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ECTOMY

Definitlon

laryngectomy is the partial :>r CC'I ieal removal of the larynx, usually as a treatment for cancer of the I ~uyn

Purpose

Normally a laryngectomy is perfa r love tumors or cancerous tissue. In rare cases, it may be done when the laryn .::Ily damaged by gunshot, automobile injuries, or similar violent acd den Laryr ectomies can be total or partial. Total laryngectomies are done wh ~n cancer advanced . The entire larynx is removed . Often if the cancer has sprsc ld. 0 r rrounding structures in the neck, such as lymph nodes, are removed at the same tl Partial laryngectomies are done when cancer is limited to one spot. Only the area th tJmor is removed. Laryngectomies may also )9 performed when other callcer t n pt/ons, such as radiation or chemotherapy, 'ail.

'recautions

I.aryngectomy is done only alter C' e larynx has been diagnosed by a series of ; ests that allow the otolaryng)log clalist often called an ear, nose, and throat ( loctor) to look into the throat and samples (biopsies) to confirm and stage t1e cancer. People need to be in ra l health to undergo a laryngectomy, and '; rill have standard pre-operative blood and tests to make sure they are able to ~ afely withstand the operatior .

[ 'escription

1 he larynx is located slightly below a pomt where the throat divides into the e :;ophagus, which takes food 10 the tamach, and the trachea (windpipe). which takes a r to the lungs. Because of ib ; loca lon, th arynx plays a critical role in normal b 'eathing, swallowing, and spElakina. Within e larynx, vocal folds (often called vocal CI Jrds) vibrate as air is exhalec pa hu cro ting speech. The epiglottis protects the tr, whea, making sure that only air 9 lungs. When the larynx is removed , th ese functions are lost.

o 1ce the larynx is removed, ai ' can ow into the lungs. During this operation, th ~ surgeon removes the laryn:, thrr ision In the neck. The surgeon also pE rforms a tracheotomy. He rr ake J opening called a stoma in the front of thlJ neck. The upper portion of the brought to the stoma and secured, making a I lermanent a'itemate way for nir to I ngs. The connection between the thr oat and the esophagus is no : norr , so after healing, the person whose I

lar {nx has been removed (calle d a I rr ee) can eat normally. However, normal sp, ~ech is no longer possible. ~ ;ever means of vocal communication can be lee med with the help of a speec:h p

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II

/ Prel)aration

I;

As \ nth, any surgical procedure. t 1e p; uired to sign a consent form after the :)rocedu1'8 Is thoroughly exph lin . 'ents prefer a second opinion, and sorr e insurers require it. Blood II nd u along with chest x-ray and EKG may be ( rdered as the doctor deems , patient· also has a pn:H>peratlve maE ting with an anesthesiologist If e t I gectomy is planned. it may be help rulto meet with a speech pal hoi r an established laryngectomee for disc Jsslon of post-operative expt~ctatl ppc;rt.

Aftercare

A p~ rson undergoing a laryngect)my sp veral days in intensive care (leU) and racE wes intravenous (IV) fluids a ,d' m i As with any major surgery, the blood pres sure, pulse, and respirations are regularly. The'patient Is encouraged to tum cough, and deep breathe to hetp 8et:Rn1onS In,the lungs. One or more drah IS are usually inserted in the nec 0 ....,.....",'rn anY'flulds that collect. These drains are Iemoved after several days.

It tal :es two to three weeks for th« I tis... roat to heal. During this time. the laryr gectomee cannot swallow fcod iva nutrition through a tube inse/1ed throt Igh the nose and down the tl lroa ach. During this time, even people with partial laryngectomies are Uf labl

Whe n air is drawn in normally th~ lUg IS warmed and moistened befQre it reae 1es the lungs. When air is d awr he stoma, it does not have the opp< Irtunity to be warmed and hu lliditl r to keep the stoma from drying out and lecoming crusty, laryngector nees raged to breathe artificially humidified air. rhe stoma is usually coverec ' with II oth to keep it clean and to keep unw; mted particles from accident :ally t ri lungs. Care of the stoma Is extremely impc rtant, since it is the person's only ay at ir, to the lungs,' After a laryngectomy, a he !llthcare professional will teac :h th la ctomee and his or her caregivers how to care for the stoma.

I mm ~Iately after a laryngectomy , an It I thad of communication such as writir 19 notes. gesturing, or pointirg m •. A parUal laryngectomy patient will grad Ja"y regain some speech Sa' feral ·.,.n,r.vv r the operation, but the voice may be hoar ~e, weak, and strained. Asp a "~.'~I"."",·",,, will work with a complete laryngectomee to establish new \1Jsy nl ..:sting.

Ther ~ are three main methods of II total laryngectomy. In esophageal spee:h the laryngectomee learns ho airdown into the esophagus and creal 9s sounds by releasing the air. .ulres,quite a bit of coordination and I~aming, and produces short bu abies) of low-volume sound.

Traclleoesophageal speech diver :8 aIr t hole in the trachea made by the surgnon. The air then passes thmug arttficial voice prosthesis (a small tube that makes a sound when air g . Recent advances have been made in im )Iantlng voice prostheses tJu t p oice quality.

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The j hird method of artificial sour d COr 01 involves using a hand-held elect 'Onic device that translates vi brati nds. There are several different style~ i of these devices, but all req uire least one hand to hold the device to the tt roat. The choice of which m eth pends on many things inclUding the age ~ nd health of the laryngectorr ee, ..,...,e:yn, other parts of the mouth. suoh as the tongL e, have also been removed.

Many patients resume daily activites after su ry. Speoial precautions must be taken durin! I showeling or shaving. Speciallnstruction nd equipment is also required for those who Wish to swim or water ski, as it i dan ercus for water to enter the windpipe and Illngs through the stoma.

Regu ar follow-up visits are i mport~nt fo 10 atment for cancer of the larynx, becal sa there is a higher-than·avE Irage . \/eloping a new cancer in the mouth, throa1, or other regions of the heae or n self"help and support groups are availa ble to help patients meet oth 9rs liar problems.

Risks

Laryn! Jectomy is often successful ill cur n ge cancers. However, it does cause · Iifest;fJ a changes. Laryngectomee=: mu t ways of speaking. They must be contin Jally concerned about the ca ra Of Serious infections can occur if water Jr other foreign material entE rs r gh an unprotected stoma. Also, worne , who undergo partial laryng, !cto 0 am some types of artificial speech will ha Ie a deep voice similar to that of am. or some women this presents psych >Iogical challenges.

Normi II results

Ideal!} , removal of the larynx will remove all cance iOUs material. The person will reCOVE r from the operation. make Wes~1 adju nts, and return to an active life.

Abnor mal results

Somet mas cancer has spread to Sllrrou s and it is necessary to remove lymph l odes, parts of the tongue, or ott er ro tissues. As with any major operat on, post-surgical infection is pos I n is of particular concem to laryngf Ictomees who have chosen t ~ ha prosthesis implanted. and is one of the ma jar reasons for having to ren-ove

_arynx Also known as the voi'~e b nx is composed of cartilage that contains the apparatu: ; for etion. This includes the vocal cords and the muscles and I ga~ m ve the cords.

I.ymph nodes Accumulations of tissue al h channel, which produce cells called lymphocytes that fight int

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TracheostDmy A surgical proc ad ... n artificial opening is made in the trachea (windpipe) to a low lungs.

For Your 'nfonnatlon

Books

ursing. Philadelphia: W.B. Saunders Company, 1998.. Monahan, Frances. M~di

)rgan~tJons

American cancer Society. 1 99 cr Road NE, Atlanta. GA 30329. (800) ACS - 2345. http://ww «.can~.:.:.~

Cancer Information Se 9000 Rockville Pike, Bethe http:/twww.nci.nih.go~ ~ca::.:.:n~~.:1===':'&:

International Associathln of es (IAL). 7440 North Shadeland Ave., Suite 100, Indianapolis, IN .la . nxlink.coml .

National InstJtute on o..afn~ r •. SO" 23Z6~ ,

. . cOmmunleation Disorders.. National Institutes on Health, 31 Cen Bethesda,MO" 20s§2-2320.

The Voice Center at E~ Isterr Virgini edical School. Norfolk. VA 23507.

Source: Gale Encyclopedia 0 M Icine, Published December, 2002 by the Gale Group

The Essay Author is Tiuh D. 0 n A.M.