Laryngectomy

Laryngectomy (sometimes spelled Laryngectomee) 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.^[1] It is done in cases of laryngeal cancer. However, many laryngeal cancer cases are now treated only with radiation and chemotherapy or other laser procedures, and laryngectomy is performed when those treatments fail to conserve the larynx.

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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.

• A fourth method is the use of the UltraVoice speaking device which is built into an upper denture or retainer and worn inside the patient's mouth. The speech from the Ultravoice has computer controlled prosody which changes the pitch creating a more natural sound than the electrolarynx.

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 are laryngectomized. 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 integrated in head and neck departments.

In animals

Laryngectomies may be applied to dogs as a debarking procedure.

References