Laryngectomy

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

Laryngectomy is the removal of the larynx and separation of the airway from the mouth, nose and esophagus. The laryngectomee breathes through an opening in the neck, a stoma. This procedure is usually performed 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 or severe swallowing problems.

Voice replacement

• Voice functions are generally replaced with a voice prosthesis placed in the tracheo esophageal puncture created by the surgeon. The voice prosthesis vibrates the esophageal tissue in lieu of the larynx.

• 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.

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 alone. But most of the remaining 10 out of every 100 people (10%) will be cured with surgery after their radiotherapy.. 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 radiaton.

In animals

Laryngectomies may be applied to dogs as a debarking procedure.

References

Debarkartation

External links

• A Video of a Physician who is a laryngectomee discussing his personal experiences
• A Video of Voice rehabilitation after laryngectomy

Further reading

• Itzhak Brook (15 February 2010). My Voice: A Physician's Personal Experience With Throat Cancer. CreateSpace. ISBN 978-1-4392-6386-0. http://books.google.com/books?id=ReFdRwAACAAJ.