PRESENTED BY:

RINKI VARINDANI , M.S. ,CCC-SLPSPEECH LANGUAGE PATHOLOGI STSELECT SPECIALTY HOSPI TAL , SOUTH DALLAS

The Laryngectomy Patient

An Introduction and In-service

The Larynx (Voice Box)

The Larynx (voice box) is in the neck at the upper end of the trachea

Two bands of muscles called ‘vocal cords’ for speaking

Prevents food/liquids fromentering the airway

Most important for breathing,speaking, swallowing

Cancer of the Larynx

Occurs when malignant cells enter the larynx May be caused by excessive smoking, heavy

drinking, exposure to HPV or other causes.May spread to adjacent structures, by

metastasis to cervical lymph nodes, or more distantly to other parts via blood stream.

Distant metastases to lungs and liver most common.

90%-95% are squamous cell carcinomas. About 60,000 laryngectomees in the U.S

today

Treatment of Cancer of the Larynx

Treatment options differ based on many factors and include the following options:

Radiation ChemotherapyCombinationPalliative

Surgery/Laryngectomy

Partial: Removal of the part of the larynx harboring the tumor Total: Removal of the entire larynx and some adjacent tissues

Total Laryngectomy

Complex surgery involving complete removal of the larynx & redirection of the trachea / windpipe.

Permanent opening called “stoma” created at the front base of the neck.

Nose & mouth no longer connected to the trachea.

Air passes in and out of the lungs through the stoma/ ‘neck breather’

Stoma is permanent. Will not be reversed or closed.

Before and After Total Laryngectomy

Tracheostomy v/s Laryngectomy

Tracheostomy v/s Laryngectomy

Tracheostomy Laryngectomy

A hole is created into the trachea through an incision through the neck

Complete removal of the larynx with redirection of trachea

Mainly used to treat airway obstruction.Person can breathe via nose/mouth

Used to treat cancer of the larynx. Person now breathes through a ‘stoma’

Speech through speaking valve. Normal sounding. No changes in voice.

Speech is never ‘normal’ again. Possible through TEP or electrolarynx.

Changes are usually temporary. Changes are permanent & irreversible.

Changes After Laryngectomy

The trachea opens at the stoma. Patients can no longer cough up mucous into their mouth or blow their nose. They cough up mucous through the stoma in their neck.

The inhaled air no longer gets humidified by passing through the nose & mouth.

The surgery takes away the epiglottis, the hyoid bone and the esophagus is reconstructed. Increased pressure generation, decreased saliva production, no peristalsis during swallow.

Sense of smell & taste affected as air bypasses the nose.

The person will never longer speak normally again.

All these changes affect the patient’s overall quality of life.

Speech After Laryngectomy

Patient Safety and Care

Skin around the stoma should be cleaned at least twice a day to prevent odor, irritation and infection.

If skin becomes red or irritated, best to leave it uncovered and not expose it to any solvents for at least 2 days for it to heal.

Ensure NO WATER enters the stoma, while bathing, showering or shaving the patient. VERY DANGEROUS!

Avoid thin paper towels & tissues. Use a cloth towel.

Avoid spraying of anything directly into the stoma.

Saline bullets/sprays into the stoma to keep it hydrated 2-3x/day.

Ensure the patient has time to perform activities. Be alert!!!

Life after Laryngectomy can be FUN!

Thank you for listening!