Which of the following are the common complications of total laryngectomy?
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To evaluate the clinical outcomes of total laryngectomy (TL), complications and factors affecting survival. Show DesignRetrospective review of hospital electronic database for head and neck squamous cell carcinoma (SCCa). SettingLarge district general hospital in England, United Kingdom. ParticipantsPatients who had TL between January 1994 and January 2008. Main outcome measures5-year disease specific survival (DSS) and disease-free survival (DFS). Results and conclusionsSeventy-one patients were reviewed, of whom 38 (54%) had laryngeal SCCa and 33 (46%) hypopharyngeal SCCa. The overall mean survival period following TL was 42.4 months. The 5-year DSS and DFS was better for laryngeal SCCa compared to hypopharyngeal SCCa, although not statistically significant (P = 0.090, P = 0.54 respectively). Patients treated for laryngeal SCCa had a mean survival period of 47.5 months compared to 36.5 months for hypopharyngeal disease. Those who had laryngeal recurrence after primary radiotherapy (RT) demonstrated statistically better survival probability than those who had hypopharyngeal recurrence (P = 0.011). Patients without cervical lymphadenopathy had statistically better survival (P = 0.049). The most common early complication was related to the cardiorespiratory system. One fatal complication of erosion of the brachiocephalic artery due to the laryngectomy tube was noted. The most common late complication was neopharyngeal stenosis. The commonest cause of death was due to locoregional recurrence, followed by medical co-morbidities. Patients referred to specialised head and neck clinic had a better survival probability than those referred to a general ENT clinic (P = 0.37). While there is increasing tendency towards laryngeal conservation, total laryngectomy remains a robust treatment option in selected patients. Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services Policy A total laryngectomy is a life-changing ordeal for most patients, and postoperative complications can make matters even worse. At the Head & Neck Institute (HNI), we have taken steps to minimize postoperative sequelae, especially with respect to breathing and voice rehabilitation. According to the American Cancer Society’s estimates, approximately 13,430 new cases of laryngeal cancer will be diagnosed in the U.S. in 2016, and approximately 3,620 patients (2,890 men and 730 women) will die from it.1 Total laryngectomy is a surgical option for patients with advanced laryngeal cancer. The operation involves the surgical removal of the larynx and the complete separation of the trachea from the mouth, nose and esophagus. At Cleveland Clinic, the preferred method of voice restoration after a total laryngectomy is tracheoesophageal puncture (TEP). ENT surgeons perform primary TEP and place a voice prosthesis at the time of the laryngectomy. This facilitates a rapid restoration of speech. Restoring a Healthy AirwayBreathing and pulmonary health present a different challenge. During a total laryngectomy, the upper and lower airways become disconnected. As a result, the patient must breathe through a permanent tracheostoma in the neck. This results in loss of filtering, a loss of humidification and warming of inspired air. The loss of some nasal functions and changes in the intratracheal climate can also result in poorer pulmonary function and lead to frequent coughing, an increase in pulmonary secretions, shortness of breath and dryness or crusting of secretions. All these postoperative changes can diminish the quality of life of a patient who is already coping with a difficult situation. Advertising Policy In order to improve postoperative pulmonary health, several studies have investigated the use of a heat moisture exchanger (HME). These studies have documented several clinical benefits, including reductions in mucus production, coughing and the need for stoma cleaning. Other benefits include improved voicing and sleep and less anxiety and fatigue. At the HNI, we have been using the HME system for some time in the outpatient setting. The Sooner the BetterHowever, recent studies have shown that the sooner this system is initiated, the sooner the patient will reap its benefits. Therefore, our speech-language pathology (SLP) team teamed up with ENT surgeons, our ENT clinical nurse specialist, our acute care ENT nursing staff and the acute care respiratory therapy section to develop protocols for initiating HME use as soon as possible following surgery.  Figure 1. A: The LaryTube is placed in the tracheostoma. B: The tube is secured with the LaryTube holder. Figure 2. A: The HME cassette is placed into the tube. B: With the tube and cassette in place, the patient can breathe with optimal pulmonary benefits. Working with Atos Medical, manufacturer of the Provox® Laryngectomy Pulmonary Kit (LPK), we customized the kit so that it contains all the supplies necessary to initiate HME as soon as possible after surgery. An LPK is issued to our patients when they leave the OR and kept throughout their hospital stay. Once a patient is weaned from the ventilator and extubated, he or she is ready to begin using the HME system. A LaryTube™ is inserted into the tracheostoma (Figure), and an HME cassette is placed into it. Immediately upon placement, patients are able to receive the maximum pulmonary benefits and begin their journey to recovery. Advertising Policy In addition to promoting better respiration, the SLP team has been able to document that early initiation of the HME system leads to an easier and faster transition to hands-free tracheoesophageal voicing. We in the SLP service are proud of our team’s accomplishments, which truly improve the quality of life and the speed of recovery of our total laryngectomy patients. Reference
Ms. Hohman is a clinical speech-language pathologist on Cleveland Clinic’s speech-language pathology team in the Head & Neck Institute. What is the most common reason for a laryngectomy?Most often, laryngectomy is done to treat cancer of the larynx. It is also done to treat: Severe trauma, such as a gunshot wound or other injury. Severe damage to the larynx from radiation treatment.
What are the effects of laryngectomy?If you have had all of your larynx removed (total laryngectomy), you will not be able to speak normally, because you'll no longer have vocal cords. There are a number of different ways you can learn to communicate again, although they can take weeks or months to learn.
Which is not affected following a total laryngectomy?When a laryngectomy patient inhales, air passes directly through the stoma into the trachea and then into the lungs. The connection between the mouth and the esophagus is usually not affected, so food and liquid can be swallowed just as they were before the operation.
How does a total laryngectomy affect speech?Having a total laryngectomy removes your larynx and vocal cords, so the way you speak after a laryngectomy is going to change. Your voice will sound different than it did before because it is no longer coming from your vocal cords.
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