Sufficient information regarding treatment decisions and management is required before any specific treatment may be adopted. Further information will be necessary to guide treatment when a laryngectomy patient has no larynx and is being considered for the prosthetic replacement of a larynx.
Laryngectomy is a drastic and challenging oncologic procedure associated with significant morbidity and mortality. Despite many advances in surgical techniques and perioperative care, the 5-year survival rate after laryngectomy remains low, and most patients remain cancer-free after surgery.
The primary purpose of a complete laryngectomy is to decrease the amount of speech impediment and improve quality of life in patients wishing to speak after surgical removal of the voicebox and supraglottic tissues (e.g. the glottis). The removal of the supraglottic tissues provides a unique opportunity for voice therapy and speech training that should be a component of the multispecialty treatment approach that is required to effectively treat patients with advanced laryngeal cancer. There is evidence to support the inclusion of specialized speech therapy in the treatment of laryngeal cancer but unfortunately the quantity and quality of research on speech therapy after larynx removal is limited.
Many laryngectomies are the most successful treatments for vocal cord mobility disorders. However, the overall risk of surgery is only 1-3% of all laryngectomies as a result of a variety of issues, including but not limited to pre-existing medical conditions, personality, and smoking.
The American Laryngological Association estimates that 30,200 patients will undergo laryngectomy in the 5 years ending in 2030 in the United States, representing an annual average of 7,900 procedures.
Many patients experience a decline in their quality of life after laryngectomy, with the most prominent problems being social isolation, the loss of voice and the decrease or loss of physical abilities. Laryngectomy impacts patients' quality of life significantly.
Mean age at the time of laryngectomy is 70.4 years. There is significant variation in the average age at onset of laryngeal cancer, with most patients developing early laryngeal cancer at an average age of 60.6 years over the last 7 years.
Although digital occlusion therapy has been used on a modest number of cases, clinicians still have questions regarding the role of digital occlusion therapy in relieving symptoms and improving quality of life of patients with laryngeal and pharyngeal cancer. Furthermore, the evidence regarding its potential therapeutic effect is inconsistent and limited.
Patients with laryngeal cancer should be encouraged to take part in a clinical trial if they are thought to have a good prognosis, or if they want to be involved in future treatment decisions. Those with worse prognoses have little benefit from clinical trials, and they seem to be taking up the offer less. If considering clinical trials, be clear about your personal preferences and how they might be influenced by treatment options. Trial results do not always match patients' preferences and can result in negative outcomes, such as long-term quality of life deficits, or death. It is hard to determine if a patient will get a clinical trial offer; therefore, the individual patient-centered nature of the clinical trial is essential.
The occlusion technique is dependent not only of the type of occluder used, but on the kind of occlusion used to achieve occlusion in a high degree of reproducibility between studies. In clinical practice, occlusion can be achieved using either digital occlusion devices or acrylic occlusion devices.
Digital occlusion is effective in inhibiting the transmission of HPV types in patients who are chronically infected with HPV 1 and 3. Results from a recent paper suggests that it is effective for all forms.
Having an affected member in a family ndescends the patient psychologically. For family members, the patient's plight with the disease can ndepress the emotional situation. Most patients are concerned about their family members.