Laryngectomy

Laryngectomy
Intervention
ICD-9-CM	30.2 30.3 30.4
MeSH	D007825
MedlinePlus	007398

Laryngectomy is the removal of the larynx and separation of the airway from the mouth, nose and esophagus. In a total laryngectomy the entire larynx is removed and in a partial laryngectomy only a portion is taken out. The laryngectomee breathes through an opening in the neck known as a stoma.^[1] This procedure is usually performed by ENT surgeon in cases of laryngeal cancer. However, many laryngeal cancer cases are now treated only with more conservative surgeries through the mouth or with radiation and/or chemotherapy; laryngectomy is performed when those treatments fail to conserve the larynx or there is sufficient destruction by the cancer that would prevent normal function once it is destroyed. Laryngectomy is also performed on individuals with other types of head and neck cancer^[2] or severe swallowing problems.

Uses

Laryngectomees number about 60,000 in the United States. Perhaps 10,000 laryngeal cancer cases are treated annually, but only about 3,000 people undergo the surgery each year. Because it is a relatively rare cancer and because the post-operative care is complex in achieving a functional result, laryngeal cancer patients should be treated at or at least consult a major federally designated cancer center, where the fields of surgery, radiology, chemotherapy, speech-language pathology are all available.

Most laryngeal cancers in the UK are glottic, meaning they start in the vocal cords within the larynx. Glottic cancers tend to be picked up at an early stage, as they cause a hoarse voice very quickly. About 90 out of every 100 people (90%) with T1 glottic cancers are cured with radiotherapy or surgery alone. Of those patients who fail radiotherapy, many will be cured with salvage surgery.^[3] Many surgeons are returning to the use of endoscopic surgery for such early cancers as the voice result is very good and comparable to that of radiation.

The airways and ventilation after laryngectomy

The anatomy changes after a laryngectomy. After a total laryngectomy, the individual is breathing through the stoma where the tracheostomy opens in the neck. There is no longer a connection between the trachea and the mouth and nose. These individuals are termed total neck breathers. After a partial laryngectomy, the individual breathes mainly through the stoma, but a connection still exists between the trachea and upper airways; these individuals are able to breathe air through the mouth and nose. They are therefore termed partial neck breathers. The extent of breathing through the upper airways in these individuals varies and a tracheostomy tube is present in many of them. Ventilation and resuscitation of total and partial neck breathers is through their stoma; however, in these individuals the mouth should be kept closed and the nose sealed to prevent air escape.^[4]

Voice replacement

Voice functions are generally replaced with a voice prosthesis placed in the tracheo esophageal puncture created by the surgeon. The voice prosthesis is a one-way air valve that allows air to pass from the lungs/trachea to the esophagus when the patient covers the stoma. The redirected air vibrates the esophageal tissue producing a hoarse voice in lieu of the larynx.^[5]
A second method is the use of an electrolarynx. An electrolarynx is an external device that is placed against the neck and creates vibration that the speaker then articulates. The sound has been characterized as mechanical and robotic.
A third method is called esophageal speech. The speaker pushes air into the esophagus and then pushes it back up, articulating speech sounds to speak. This method is time-consuming and difficult to learn and is seldom used by laryngectomees.^[6]

In animals

Laryngectomies may be applied to dogs as a debarking procedure, though many people may consider this a cruel option.

References

↑ "ACS :: Speech After Laryngectomy". Archived from the original on 2007-11-05. Retrieved 2007-12-05.
↑ Brook I (February 2009). "Neck cancer: a physician's personal experience". Arch. Otolaryngol. Head Neck Surg. 135 (2): 118. doi:10.1001/archoto.2008.529. PMID 19221236.
↑ http://www.cancerhelp.org.uk/type/larynx-cancer/treatment/statistics-and-outlook-for-cancer-of-the-larynx#overall
↑ Brook I (June)|Medical intelligence article: Ventilation of neck breathers undergoing a diagnostic procedure or surgery. Anesth Analg. 114(6)1318-21. 2012
↑ Brook I (July 2009). "A piece of my mind. Rediscovering my voice". JAMA. 302 (3): 236. doi:10.1001/jama.2009.981. PMID 19602676.
↑ Brown DH, Hilgers FJ, Irish JC, Balm AJ (July 2003). "Postlaryngectomy voice rehabilitation: state of the art at the millennium". World J Surg. 27 (7): 824–31. doi:10.1007/s00268-003-7107-4. PMID 14509514.

Tests, surgery and other procedures involving the respiratory system (ICD-9-CM V3 21–22, 30–34, ICD-10-PCS 0B)

Upper RT	nose Rhinoplasty Septoplasty Alarplasty Rhinectomy Rhinomanometry sinus Sinusotomy larynx Laryngoscopy Laryngectomy Laryngotomy Thyrotomy

Lower RT	trachea Cricothyrotomy Tracheoesophageal puncture Tracheotomy bronchus Bronchoscopy lung Pneumonectomy Lobectomy Wedge resection Lung transplantation Decortication of lung Heart-lung transplant

Chest wall, pleura, mediastinum, and diaphragm	pleura/pleural cavity Thoracentesis Pleurodesis Thoracoscopy Thoracotomy Chest tube mediastinum Mediastinoscopy Nuss procedure

Medical imaging	Bronchography CT pulmonary angiogram High resolution CT Spiral CT Ventilation/perfusion scan

CPRs	Pneumonia severity index CURB-65

Lung function test	Body plethysmography Spirometry Bronchial challenge test Capnography Diffusion capacity

Cytology	Sputum culture Bronchoalveolar lavage

Respiratory therapy/ intubation	Mechanical ventilation Positive pressure ventilation Artificial respiration Nebulizer Hyperbaric medicine Oxygen therapy Decompression chamber Heliox Negative pressure ventilator Postural drainage CPR

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