 25

cuffed one-way

fenestrations

Question 26

Cuff-inflation increased aspiration by a factor of ____

Answer 26

2.7

Question 27

Cuffs resulted in problems like ______, ________ and ________

Answer 27

leakage, tracheal irritation and trauma and esophageal trauma (pressure can reduce esophageal motility)

Question 28

After speech therapy the goal for someone with unilateral partial cordectomy would be_________

Answer 28

glottal phonation

Question 29

Voice rehabilitation after unilateral partial cordectomy involves working on _______ and ________

Answer 29

respiration and glottal phonation

Question 30

After speech therapy someone with bilateral partial cordectomy would use _______

Answer 30

glottal phonation

Question 31

Describe the 2 goals of therapy in partial laryngectomy:

Answer 31

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

Question 32

In Partial laryngectomy the goal is to restore _______ depending on the voice quality, quanity and ease of production ______________ may constitute acceptable alternatives

Answer 32

glottal phonation

mixed or ventricular

Question 33

T or F: Endoscopy or ears can be used to identify the phonation type (glottal, mixed or ventricular)

Answer 33

True

Question 34

List the 3 levels of a rehabilitation program in partial laryngectomy:

Answer 34

1) Sonorization level
2) Speech level
3) Vocal plasticity level

Question 35

What is the goal of the sonorization level:

Answer 35

Promote phonation at any cost

Question 36

List the techniques used at the sonorization level:

Answer 36

• humming
• vocal fry (strohbass)
• half-swallow ‘boom’
• hard vocal attack
• bilabial lip-trill /B/
• gentle pushing

Question 37

What is the goal of the Speech level:

Answer 37

Improve vocal quality

Question 38

List 2 techniques to improve vocal quality at the speech level:

Answer 38

• identify optimum head and neck posture for phonation

- improve speech intelligibility through over articulation

Question 39

The goal of the vocal plasticity level is to:

Answer 39

expand dynamic and frequency range

Question 40

List techniques to expand dynamic and frequency range:

Answer 40

• practice prosodic patterns

- singing and reading

Question 41

List strategies to rehabilitate swallowing in partial laryngectomy:

Answer 41

• supra and super glottic swallow
• mendelson maneuver
• increase laryngeal protrusion
• tongue protrusion to elevate the larynx
• head and neck postural changes

Question 42

For a hypofunctional voice you would use________ exercises.

Answer 42

activating voice exercises

Question 43

For a hyperfunctional voice you would use ________

Answer 43

voice relaxation exercises