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First duty of a man is to speak that is his chief business in this world
Partial laryngectomy
KUNNAMPALLIL GEJO JOHN,
Surgical intervention to preserve the part of the function of the larynx Between the partial laryngectomy and total laryngectomy Like total laryngectomy-speech is preserved Like partial laryngectomy-nasal breathing is sacrificed
KUNNAMPALLIL GEJO JOHN,
Total laryngectomy
Nasal
Partial laryngectomy
Nasal
breathing is preserved Verbal communication is present Temporary tracheostoma Stoma will be in situ for only few days
Nasal breathing is sacrificed Verbal communication is preserved Permanent stoma Patient can speak with preserved larynx
shunt At the tine of surgery part of the larynx is preserved Preserved larynx - one vocal cord, one arytenoid, one false vocal cord,
when?
days after removal of NG tube After medical line of treatment completes
KUNNAMPALLIL GEJO JOHN,
3-4
min/session Individual therapy Group therapy Resume sentence level before initiation of post operative RT
KUNNAMPALLIL GEJO JOHN,
How do we proceed?
Good posture Relaxing exercises for head and neck area Normal inhalation Closing of the stoma Phonation Words beginning with a vowel and sentences Refinement of speech
KUNNAMPALLIL GEJO JOHN,
Patient in conversation
Proper valving
Inhalation-occlusion of stomaexhalation & articulation
KUNNAMPALLIL GEJO JOHN,
too much pressure -Strained voice Not too little - Air escape from the stoma Not closing the mouth of the shunt at the tracheal level - air will not pass through shunt
KUNNAMPALLIL GEJO JOHN,
cough Short neck Improper closure of stoma Lack of motivation Vaso vagal irritation Inability to understand instruction Short of breath
KUNNAMPALLIL GEJO JOHN,
Severe ------
If all my possessions were taken away from me, I would like to keep the power of speech, so that I would soon regain the rest Daniel Webster
Thank you
KUNNAMPALLIL GEJO JOHN,