Alaryngeal speech rehabilitation
- Jan S Lewin, PhD
Jan S Lewin, PhD
- Professor, Department of Head and Neck Surgery
- Section Chief, Speech Pathology and Audiology
- The University of Texas MD Anderson Cancer Center
- Henry T Hoffman, MD, MS, FACS
Henry T Hoffman, MD, MS, FACS
- Professor of Otolaryngology
- University of Iowa
- Steven M Sperry, MD
Steven M Sperry, MD
- Assistant Professor
- Head & Neck Oncology and Reconstructive Surgery
- Dept of Otolaryngology—Head & Neck Surgery
- University of Iowa Hospitals and Clinics
- Section Editors
- Bruce E Brockstein, MD
Bruce E Brockstein, MD
- Section Editor — Cancer of the Head and Neck
- Clinical Professor of Medicine
- University of Chicago Pritzker School of Medicine
- Marvin P Fried, MD, FACS
Marvin P Fried, MD, FACS
- Section Editor — Head and Neck Surgery
- Professor and University Chairman, Department of Otorhinolaryngology - Head and Neck Surgery
- Montefiore Medical Center, Albert Einstein College of Medicine
Patients with head and neck cancer face multiple psychological and functional problems associated with the diagnosis and treatment of their disease. Although cure remains a primary goal, preservation or restoration of function is a secondary goal of therapy in patients with head and neck cancer. (See "Locally advanced squamous cell carcinoma of the head and neck: Approaches combining chemotherapy and radiation therapy".)
The options for alaryngeal voice rehabilitation in the patient with total laryngectomy will be reviewed here. This discussion is geared toward the practicing head and neck surgeon and all other care givers who are involved in the care of the head and neck cancer patient. However, this topic does not go into details regarding specific surgical techniques, and the interested reader should consult a surgical atlas and other technique articles for further information.
General issues related to speech and swallowing rehabilitation are discussed separately. (See "Speech and swallowing rehabilitation of the patient with head and neck cancer".)
A goal of rehabilitation following total laryngectomy is restoration of voice and speech production. Most patients achieve this goal, but not all are capable, either through anatomic constraints (eg, total glossectomy) or mental and physical handicap.
There are three major approaches used to restore oral communication, and many patients learn to use all three methods:
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- GENERAL PRINCIPLES
- TRACHEOESOPHAGEAL PUNCTURE VOICE RESTORATION
- Patient selection
- Definition of success
- Factors influencing TEP success
- - Surgical factors
- - Other factors
- - Physiologic-anatomic variations
- - Mechanical problems
- ESOPHAGEAL SPEECH