partial laryngectomy

Question 1

the goal of partial laryngectomy is to effectively ____ ____ while maintaining physiological ___, ___, ___.

Answer 1

• remove cancer
• breathing, swallowing, and voice production

Question 2

potential problems of partial laryngectomies? (3)

Answer 2

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

Question 3

what is a cordectomy? (3)

Answer 3

• superficial stripping of lesion
• partial removal
• total removal

Question 4

cordectomy: what is usually left in place to help preserve laryngeal function?

Answer 4

arytenoids

Question 5

voice quality after cordectomy?

Answer 5

mixed

Question 6

cordectomy: ___ compensation may occur.

Answer 6

hyperfunctional

Question 7

therapy goals post-cordectomy? (2)

Answer 7

1. ID anatomical and physiological problems
2. ID and prevent maladaptive behaviours

Question 8

cordectomy: for hyperfunctional patients… (3)

Answer 8

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

Question 9

cordectomy: for patients with post-op soft and insufficient voice… (1)

Answer 9

symptomatic voice exercises (e.g., careful pushing)

Question 10

what is an anterior commissure resection for? what is left in place?

Answer 10

• for tumours at AC
• arytenoids

Question 11

when would a hemilaryngectomy be done?

Answer 11

when tumour spreads vertically (e.g., to ventricular folds)

Question 12

what is it called when a more confined vertical resection where the arytenoid is left in place is done?

Answer 12

vertical partial laryngectomy

Question 13

tx goals post- vertical partial or hemilaryngectomy? (3)

Answer 13

• use vowel phonation tasks to ID source of voicing (glottal vs ventricular)
• if residual VF cannot approximate, ventricular is acceptable
• if needed, -utterance length

Question 14

what is an extended frontolateral laryngectomy? (2)

Answer 14

• more extensive form of hemilaryngectomy
• resection goes past AC into other VF

Question 15

tx goals post- extended frontolateral laryngectomy? (3)

Answer 15

• reduce vocal noise
• build up pulmonary pressure
• posture adjustments

Question 16

what is a supraglottic subtotal laryngectomy?

Answer 16

removal of laryngeal structures above VFs (epiglottis, ventricular folds, hyoid, thyroid cartilage)

Question 17

supraglottic subtotal laryngectomy concerns? (4)

Answer 17

• airway safety/aspiration
• voice quality/quantity
• pt may require tracheostoma
• overadduction = hyperfunctional voice

Question 18

tx goals post- supraglottic subtotal laryngectomy? (2)

Answer 18

• eliminate aspiration
• re-establish phonation

Question 19

what is supracricoid partial laryngectomy with cricohyoidoepiglottopexy?

Answer 19

• variation of supraglottic laryngectomy
• hyoid and epiglottis are preserved
• cricoid pulled up to hyoid for better swallow and voice

Question 20

management of compromised airway? (2)

Answer 20

1. tracheostoma (permanent)
2. tracheotomy (temporary)

Question 21

purpose of fenestration in silver speech tubes?

Answer 21

promotes airflow to larynx for phonation

Question 22

what is a passy-muir one-way speech valve? (2)

Answer 22

• hands-free valve
• threshold of exhalation makes valve shut, allowing air to travel to larynx for voice

Question 23

problem w one-way speech valve?

Answer 23

nothing protecting lower airway; risky for pt’s who aspirate

Question 24

what does a cuffed tracheotomy tube fill?
what is its purpose?

Answer 24

• fills space bw tracheostoma and tracheal walls
• closes off airway in ventilated pt to prevent air leakage

Question 25

complications of cuffs? (4)

Answer 25

- leakage - tracheal irritation and trauma - esophageal trauma - aspiration

Question 26

voice rehab priorities/sequence after unilateral or bilateral partial cordectomy? (3)

Answer 26

1. respiration 2. spontaneous ventricular phonation 3. after speech tx: glottal phonation

Question 27

levels of rehab program? (3)

Answer 27

1. sonorization level (voice) 2. speech level (syllables, words, sentences) 3. vocal plasticity level (changing loudness, pitch, stress)

Question 28

sonorization level techniques? (note if relaxing or activating)

Answer 28

1. humming (R) 2. vocal fry (R) 3. bilabial lip trill /b/ (R) 4. half swallow boom (A) 5. hard vocal attack (A) 6. gentle pushing (A)

Question 29

speech level techniques? (2)

Answer 29

- ID optimum head/neck posture for phonation - use over-artic

Question 30

vocal plasticity techniques? (3)

Answer 30

- expand dynamic and frequency range - practice prosodic patterns - practice singing and reading