LASER surgery of the larynx, the laringectomie subtotals and improved radiotherapy allow many patients to treat cancers of the larynx without excise it completely.
Unfortunately still today many cancers of the larynx and pharynx can be carried out only with the intervention of ’ total laryngectomy (eventually extended to the pharynx: faringolaringectomia)
L ’ l ’ total laryngectomy speech expected removal of the entire larynx, l ’ interview of the trachea to the skin (full permanent tracheostomy) and the rebuilding of a new food away completely independent of the airway. At discharge, patients undergoing total laryngectomy eat normally through the mouth but breathe exclusively through the Trach (no longer from the mouth and nose).
Patients often see this intervention as very mutilating but actually you can live with it almost normally: tracheotomy can be easily hidden by a scarf or clothing with the neck slightly’ tall and you can retrieve your voice!
First we must understand that the voice is a sound that is achieved by controlling the vibration of the mucous membranes produced by a ’ air flow. ’ air flow is normally given by the lungs and makes vibrate the vocal cord mucosa.
But there is a valid alternative: vibrate the mucosa of the esophagus from the stomach ’ ’ exploited l air coming:
–natural voice erigmofonica: It is not easy to learn but with practice and patience you can get a very good entry, just hoarse but intelligible. Obviously l ’ air supply from the stomach is poor than we can pump up your lungs, and then sentences will necessarily be shorter.
–voice phonation valve erigmofonica: It allows to vibrate the mucous membrane of esophagus using ’ l ’ air coming from the lungs. We have however said that the airborne and away from ’ total laryngectomy speech separate digestive, to get that kind of voice you have to place a valve between the trachea and the esophagus ’ (in the operating room, under general anesthesia), This valve allows the air to pass ’ in ’ chiudento the tracheostoma esophagus but not saliva and food to pass into the trachea. You get the voice easily and you can also mean longer sentences. The main disadvantage of this technique is that the valve phonation can break or can be colonized by fungi and therefore must be replaced periodically (Come on 3 months to 2 years at most, is highly variable and unpredictable). The replacement is an ambulatory procedure but a little’ time consuming,. The cost of the prosthesis phonation is quite high but still covered by the national health system.
Recorded voice of a patient undergoing total laryngectomy with valve phonation:
As a last resort you can use the throat microphone: a tool that interprets the contraction of the muscles of the neck to produce a sound
