Rinki Varindani, a speech language pathologist, presented an introduction and in-service about laryngectomy patients. The larynx or voice box is located in the neck and contains vocal cords for speaking. Cancer of the larynx is often caused by smoking and drinking and can spread through the body. Treatment options include radiation, chemotherapy, surgery, or a combination. A total laryngectomy involves complete removal of the larynx and redirection of the trachea, leaving a permanent opening called a stoma. After laryngectomy, patients can no longer speak normally and must adjust to breathing through the stoma and other changes to swallowing, smell, and taste. Proper care of the stoma is important for prevention

1. The Laryngectomy Patient
An Introduction and In-service
PRESENTED BY:
RINKI VARINDANI, M.S.,CCC-SLP
SPEECH LANGUAGE PATHOLOGIST
SELECT SPECIALTY HOSPITAL,
SOUTH DALLAS

2. 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 from
entering the airway
 Most important for breathing,
speaking, swallowing

3. Cancer of the Larynx
 Occurs when malignant cells enter the larynx
 May be caused by excessive smoking, heavy drinking,
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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

4. Treatment of Cancer of the Larynx
Treatment options differ based on many factors and include
the following options:
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Radiation
Chemotherapy
Combination
Palliative
 Surgery/Laryngectomy
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Partial: Removal of the part of the larynx harboring the tumor
Total: Removal of the entire larynx and some adjacent tissues

5. Total Laryngectomy
 Complex surgery involving complete
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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.

6. Before and After Total Laryngectomy

7. Tracheostomy v/s Laryngectomy

8. Tracheostomy v/s Laryngectomy
Tracheostomy
A hole is created into the trachea
through an incision through the neck
Laryngectomy
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.

9. Changes After Laryngectomy
 The trachea opens at the stoma. Patients can no longer cough
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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.

10. Speech After Laryngectomy

11. 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!!!

12. Life after Laryngectomy can be FUN!

13. Thank you for listening!