Laryngectomy

Laryngectomy is a medical operation in which the human larynx is removed.

Naming

The word is composed of the ancient Greek ingredients λάρυγξ larynx, throat ' and ἐκτομή ektomē, cut, cut'. Ectomy is in medicine, the common ending for organentfernende operations.

Indications and alternatives

Reason for the laryngectomy is almost always a cancer of the larynx ( laryngeal carcinoma ) or the deep throat ( hypopharynx ). Cancers of the larynx, which are less advanced, can usually be organ-and function -preserving thus treated, eg by using only parts of the larynx can be removed (eg, as Endolaryngeal laryngeal surgery or hemilaryngectomy ).

In extensive cancers can be a substitute for or a supplement to a laryngectomy radiotherapy or combined radiotherapy and chemotherapy.

History

It was conducted for the first time as emergency surgery on New Year's Eve of 1873, whose name remained famous by the surgeon Theodor Billroth mainly due to its later performed stomach surgery in medicine. Today the most hours of continuous operation is performed no more than emergency surgery, but only after thorough preliminary investigations ( microlaryngoscopy, computer tomography, staging investigations, ...) as a well-planned operation. The operation is up today usually not the surgeon, but specialized ear, nose and throat doctors.

Surgical Technique

The procedure is performed only makes sense in general anesthesia. Most removal of neck lymph nodes (so-called neck dissection ) is performed at the same time. When neck dissection two types can be distinguished: first, the functional neck dissection, in which only the lymph nodes are removed and on the other the radical neck dissection, in which not only the lymph nodes and the sternocleidomastoid muscle, the accessory nerve and the inferior vena internal jugular be removed.

Rehabilitation

The larynx has two main tasks. It separates dining and airways so that the inhaled air through the mouth into the trachea and also taken by mouth but food pass into the esophagus. As a second function, the voice is produced in it. Because these tasks are missing after the removal of the larynx, first supply and air paths are separated in the operation. The mouth leads only into the esophagus. The trachea is, in turn, namely discharged a tracheostomy in a breathing hole in the neck.

For the vocal spare three methods are essentially the question:

• Electronic speech aid ( The tone is via a held in the mouth or throat, battery-powered device. The sound is partly perceived as " technical". )
• Ruktusstimme, also Ösophagusersatzstimme ( The patient learns to consciously push air into the esophagus and to use them for the formation of sounds. )
• Voice fistula, also shunt valve (usually plastic valves that are inserted surgically between the trachea and esophagus and allow it to use the breathing air of the lungs for vocalization ).

The resulting vote is known as a substitute voice.

All these methods require extensive training, which takes place under the guidance of speech. Contact with speech therapists and already laryngectomy patients should be made ​​already possible before the surgery because of the not yet laryngectomy better ask questions and to prepare for the time after the operation.

Often regional self -help groups are organized in close cooperation with the operating clinic. The communication difficulties due to the initial voicelessness and the subsequent limitations on the replacement voice mingle with other effects of tumor treatment (eg dysphagia, for dry mouth after radiotherapy, fatigue syndrome, ...) and psychological consequences of tumor diagnosis (fear of surgery, fear of helplessness, fear of dying ), which need to be addressed simultaneously. Rehabilitation is therefore to be understood as a complex, interdisciplinary long-term task. In Germany is a stationary follow-up treatment after laryngectomy the rule.