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A review of tracheostomy and laryngectomy

A presentation on Prezi presentations that will amaze and inspire your audience.
by

Ibrahim Alava

on 4 January 2014

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Transcript of A review of tracheostomy and laryngectomy

There is a hole
in the neck

A review of tracheostomy and laryngectomy
Ibrahim Alava III, MD
Otolaryngology - Head and Neck Surgery
University of Texas - Houston
Objectives
Know the difference between a tracheostomy and laryngectomy

Review the indications for both procedures

Know the tubes used for both tracheostomy and laryngectomy

Demonstrate the usage of the proper nomenclature when discussing tracheostomy and laryngectomy
Tracheostomy
Tracheotomy
Surgical Procedure that places a "hole" into the trachea through an incision through the neck
History
First described by Egyptians in 3600 B.C

Mainly used to treat airway obstruction

Used by Alexander the Great to save
a soldier in battle by inserting his sword
into the neck
Tracheostomy
The fenestration or "hole" created in a trachea
Why?
Indications
Airway Obstruction
Tumor
Trauma
Foreign Body
Long term ventilator dependence
Need for pulmonary toilet
Aspiration
Pulmonary pathology
Decrease dead space
OSA
Airway Anatomy
Larynx - Voice Box
Trachea - Windpipe
Bronchi
Lungs
Airway
Larynx Anatomy
Thyroid Cartilage
Cricoid Cartilage
Hyoid bone
Trachea
Tracheotomy
Steps of Procedure
Palpate landmarks
Incision through skin/soft tissue
Find midline of strap muscles
Retract strap muscles
Divide OR retract thyroid gland
Incise tracheal cartilage
Introduce tube
Tracheostomy Tube Components
Oral cavity
Nasal cavity
Pharynx
11cm long
D-shaped, incomplete rings
16-20 rings
Starts at C-6 to T-5
Tracheostomy:
Surgical Animation
Tracheostomy Tubes
Material?
Hard plastic
Soft plastic
Metal
Cuff?
With or Without
Inner Cannula?
With or Without
Size
Adjustable
Brand?
Shiley
Bivona
Portex
Jackson
Tracheostomy Tube examples
Brands
Laryngectomy
Total Laryngectomy: Definition
Surgical removal of the larynx, with diversion of trachea to the skin and closure of pharynx and esophagus, separating the airway from the digestive tract
History
First performed by Billroth in 1873 on school teacher
Partial laryngectomies pre-date the total laryngectomy
Remained the "Gold Standard" for treatment of larynx cancers up until late 80s early 90s
Early 1990s
- VA trial
Changed the paradigm of treatment
2/3 of patients kept larynx after laryngeal conservation approach - Radiation/Chemo
Survival - equal in each arm
Current practice
- Total laryngectomy resevered for salvage/dysfunctional larynx
2009
- Laryngectomy removed by RRC as key indicator for graduating otolaryngologist
Why?
Indications
Cancer
Bulky destructive tumors
Salvage after Radiation
Dysfunctional larynx
Trauma
Previous Chemo/Radiation
Chronic tracheostomy
Chronic Dysphagia
Chronic Aspiration
Tubes, holes, filters and more tubes
Tracheostoma
NO tube, Trachea sewn to skin
Surgical Procedure
Lary-tube, Lary-button and HME
HME:
Heat & moisture exchanger
Heat and moisture exchanging capacity,
Resistance, and
Filtering particles
3 Purposes of HME for laryngectomy patients
Voice Restoration
Electrolarynx and TEP
Electrolarynx
Tracheo-esophageal Prosthesis
Device generates vibrations through skin that are transmitted and formed into a voice
One way valve between trachea and esophagus
When stoma is occluded, air is forced into the prosthesis and out into esophagus and mouth
Pulmonary driven like normal speech
TEP Speech
What's that Purple Valve???
Passey-Muir Valve
One-way valve
Allows inspiration through the tube
Expiration through larynx and upper airway
Passey - Muir Valve
Airway and Swallowing physiology:
PMV usage
Quiz
Does a laryngectomy patient require a tube?
Can a laryngectomy patient be orally intubated?
Do tracheostomy patients require a tube?
Can tracheostomy patients talk?
Can laryngectomy patients talk?
Can laryngectomy patients smell?
Can tracheostomy patients smell?
Laryngectomy Caveats!!!
Do's and Don'ts
After Surgery they are aphonic - they cannot call for help!

They CANNOT be orally intubated!
Summary
A tracheostomy is usually temporary
Laryngectomies are permanent
Using the correct terminology decreases confusion
Both patients can "voice"
Laryngectomees cannot be orally intubated
Always ask questions when there is confusion
Full transcript