DOCSLIB.ORG

Laryngeal Transplantation Report

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Laryngeal Transplantation Report The Royal College of Surgeons of England Laryngeal transplantation Laryngeal transplantation WORKING PArtY FINAL REPOrt June 2011 External Affairs [email protected] Published by The Royal College of Surgeons of England 35–43 Lincoln’s Inn Fields London WC2A 3PE www.rcseng.ac.uk/publications/docs The Royal College of Surgeons of England © 2011 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of The Royal College of Surgeons of England. While every effort has been made to ensure the accuracy of the information contained in this publication, no guarantee can be given that all errors and omissions have been excluded. No responsibility for loss occasioned to any person acting or refraining from action as a result of the material in this publication can be accepted by The Royal College of Surgeons of England. Registered charity no. 212808 The cover image of this document is taken from the India proofs of the first edition of Gray’s Anatomy, held in the College archives. Table of contents Foreword 3 Executive summary 3 1 Background 4 2 Laryngeal transplantation 5 Which parts need to be transplanted? 6 Blood supply 6 Nerve supply 6 Functional outcomes of laryngeal transplantation 6 Breathing 6 Swallowing 6 Voice and speech quality 6 Alternative techniques for voice restoration 7 Previous laryngeal transplantations 7 Key references and further reading 7 3 Immunology 8 Advances in immunology and suppression 8 Rejection rates 8 Long-term effects 8 Key references and further reading 8 4 Psychological and societal issues relevant to laryngeal transplantation 9 Patient selection 9 Treatment decision making 9 Post-operative issues 9 Fears about the viability of the transplant and of rejection 10 Integrating the transplant into an existing body image 10 Adherence to post-transplant treatment regimens 10 Key references and further reading 10 5 Ethico-legal issues concerning laryngeal transplantation 11 Risks and benefits of laryngeal transplantation 11 Recruitment and consent process 11 Information 11 Recruitment and voluntariness 11 Competence 12 Research ethics 12 Key references and further reading 12 1 6 Service implications for delivering a laryngeal transplantation service 13 Assessing patient suitability 13 Training of surgical and peri-operative teams 13 Advance care planning and follow-up requirements 13 Key references and further reading 14 7 Other considerations 15 Dealing with the media 15 8 Conclusions and recommendations 15 A Annex A: Working party membership 16 2 The Royal College of Surgeons of England Laryngeal transplantation Foreword Transplantation continues to progress at a rapid pace but still report will also be applicable to other areas of transplantation. remains one of the most challenging areas of modern medicine. I appreciate that a new transplant procedure brings into sharp Since the first kidney transplant over 50 years ago we are now focus many ethical, psychological and societal questions, which able to transplant solid organs such as kidneys, livers and hearts I believe this report addresses in order to inform the wider with good short and long-term outcomes for patients. Many debate. advances in the surgical aspects over the last half century would not have been made possible without our understanding of how I would like to thank the working group for bringing their wide the immune system responds to a transplanted organ and the range of expertise to this work. I recommend it as a good development of corresponding immunosuppressive treatments summary of this new area of surgery as well as a source of that prevent rejection. guidance to those involved in pioneering the operation to ensure that this procedure delivers the best possible outcomes I hope the guidance in this report will be helpful to those for patients. involved in pioneering this operation in the UK and will also provide useful information to patients who may benefit in John Black the future from this procedure. Some of the contents of this President, The Royal College of Surgeons of England Executive summary The aim of laryngeal transplantation is to restore a physical and The working party believes that there is a potential for laryngeal functioning organ, to replace a lost or irreparably injured larynx transplantation to improve the quality of life of an individual (voice box) and to allow the recipient to achieve ‘normal’ or who has lost or irrreparably damaged his or her larynx. In the ‘acceptable’ stoma (tracheostoma), free breathing, swallowing decade since the first (and only) published transplantation and voice. The first successful operation was a total laryngeal was conducted, there have been advances in both surgical transplantation performed by Marshall Strome in Ohio, USA, in technology and immunosuppression that make the short and 1998. Since that pioneering procedure only one other human long-term outcomes for recipients more predictable. total laryngeal transplant has been undertaken worldwide but never, so far, in the UK. This report recommends that laryngeal transplantation only be contemplated in patients who have suffered irreversible Like all surgical procedures, laryngeal transplantation carries trauma or injury to their larynx or patients who, as a result of risks and burdens as well as benefits. Laryngeal transplantation a large benign or low-grade malignant tumour, have undergone is aimed at improving quality of life rather than saving life and treatment by way of a total laryngectomy. At present, because it carries potentially lifelong medical implications. Although of the increased risk of a second cancer, patients who have been immunosuppressive therapy is ever improving, trauma patients treated for locally advanced or recurrent throat cancer should would be the ideal candidates for early laryngeal transplantation. not be considered suitable. The assessment and selection of laryngeal transplant candidates is important, ideally with the medical and psychological criteria The report also highlights that recent successes in specific sites, being defined in advance of the procedure by a multi-disciplinary such as arm and face transplantation, indicate that there can be team. The risks involved in laryngeal transplantation warrant a reduced need for intensive immunosupression. The report a thorough disclosure and a detailed consent form. Patient also makes specific recommendations that the transplant team confidentiality should be upheld, unless the patient consents to provide and monitor detailed functional and psychological revealing otherwise protected information. outcomes pre and post-operatively. 3 Laryngeal transplantation The Royal College of Surgeons of England Background Transplantation is one of the most challenging and complex prevent rejection, thereby maintaining viability of the 1areas of modern medicine. The field of transplantation transplanted organ. medicine continues to progress at a rapid pace, with improvements in the outcomes of established transplants One area of transplantation that has received much attention in (such as heart, kidney and liver) as well as new areas the surgical literature is the potential to transplant a voice box (such as face, arm and hand), which are still in their infancy. (larynx). The College set up a working group to consider the progress of laryngeal transplantation and whether such surgery Advances in transplantation have only been possible ought to be performed in the UK, given the current state of by corresponding developments in our understanding knowledge and its future. of how the immune system responds to transplanted organs and tissues and the effect on the viability of This report provides guidance to those involved in pioneering the transplant. Of particular importance has been the the operation in the UK as well as adding information to the development of immunosuppressive treatments that wider debate in this new area of transplantation. 1902 Alexis Carrel demonstrates a method of joining blood vessels to make organ transplant feasible in France 1905 First reported cornea transplant by Eduard Zirm takes place in Moravia (now Czech Republic) 1954 First successful kidney transplant operation performed by Joseph Murray in Boston, USA 1963 First liver transplant performed by Thomas Starzl in Denver, USA 1967 First heart transplant operation performed by Christiaan Barnard in South Africa 1983 First combined heart and lung transplant performed by Magdi Yacoub, UK 1994 NHS Organ Donor Register established in the UK 1998 First hand transplant performed by Clint Hallam, France First laryngeal transplantation performed by Marshall Strome, Ohio, USA 2001 First complete double arm transplant carried out by Edgar Biemer and Christoph Hoehnke, Germany 2005 First partial face transplant carried out by Bernard Devauchelle and Jean-Michel Dubernard, France 2008 First stem-cell airway transplant performed by Paolo Macchiarini, Spain, and Martin Birchall, UK 2010 First full-face transplant carried out by Joan Pere Barret, Spain Table 1 Modern tissue transplantation 4 The Royal College of Surgeons of England Laryngeal transplantation Laryngeal transplantation The aim of laryngeal transplantation is to give the recipient How the larynx works 2normal breathing, swallowing and voice production. Laboratory The larynx is another name for the voice box. Its position in research providing
Load more

Recommended publications
  • Ethical, Legal and Psychosocial Aspects of Transplantation Global Challenges
    E. K. Massey, F. Ambagtsheer, W. Weimar (Eds.) Ethical, Legal and Psychosocial Aspects of Transplantation Global Challenges PABST E. K. Massey, F. Ambagtsheer, W. Weimar (Eds.) Ethical, Legal and Psychosocial Aspects of Transplantation Global Challenges PABST SCIENCE PUBLISHERS Lengerich Bibliographic information published by Die Deutsche Nationalbibliothek Die Deutsche Nationalbibliothek lists this publication in the Deutsche Nationalbibliografie; detailed bibliographic data is available in the Internet at <http://dnb.ddb.de>. This work is subject to copyright. All rights are reserved, whether the whole or part of the mate- rial is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in other ways, and storage in data banks. The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a spe- cific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The authors and the publisher of this volume have taken care that the information and recommen- dations contained herein are accurate and compatible with the standards generally accepted at the time of publication. Nevertheless, it is difficult to ensure that all the information given is entirely accurate for all circumstances. The publisher disclaims any liability, loss, or damage incurred as a consequence, directly or indirectly, of the use and application of any of the contents of this volume. © 2017 Pabst Science Publishers · D-49525 Lengerich Internet: www.pabst-publishers.de, www.pabst-science-publishers.com E-mail: [email protected] Print: ISBN 978-3-95853-292-2 eBook: ISBN 978-3-95853-293-9 (www.ciando.com) Formatting: µ Printed in Germany by KM-Druck, D-64823 Gross-Umstadt Contents Preface Introduction Emma K.
    [Show full text]
  • Effectiveness and Superiority of Ventilation with Laryngeal Mask
    a & hesi C st lin e ic n a A l f R o e l s Journal of Anesthesia & Clinical e a a n r r Wu et al., J Anesth Clin Res 2017, 8:7 c u h o J DOI: 10.4172/2155-6148.1000738 ISSN: 2155-6148 Research Research Article Open Access Effectiveness and Superiority of Ventilation with Laryngeal Mask Airway in Partial Laryngectomy Jinhong Wu, Weixing Li and Wenxian Li* Department of Anesthesiology, Eye, Ear, Nose and Throat Hospital, Fudan University, China *Corresponding author: Wenxian Li, Department of Anesthesiology, Eye, Ear, Nose and Throat Hospital, Fudan University, 83 Fenyang Road, Xuhui District, Shanghai 200031, China, Tel: +86-21-64377134; Fax: +86-21-64377151; E-mail: [email protected] Received date: Jun 06, 2017; Accepted date: Jul 01, 2017; Published date: Jul 04, 2017 Copyright: © 2017 Wu J, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Background: Laryngeal carcinoma occupies the space of glottis. It may lead to difficult airway, and is prone to bleed if intubated with endotracheal tube (ETI). Intubation can also result in the possibility of tumor cultivation in the lung. Use of laryngeal mask airway (LMA) could avoid the disadvantages of endotracheal intubation, which would benefit patients undergoing partial laryngectomy. Methods: This was a randomized controlled clinical trial. Thirty adult patients scheduled to receive partial laryngectomy were enrolled. All study subjects received an ASA rating of grade III.
    [Show full text]
  • Ethical Issues in Living-Related Corneal Tissue Transplantation
    Viewpoint Ethical issues in living-related corneal J Med Ethics: first published as 10.1136/medethics-2018-105146 on 23 May 2019. Downloaded from tissue transplantation Joséphine Behaegel, 1,2 Sorcha Ní Dhubhghaill,1,2 Heather Draper3 1Department of Ophthalmology, ABSTRact injury, typically chemical burns, chronic inflamma- Antwerp University Hospital, The cornea was the first human solid tissue to be tion and certain genetic diseases, the limbal stem Edegem, Belgium 2 transplanted successfully, and is now a common cells may be lost and the cornea becomes vascula- Faculty of Medicine and 5 6 Health Sciences, Dept of procedure in ophthalmic surgery. The grafts come from rised and opaque, leading to blindness (figure 1). Ophthalmology, Visual Optics deceased donors. Corneal therapies are now being In such cases, standard corneal transplants fail and Visual Rehabilitation, developed that rely on tissue from living-related donors. because of the inability to maintain a healthy epithe- University of Antwerp, Wilrijk, This presents new ethical challenges for ophthalmic lium. Limbal stem cell transplantation is designed to Belgium 3Division of Health Sciences, surgeons, who have hitherto been somewhat insulated address this problem by replacing the damaged or Warwick Medical School, from debates in transplantation and donation ethics. lost limbal stem cells (LSC) and restoring the ocular University of Warwick, Coventry, This paper provides the first overview of the ethical surface, which in turn increases the success rates of United Kingdom considerations generated by ocular tissue donation subsequent sight-restoring corneal transplants.7 8 from living donors and suggests how these might Limbal stem cell donations only entail the removal Correspondence to be addressed in practice.
    [Show full text]
  • Gemstone Spectral Imaging Technique
    Gemstone Spectral Imaging HANDBOOK OF CLINICAL EVIDENCE for Radiologists and Radiographers Vascular Performance Artefact Innovation Reduction Technology Material Decomposition Oncology gehealthcare.com Introduction Diagnostic Imaging is a fast-moving field harvesting the latest technologies from the newest in hardware capabilities to the first artificial intelligence applications in radiology. The objective is improving patient clinical outcomes and we are now expecting to go beyond by improving the patient pathway, reducing the number of exams and giving access to the right diagnosis, effortlessly. CT imaging has quickly become the cornerstone of imaging departments, not only providing more and more anatomical information by improving image quality, but also taking the lead in functional information to really assess the impact of disease. Gemstone™ Spectral Imaging (GSI) is the avenue to answer challenging clinical questions by using a single scan to provide both anatomical and functional information in one study thereby reducing the number of exams needed to deliver a diagnosis. This technique is widely accepted by clinical societies and peer reviewed publications show patient & clinical outcomes. Through this handbook, you will find the latest uses of our GSI technology, its outcomes and real testimonials from our users. We truly want to help you integrate this into your daily clinical practice in multiple clinical applications to further add value to your patient care pathway in CT. We have gathered infographics illustrating the use of GSI, clinical examples from all over Europe and a brief literature review. This handbook is for your patients, for your team and for you. We hope you find it valuable and as always contact your GE Healthcare representative if you have any questions.
    [Show full text]
  • ACR Manual on Contrast Media
    ACR Manual On Contrast Media 2021 ACR Committee on Drugs and Contrast Media Preface 2 ACR Manual on Contrast Media 2021 ACR Committee on Drugs and Contrast Media © Copyright 2021 American College of Radiology ISBN: 978-1-55903-012-0 TABLE OF CONTENTS Topic Page 1. Preface 1 2. Version History 2 3. Introduction 4 4. Patient Selection and Preparation Strategies Before Contrast 5 Medium Administration 5. Fasting Prior to Intravascular Contrast Media Administration 14 6. Safe Injection of Contrast Media 15 7. Extravasation of Contrast Media 18 8. Allergic-Like And Physiologic Reactions to Intravascular 22 Iodinated Contrast Media 9. Contrast Media Warming 29 10. Contrast-Associated Acute Kidney Injury and Contrast 33 Induced Acute Kidney Injury in Adults 11. Metformin 45 12. Contrast Media in Children 48 13. Gastrointestinal (GI) Contrast Media in Adults: Indications and 57 Guidelines 14. ACR–ASNR Position Statement On the Use of Gadolinium 78 Contrast Agents 15. Adverse Reactions To Gadolinium-Based Contrast Media 79 16. Nephrogenic Systemic Fibrosis (NSF) 83 17. Ultrasound Contrast Media 92 18. Treatment of Contrast Reactions 95 19. Administration of Contrast Media to Pregnant or Potentially 97 Pregnant Patients 20. Administration of Contrast Media to Women Who are Breast- 101 Feeding Table 1 – Categories Of Acute Reactions 103 Table 2 – Treatment Of Acute Reactions To Contrast Media In 105 Children Table 3 – Management Of Acute Reactions To Contrast Media In 114 Adults Table 4 – Equipment For Contrast Reaction Kits In Radiology 122 Appendix A – Contrast Media Specifications 124 PREFACE This edition of the ACR Manual on Contrast Media replaces all earlier editions.
    [Show full text]
  • Closed Rhinoplasty: Effects and Changes on Voice - a Preliminary Report
    Topic: EuRePS Meeting 2015: best five papers Closed rhinoplasty: effects and changes on voice - a preliminary report Giuseppe Guarro, Romano Maffia, Barbara Rasile, Carmine Alfano Department of Plastic and Reconstructive Surgery, University of Perugia, 06156 Perugia, Italy. Address for correspondence: Dr. Giuseppe Guarro, Department of Plastic and Reconstructive Surgery, University of Perugia, S. Andrea delle Fratte, 06156 Perugia, Italy. E-mail: [email protected] ABSTRACT Aim: Effects of rhinoplasty were already studied from many points of view: otherwise poor is scientific production focused on changes of voice after rhinoplasty. This preliminary study analyzed objectively and subjectively these potential effects on 19 patients who underwent exclusively closed rhinoplasty. Methods: This preliminary evaluation was conducted from September 2012 to May 2013 and 19 patients have undergone primary rhinoplasty with exclusively closed approach (7 males, 12 females). All patients were evaluated before and 6 months after surgery. Each of them answered to a questionnaire (Voice Handicap Index Score) and the voice was recorded for spectrographic analysis: this system allowed to perform the measurement of the intensity and frequency of vowels (“A” and “E”) and nasal consonants (“N” and “M”) before and after surgery. Data were analysed with the Mann-Whitney test. Results: Sixteen patients showed statistically significant differences after surgery. It was detected in 69% of cases an increased frequency of emission of the consonant sounds (P = 0.046), while in 74% of cases the same phenomenon was noticed for vowel sounds (P = 0.048). Conclusion: Many patients who undergo rhinoplasty think that the intervention only leads to anatomical changes and improvement of respiratory function.
    [Show full text]
  • Juntendo Medical Journal 2017
    Special Reviews Juntendo Medical Journal 2017. 63(1), 2-7 A New Immunotherapy Using Regulatory T-Cells for High-Risk Corneal Transplantation TAKENORI INOMATA＊ ＊Department of Ophthalmology, Juntendo University Faculty of Medicine, Tokyo, Japan Corneal transplantation is the most commonly performed tissue transplantation worldwide. Despite very high (above 90%) survival rates in recipients with nonvascularized and noninflamed graft beds, survival rates significantly decline (under 50%) when grafts are placed onto vascularized or inflamed host beds associated with conditions such as previous graft rejection, infection, or trauma. These results are seen despite treatment with high doses of nonspecific immunosuppressive medications, which often do not promote long-term survival. Therefore, new strategies are required to modulate the immune system without conventional immunosuppressive agents and improve transplant survival in“high-risk”patients with inflamed host beds. Regulatory T-cells (Treg) are key modulators of the immune response and may play a crucial role in a new therapy for high-risk corneal transplantation. Here we introduce the murine high-risk corneal transplantation model and review the implications of Tregs for corneal transplantation. Key words: corneal transplantation, regulatory T-cell, high-risk corneal transplantation, neovascularization Introduction eyeʼs refractive power. The cornea has three layers, including the epithelium, stroma and endothelium, 1. Outline of corneal transplantation divided by Bowmanʼs membrane and Descemetʼs The first corneal transplantation was successfully membrane respectively. Corneal transplantation is performed by Dr. Eduard Zirm in 1905 1). Along with a surgical procedure where a damaged or diseased the growing demand for corneal transplantation, the cornea is replaced by donated corneal tissue. first institutional eye bank was born in New York in Corneal transplantation has evolved into an array of 1944.
    [Show full text]
  • Laryngectomy
    The Head+Neck Center John U. Coniglio, MD, LLC 1065 Senator Keating Blvd. Suite 240 Rochester, NY 14618 Office Hours: 8-4 Monday-Friday t 585.256.3550 f 585.256.3554 www.RochesterHNC.com Laryngectomy SINUS Voice change, difficulty swallowing, unexplained weight loss, ear or ENDOCRINE HEAD AND NECK CANCER throat pain and a lump in the throat, smoking and alcohol use are all VOICE DISORDERS SALIVARY GLANDS indications for further evaluation. Smoking and alcohol can contribute TONSILS AND ADENOIDS to these symptoms. A direct laryngoscopy – an exam of larynx (voice EARS PEDIATRICS box), with biopsy – will help determine if a laryngectomy is indicated. SNORING / SLEEP APNEA Laryngectomy may involve partial or total removal of one or more or both vocal cords. Alteration of voice will occur with either total or partial laryngectomy. Postoperative rehabilitation is usually successful in helping the patient recover a voice that can be understood. The degree of alteration in voice depends on the extent of the disease. Partial or total laryngectomy has been a highly successful method to remove cancer of the larynx. The extent of the tumor invasion, and therefore the extent of surgery, determines the way you will communicate following surgery. The choice of surgery over other forms of treatment such as radiation or chemotherapy is determined by the site of the tumor. It is quite likely that there has been spread of the tumor to the neck; a neck or lymph node dissection may also be recommended. Complete neck dissection (exploration of the neck tissues) is performed in order to remove known or suspected lymph nodes containing cancer that has spread from the primary tumor site.
    [Show full text]
  • Laryngectomy
    LARYNGECTOMY Definitlon Laryngectomy is the partial or complete surgical removal of the larynx, usually as a treatment for cancer of the larynx. Purpose Normally a laryngectomy is performed to remove tumors or cancerous tissue. In rare cases, it may be done when the larynx is badly damaged by gunshot, automobile injuries, or similar violent accidents. Laryngectomies can be total or partial. Total laryngectomies are done when cancer is advanced. The entire larynx is removed. Often if the cancer has spread, other surrounding structures in the neck, such as lymph nodes, are removed at the same time. Partial laryngectomies are done when cancer is limited to one spot. Only the area with the tumor Is removed. Laryngectomies may also be performed when other cancer treatment options, such as radiation or chemotherapy. fail. Precautions Laryngectomy is done only after cancer of the larynx has been diagnosed by a series of tests that allow the otolaryngologist (a specialist often called an ear, nose, and throat doctor) to look into the throat and take tissue samples (biopsies) to confirm and stage the cancer. People need to be in good general health to undergo a laryngectomy, and will have standard pre-operative blood work and tests to make sure they are able to safely withstand the operation. Description The larynx is located slightly below the point where the throat divides into the esophagus, which takes food to the stomach, and the trachea (windpipe), which takes air to the lungs. Because of its location, the larynx plays a critical role in normal breathing, swallowing, and speaking.
    [Show full text]
  • Icd-9-Cm (2010)
    ICD-9-CM (2010) PROCEDURE CODE LONG DESCRIPTION SHORT DESCRIPTION 0001 Therapeutic ultrasound of vessels of head and neck Ther ult head & neck ves 0002 Therapeutic ultrasound of heart Ther ultrasound of heart 0003 Therapeutic ultrasound of peripheral vascular vessels Ther ult peripheral ves 0009 Other therapeutic ultrasound Other therapeutic ultsnd 0010 Implantation of chemotherapeutic agent Implant chemothera agent 0011 Infusion of drotrecogin alfa (activated) Infus drotrecogin alfa 0012 Administration of inhaled nitric oxide Adm inhal nitric oxide 0013 Injection or infusion of nesiritide Inject/infus nesiritide 0014 Injection or infusion of oxazolidinone class of antibiotics Injection oxazolidinone 0015 High-dose infusion interleukin-2 [IL-2] High-dose infusion IL-2 0016 Pressurized treatment of venous bypass graft [conduit] with pharmaceutical substance Pressurized treat graft 0017 Infusion of vasopressor agent Infusion of vasopressor 0018 Infusion of immunosuppressive antibody therapy Infus immunosup antibody 0019 Disruption of blood brain barrier via infusion [BBBD] BBBD via infusion 0021 Intravascular imaging of extracranial cerebral vessels IVUS extracran cereb ves 0022 Intravascular imaging of intrathoracic vessels IVUS intrathoracic ves 0023 Intravascular imaging of peripheral vessels IVUS peripheral vessels 0024 Intravascular imaging of coronary vessels IVUS coronary vessels 0025 Intravascular imaging of renal vessels IVUS renal vessels 0028 Intravascular imaging, other specified vessel(s) Intravascul imaging NEC 0029 Intravascular
    [Show full text]
  • FF #281 Laryngectomy. 3Rd Ed
    FAST FACTS AND CONCEPTS #281 CARE OF THE POST-LARYNGECTOMY STOMA Shweta Garg PA-C, Elliott Kozin MD, Daniel Deschler MD Background Many patients with laryngeal cancer require a laryngectomy. While laryngectomies are typically done as a curative cancer surgery, some patients will have recurrences and be seen in palliative care and hospice settings. Laryngectomy stomas differ from tracheostomies (see Fast Fact #250) in important ways, which can profoundly impact a patient’s well being. A working knowledge of the basic management and equipment used in patients with a stoma after laryngectomy can avoid complications and improve a patient’s comfort and safety (1). Laryngectomy Stoma versus Tracheostomy There are a few key differences between a post- laryngectomy stoma and tracheostomy. At the most basic level, a post-laryngectomy stoma is created after a patient undergoes a total laryngectomy, which involves the removal of the larynx, including vocal cords and associated structures. A permanent, direct connection between the trachea and the skin of the neck is made sewing the open end of the trachea to the neck skin forming an opening through which the patient breathes. After a laryngectomy, the patient no longer has a communication between the lungs and oral cavity or nose. These patients are casually referred to as “neck breathers” (2). In contrast, a tracheostomy, also referred to as a tracheotomy, is surgical opening into the trachea to bypass the upper airway, which is not necessarily permanent. A tracheostomy tube is inserted and stents the tracheostomy open, thereby facilitating air exchange. In patients with tracheostomies, the larynx remains present and there is still a connection between the oral cavity and nose to the lungs.
    [Show full text]
  • Assessment and Retrieval of Aspirated Tracheoesophageal Prosthesis in the Ambulatory Setting
    UCLA UCLA Previously Published Works Title Assessment and Retrieval of Aspirated Tracheoesophageal Prosthesis in the Ambulatory Setting. Permalink https://escholarship.org/uc/item/7pv2g71t Authors Dewan, Karuna Erman, Andrew Long, Jennifer L et al. Publication Date 2018 DOI 10.1155/2018/9369602 Peer reviewed eScholarship.org Powered by the California Digital Library University of California Hindawi Case Reports in Otolaryngology Volume 2018, Article ID 9369602, 4 pages https://doi.org/10.1155/2018/9369602 Case Report Assessment and Retrieval of Aspirated Tracheoesophageal Prosthesis in the Ambulatory Setting Karuna Dewan , Andrew Erman, Jennifer L. Long, and Dinesh K. Chhetri Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA Correspondence should be addressed to Karuna Dewan; [email protected] Received 14 June 2018; Accepted 26 August 2018; Published 13 September 2018 Academic Editor: Marco Berlucchi Copyright © 2018 Karuna Dewan et al. *is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Tracheoesophageal prosthesis (TEP) is the most common voice restoration method following total laryngectomy. Prosthesis extrusion and aspiration occurs in 3.9% to 6.7% and causes dyspnea. Emergency centers are unfamiliar with management of the aspirated TEP. Prior studies report removal of aspirated TEP prostheses under general anesthesia. Laryngectomees commonly have poor pulmonary function, posing increased risks for complications of general anesthesia. We present a straightforward approach to three cases of aspirated TEP prosthesis removed in the ambulatory setting. In each case, aspirated TEP was diagnosed with flexible bronchoscopy under local anesthesia at the time of consultation, and all prostheses were retrieved atraumatically using a biopsy grasper forceps inserted via the side channel of the bronchoscope.
    [Show full text]