Laryngectomy Question

My patients that had a laryngectomy done were usually eatting regular food soon after. Never had one on a dysphagia diet, remember that the surgery is being done on the trachea not the esophagus. A lot will depend on the technique that the surgeon uses also how invasive the disease it into other tissue. I am trying to remember when and if I ever had one of them with an NGT and I can't think of one. If you look at your anatomy, the epiglottis is still intact and funtioning normally, they are essentially having their voice box removed. I still remember seeing the patients at the VA who still continued to smoke, they just held their cigarette up to their stoma. And they are still doing that now. Your final outcome will depend on if they are removing only the voicebox or quite a bit of other tissue. Remember that the cancer is usually an invasive disease and can spread to other areas. Are they having a radical neck procedure at the same time? If so, they will definitely have a feeding tube, and we used to put a Dobhoff in right in the OR, but much more surgery is done with that.

Hope that this helps.

Checked on a few Speech Pathology journals that I have in my office for any help. Again they said that the swollowing problems are dependent upon how much tissue is being removed and also if their is residula scar tissue from radiation therapy, etc. The most important aspect and one that I agree with is to get the Speech Pathologist involved BEFORE the patient has his/her surgery. They can discuss different speaking options with the patient which is usually the most important concern of any patients that I have worked with in the past.

Another suggestion, we used Etch-A-Sketch boards in the old days before white boards were available all over. Perfect to have at the bedside the day of surgery.

Good luck.................let me know if I can be of any more assistance.

Make sure the PRE-OP teaching is spot on!!!! Cannot and I MEAN cannot emphasise that too much. Does not matter if it is a tracheostomy patient for idopathic tacheal stenosis or a laryngectomy it is a life altering surgery. One patient I had was a private patient and no-one had explained to her that she would not be able to swim - devastating to someone who lives in the tropics and had just put in a swimming pool!!

We make it mandatory that they see and speak to the lost chord society.

I don't know whether you have these links or not.

http://www.gh.vic.gov.au/periop/ent-plas/laryngec.htm

http://www.med.monash.edu.au/healthservices/cce/evidence/pdf/b/703.pdf