Post-laryngectomy care
Laryngectomy is the surgical removal of the voicebox for irreparable damage by the cancer or as a result of treatment. A patient who undergoes the procedure is known as a ‘laryngectomee’. When successfully cured of cancer, these patients can go on to live well for decades. Following removal of the voicebox, the foodpipe is reconstructed to allow eating normally through the mouth, but the airway is opened permanently in the lower neck (known as a ‘stoma’), with the patient breathing through this new passage. Unfortunately, voice production is irreparably altered. Alternative techniques of voice production include electrolarynx (an electrical device) and a tracheo-oesophageal speech valve (a surgically placed shunt that diverts air from the foodpipe into the airway to speak). Some of the other changes experienced include decreases in smell and taste, inability to blow your nose, inability to hold your breath and bear down, and the inability to warm, moisten or filter air you are inhaling.
Some important considerations are:
Humidification: Since the opening in the airway is bypassing the voicebox, throat and mouth, inhaled air does not have the level of warmth and humidity that is required. Hence an ultrasonic nebulizer or room-size humidifier is useful to help meet this need, more so in winter months. Drinking plenty of liquids is important to maintain hydration.
Hygiene: As there are secretions around the stoma, it is important to keep this skin clean and dry. This can be achieved by gentle wiping with a clean non-abrasive cloth dipped in water or a cotton bud. Soon after the surgery if there is excessive liquid collecting around the stoma, dressings may be required.
Suction: This allows mechanical removal of sticky, stubborn secretions that aren’t removed by coughing. Portable suction machines are available for hire or purchase in most places. To suction the stoma, one needs to wear gloves and handle the catheter in a ‘sterile’ fashion – avoid touching the tip that goes in to the stoma to any other surface. Do not insert the suction catheter more than thrice during a suctioning period, take a few deep breaths between each episode of suctioning.
Appliances: These may not be required, except to prevent the stoma decreasing in size over time. A laryngectomy tube or a stoma vent can be placed in the stoma to keep the stoma patent and to help reduce breathing difficulty.
Mouth care: Because of reduced taste and smell, you may be unaware of mouth odour, so regular oral hygiene with brushing, flossing and mouthwash will help prevent this.
In case of emergency:
Talking on the telephone may be difficult in spite of voice rehabilitation, so it is important to have a plan in case of emergency, such as text-to-speech applications. Keep telephone numbers for ambulance, fire department, visiting nurse or doctor near the phone.
During cardiopulmonary resuscitation (CPR), breathing must be performed mouth to stoma, not mouth to mouth. Similarly, oxygen administration needs to be to the stoma, not the mouth or nose.
A medical alert bracelet can inform others of your condition in case of emergency
Dressing: Covering the stoma to prevent dust, insects or other foreign matter from entering is important. This will also prevent odours and reduce the sound of your breathing. Various shield and covers are available. Changing the neckline of you clothing or covering the stoma with an ascot or scarf may help with this as well.