Laryngectomy

Question 1

Three purposes of larynx

Answer 1

1. Valve for respiration
2. Valve for swallowing
3. Phonation

Question 2

Reasons for a laryngectomy (3)

Answer 2

1. Laryngeal cancer
2. Trauma to larynx
3. Stenosis

Question 3

Occurrence of Laryngeal cancer

Answer 3

Mostly in males 50-70; death rate ~30%; early dx leads to better outcomes

Question 4

Etiology of laryngeal cancer

Answer 4

Smoking; smoking+alcohol; exposure to environmental pollution

Question 5

Forms of laryngeal cancer

Answer 5

Squamous cell carcinoma (most common, originates in epithelial tissues)
Chondrocardinoma
Chondrosarcoma (these originate in the laryngeal cartilages)

Question 6

Three general locations for malignant neoplasms

Answer 6

1. Supraglottic
2. Glottic (true VFs or anterior/posterior commisures)
3. Subglottic

Question 7

Three ways cancer can spread

Answer 7

1. Enlargement
2. Spread via blood
3. Metastasis (spread via lymph fluid)

Question 8

Tumor staging T

Answer 8

Tumor–Tx-T4

Question 9

Tumor staging N

Answer 9

Nodal involvement–Nx-N3

Question 10

Tumor staging M

Answer 10

Metastasis–Mx-M1

Question 11

Tumor staging R

Answer 11

Residual tumor–R0-R2

Question 12

Microflap surgery

Answer 12

Elevates the flap of the epithelium to remove cancer

Question 13

Cordectomy

Answer 13

Removes VF through the neck

Question 14

Parital Laryngectomy

Answer 14

Can be hemilaryngectomy or vertical partial laryngectomy

Removes at least half of the thyroid, arytenoids, VFs, and tissue on involved side

Question 15

Supraglottic laryngectomy

Answer 15

For tumors confined to the epiglottis and false VFs only. True VFs not affected, so voice quality ok.

Question 16

Near total laryngectomy

Answer 16

Removes entire larynx except for one strip on the contralateral side to connect the trachea and the pharynx. speaking shunt is created for voice

Question 17

Total laryngectomy

Answer 17

Removal of the entire larynx. Requires tracheostoma for breathing and outside device for speech

Question 18

Effects of laryngectomy on nose

Answer 18

Lose sense of smell, can’t sniff or blow nose, air is not warmed through the nasal passage

Question 19

Effects of laryngectomy on mouth

Answer 19

Taste is often affected, eating/swallowing problems reported in over 50%, base of tongue may be shortened due to excision of fibers

Question 20

Effects of laryngectomy on respiration

Answer 20

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

Question 21

Ways to improve hydration (5)

Answer 21

1. Increased fluid intake
2. Stoma covers
3. Air filters
4. Suctioning
5. Decrease caffeine, alcohol, salt, etc…

Question 22

Preoperative counselling includes (6)

Answer 22

1. Building rapport
2. Explaining the surgery
3. Explaining changes
4. Providing written material
5. Discussing speech options
6. Indirect assessment and oral mech

Question 23

Postoperative counselling includes (5)

Answer 23

1. Answering questions
2. Reviewing speech options
3. Assessment and oral mech
4. Review changes
5. Help with issues that arise

Question 24

Pneumatic device

Answer 24

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

Question 25

Artificial Larynx

Answer 25

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.

Question 26

Esophageal speech

Answer 26

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.

Question 27

TEP

Answer 27

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.