featured diagnosis: laryngectomy

I wanted to start reviewing some different diagnoses--a basic overview and then some implications for treatment. Besides, let's be honest, grad school was a while ago and it may be good for a quick refresher! (Keep in mind, it is an overview and therefore is very basic.)

So today I wanted to review larygectomies. 

WHAT IS IT? 

A laryngectomy is the surgical removal of the larynx and subsequent separation of the airway from the mouth, nose, and esophagus. 

A stoma is created to allow a person to breath through an opening in the neck. 

There are 2 different types of laryngectomies: 

-Total laryngectomy--the vocal folds, hyoid bone, epiglottis, thyroid and cricoid cartilage, and a few trachel cartilage rings are removed

-Partial laryngectomy--only a portion of the larynx is removed 

The picture below is a total laryngectomy. 

WHY IS IT DONE? 

There are a few reasons why someone would have a laryngectomy performed, including: cancer and severe injury to the neck.

WHAT ARE THE IMPLICATIONS FOR TREATMENT?

Swallowing: 

-In a total laryngectomy, it is impossible for a patient to aspirate as there is no longer a connection between the mouth and the lungs. However, there can be disruption of the oral and pharyngeal phases of swallowing. The patient's tongue base pushes food towards the esophagus. The procedure may limit base of tongue movement. However, gravity can help with this and therefore it is important that a patient is upright when eating/drinking. From this point, pharyngeal constriction occurs but there is no longer normal subglottic pressure and the muscles must perform the work on their own of moving the food down. The removal of the larynx results in increased resistance to flow from loss of movement that assists in the opening of the UES. It is important to note that sometimes a myotomy is performed on the cricopharyngeus in order to allow food to pass through the upper esophageal sphincter with ease. 

-In a partial laryngectomy, patients can still be at risk of aspiration and the affects on swallowing depend on what was removed in surgery.

Speech: 

-Removal of the larynx precludes patients from being able to speak naturally. There are a few options for speaking post-surgery: 

-Tracheoesophageal puncture: includes a procedure to place a one-way valve between the trachea and esophagus. The valve allows air to travel from the trachea into the esophagus to allow vibrations for voicing (does require closure of the stoma)

-Electrolarynx: electronic buzzer that provides vibrations for vocalizations when placed against your throat

-Esophageal speech: AKA "burp talking"--muscle at top of esophagus becomes source for vibrations 

Laryngectomies can be very complex and have many implications for speech and swallowing. You as an SLP are integral in a patient's recovery! Something to remember: be sure to get clearance from the surgeon/doctor before providing treatment. These surgeries require time for recovery and oral feedings/speech therapy may not be appropriate for a period of time post-surgery. Hopefully this information is helpful for beginning treatment! 

Happy treating! 

Mallory 

References: 

https://www.healthline.com/health/laryngectomy

https://en.wikipedia.org/wiki/Laryngectomy

https://headandneckcancerguide.org/adults/cancer-diagnosis-treatments/surgery-and-rehabilitation/cancer-removal-surgeries/laryngectomy/

https://www.asha.org/Events/convention/handouts/2009/1408_Brobeck_Teresa/

http://www.sw.org/cancer-institute/head-neck/voice/head-neck-voice-restoration