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Dysphagia and Aspiration
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
The difficult decision is with patients who are not going to recover a safe swallow or who are experiencing either a neurological condition that is progressive or severe scarring and contracture related to radiotherapy treatment. Supportive procedures described above may be helpful for a while, but there will come a time when a laryngectomy may become the procedure of choice. It provides a definitive separation of the respiratory and digestive tracts. Feeding tubes and tracheostomies are avoided and depending on residual dexterity and neurological function surgical voice restoration may be possible.
Larynx
Published in Neeraj Sethi, R. James A. England, Neil de Zoysa, Head, Neck and Thyroid Surgery, 2020
There are various procedures that fall under the broad heading of partial laryngectomy, and obviously the extent of the tumour determines which procedure is appropriate. The aim of any partial laryngectomy is oncological cure with preservation of respiration via the upper airway, maintenance of oral nutrition without long-term tube feeding and voice rehabilitation. Therefore it is essential to consider what structures are intended to be left behind that will facilitate these aims; at least one functional (i.e. innervated) crico-arytenoid unit must be preserved. Equally as important as surgical expertise is case selection, patients need to be highly motivated to rehabilitate from the surgery, which they will only be able to do with the input and close supervision of dedicated speech and language therapists with an interest in swallowing rehabilitation.
The Head and Neck
Published in E. George Elias, CRC Handbook of Surgical Oncology, 2020
The main complication after a partial laryngectomy is aspiration; if the patient cannot control aspiration, this necessitates total laryngectomy. Total laryngectomy has a 25% complication rate in the form of pharyngocutaneous fistula. This incidence increases to 75% if partial or total pharyngectomy is added to the laryngectomy.37 Preplanned reconstruction by myocutaneous flaps may decrease the incidence of this complication. Furthermore, it is of utmost importance that laryngectomy patients be rehabilitated by learning esophageal speech or by learning to use one of the external or implantable speech devices.
Course of social support and associations with distress after partial laryngectomy
Published in Journal of Psychosocial Oncology, 2022
Julia Roick, Andreas Dietz, Sven Koscielny, Friedemann Pabst, Kerstin Breitenstein, Jens Oeken, Elke-Juliane Schock, Andreas Boehm, Iwona Winter, Jens Büntzel, Andreas Müller, Stefan K. Plontke, Michael Herzog, Susanne Singer
Data were collected in a multicenter longitudinal study at 15 otorhinolaryngology departments in Germany (University Medical Centers Leipzig, Jena and Halle; Clinical Centers Sankt Georg Leipzig, Dresden-Friedrichstadt, Chemnitz, Stollberg, Südharz Nordhausen, Elbland Riesa, Martha Maria Halle Dölau, Helios Erfurt, Carl Thiem Cottbus, and Waldklinikum Gera; Rehabilitation Clinics Bavaria Kreischa and Sonnenberg Bad Sooden-Allendorf). All patients older than 18 years who received a partial laryngectomy because of laryngeal or hypopharyngeal cancer or – in some cases - who had it received during the past 3 months (those were included at t3, see below) in one of the cooperating departments were reported to the study center Leipzig by the clinic staff (consecutive sample). Potential participants were then visited by a trained interviewer from the study center Leipzig in the cooperating department and informed about the procedure and aims of the study. After obtaining written informed consent, patients were asked by the interviewer using standardized structured interviews before treatment (t1), one week after partial laryngectomy (t2), 3 months after partial laryngectomy or upon completion of rehabilitation treatment (t3), and 1 year after baseline (t4). This study was granted ethical approval by the institutional review board of Leipzig University (#210-12-02072012).
Listener impressions of alaryngeal communication modalities
Published in International Journal of Speech-Language Pathology, 2021
Stephanie M. Knollhoff, Stephanie A. Borrie, Tyson S. Barrett, Jeff P. Searl
One common location for a head and neck cancer tumour is the larynx. The larynx serves as the location where air is transformed into sound, via vocal fold vibration, that ultimately becomes an individual’s voice. Currently, the medical gold standard of treatment for advanced laryngeal cancer, particularly tumour staging four and recurrent laryngeal cancer, is a total laryngectomy (Sheahan, 2014). Total laryngectomy involves the complete removal of the larynx, hyoid bone to trachea, creating a major disruption to speech production due to the elimination of the vocal folds. Additionally, airflow from the lungs has to be rerouted through a stoma in the neck (i.e. tracheostomy) leaving only one pathway from the oral cavity to the oesophagus (Adil & Goldenberg, 2018; Dietrich, 1999). Recipients of a total laryngectomy will experience alterations to their verbal communication and respiration, requiring speech rehabilitation.
Tracheoesophageal speech restoration: issues for training and clinical support
Published in Speech, Language and Hearing, 2018
Kelli Hancock, Elizabeth C. Ward, Robyn Burnett, Peta Edwards, Priscilla Lenne, Julia Maclean, Felicity Megee
The process of re-establishing communication post laryngectomy using tracheoesophageal speech (TES) is the role of the speech language pathologist (SLP) in many countries around the world (American Speech Language Hearing Association (ASHA) Position Statement, 2004; Bradley, Counter, Hurren, & Cocks, 2013; Royal College of Speech & Language Therapist (RCSLT) Clinical Guidelines, 2005; Speech Pathology Australia (SPA) Laryngectomy Clinical Guideline, 2013). The SLP role spans the continuum of care, including preoperative counselling and education, selection and fitting of the voice prosthesis, ongoing patient education and support, troubleshooting the acquisition of TES and its long term use. In recent years there have been many advances in the field of TES rehabilitation. New and enhanced voice prosthesis designs, shifting practices such as the move to inserting the voice prosthesis at the time of surgery, and the changing nature of the patient population due to extended and salvage surgery have all increased the complexity of management.