(stoma) and is referred to as a total neck breather, since the airway between the mouth,
nose, and throat has been completely closed.
(1) Total laryngectomy with laryngoplasty involves the formation of a tube
that leads from the upper trachea to the lower pharynx. This "speaking" tube allows for
speech that sounds almost normal. A patient having this type of laryngectomy is
referred to as a partial neck breather, since the tube allows the passage of air from the
nose and mouth into the trachea.
(2) When the patient has a total laryngectomy, the surgeon will most likely
place a laryngectomy tube in the newly formed stoma. This tube may be removed when
the stoma has healed, usually within 4-6 weeks. The laryngectomy tube is shorter, but
larger in diameter, than a tracheostomy tube. Care of the laryngectomy tube is the
same as that for the tracheostomy tube.
(3) Since the patient will not be able to speak initially, some means of
communication must be developed for the patient. Commonly used techniques are
simple note writing, flash cards, magnetic letter boards, and magic slates. Always have
a call bell within the patient's reach. When the stoma has healed, the speech
pathologists will work with the patient to help him learn new speaking methods.
d. Special considerations for the laryngectomee include the following:
(1) For the laryngectomee, air passes directly into the trachea without being
moistened and warmed by the upper respiratory mucosa. This causes the trachea and
bronchi to secrete excessive amounts of mucous, and the patient may experience
frequent bouts of coughing. In time, the mucosa of the trachea and bronchi will adapt to
this altered physiology. In the meantime, however, the patient will be more comfortable
with added humidification in the inspired air. This may be provided by steam or cool
(2) Precautions must be taken in the shower to prevent water from entering
the stoma. A small plastic bib worn around the neck works well. Swimming is not
recommended, as the laryngectomee may drown without ever putting his face in the
(3) Care must be taken to prevent hair spray, powder, loose hairs, and any
other foreign objects from entering the stoma.
(4) A laryngectomee should carry or wear identification that will alert a
first-aid giver to his special resuscitation needs. A laryngectomy stoma may be hidden
by a scarf and not noticed by the first-aid giver. A neck breather, whether partial or
total, requires artificial ventilation through the stoma. This may be done by mouth-to-
stoma artificial respiration or by bag-mask to stoma. If the patient wears a tube in his
stoma, do not remove it. Give artificial ventilation through it. The mouth and nose must
be sealed closed to prevent the escape of air from the nose and mouth, in the event that
the patient is a partial neck breather.