The Laryngectomy Patient
An Introduction and In-service
RINKI VARINDANI, M.S.,CCC-SLP
SPEECH LANGUAGE PATHOLOGIST
SELECT SPECIALTY HOSPITAL,
The Larynx (Voice Box)
The Larynx (voice box) is in
the neck at the upper end of
Two bands of muscles called
„vocal cords‟ for speaking
Prevents food/liquids from
entering the airway
Most important for breathing,
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:
Partial: Removal of the part of the larynx harboring the tumor
Total: Removal of the entire larynx and some adjacent tissues
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.
Tracheostomy v/s 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. Used to treat cancer of the larynx.
Person can breathe via nose/mouth
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.
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!!!