Laryngectomy
Laryngectomy is a medical operation that involves removing the human larynx .
Naming
The word is made up of the ancient Greek components λάρυγξ lárynx 'throat' and ἐκτομή ektomē 'cut off, cut out'. In medicine, ectomy is the common ending for organ-removing operations.
Indication and alternatives
The reason for the laryngectomy is almost always a cancer of the larynx ( laryngeal carcinoma ) or the deep throat ( hypopharyngeal carcinoma ). Cancers of the larynx that are less advanced can usually be treated in a way that preserves the organs and therefore functions, e.g. B. by removing only parts of the larynx (e.g. as endolaryngeal larynx surgery or hemilaryngectomy).
In the case of extensive cancer diseases, radiation therapy or combined radiation and chemotherapy can be used as a replacement for or in addition to laryngectomy.
history
It was carried out for the first time as an emergency operation on New Year's Eve of 1873 by the surgeon Theodor Billroth , whose name remained famous in medicine, mainly because of his stomach operations that were carried out later. Today, the operation, which usually takes many hours, is no longer carried out as an emergency operation, but only after thorough preliminary examinations (microlaryngoscopy, computer tomography, staging examinations ...) as a well-planned operation. As a rule, the operation is no longer the responsibility of the surgeon, but rather specialized ear, nose and throat specialists.
Surgical technique
It makes sense to only perform the procedure under general anesthesia. Most of the time, neck lymph nodes are removed (so-called neck dissection ). There are two types of neck dissection: on the one hand, functional neck dissection, in which only the lymph nodes are removed, and, on the other hand, radical neck dissection, in which, in addition to the lymph nodes, the sternocleidomastoid muscle , the accessory nerve and the vein are also removed internal jugularis must be removed.
rehabilitation
The larynx has two main functions. It separates food and airways, so that the air inhaled through the mouth into the windpipe and the food also taken in through the mouth but into the esophagus. The voice is generated in it as a second function. Since these tasks are missing after the removal of the larynx, the food and airways are first separated during the operation. The mouth only leads into the esophagus. The windpipe in turn is led into a breathing opening in the throat, namely a tracheostoma .
There are essentially three methods that can be used for voice replacement:
- Electronic speaking aid (The sound is produced by a battery-operated device held to the mouth or throat. The sound is sometimes perceived as "technical".)
- Ruktus voice , also esophageal replacement voice (the patient learns to consciously push air into the esophagus and use it to form sounds.)
- Vocal fistula , also known as shunt valve (mostly plastic valves that are surgically inserted between the airways and esophagus and that allow the breathing air of the lungs to be used for vocalization).
The resulting voice is also known as the substitute voice .
All of these methods require extensive training, which is carried out under the guidance of speech therapists . Contact with speech therapists and patients who have already been laryngectomized should, if possible, be established before the operation, as this allows those who have not yet been laryngectomized to ask questions and prepare for the time after the operation.
Regional self-help groups are often organized in close cooperation with the operating clinic. The communication difficulties caused by the initial voicelessness and the later limitations of the substitute voice are mixed up with other consequences of the tumor treatment (e.g. swallowing disorders with dry mouth after radiation therapy, fatigue syndrome ...) and psychological consequences of the tumor diagnosis (fear of surgery, fear of helplessness, fear of the Dying) that must be addressed at the same time. Rehabilitation is therefore to be understood as a complex, interdisciplinary long-term task. In Germany, inpatient follow-up treatment after laryngectomy is the rule.
literature
- about the story: Dieter Leithäuser: Searching for traces. Stories from ENT medicine. Urban and Vogel, 2002, ISBN 3-89935-180-0
Individual evidence
- ^ Wilhelm Gemoll : Greek-German school and hand dictionary . G. Freytag Verlag / Hölder-Pichler-Tempsky, Munich / Vienna 1965.
