Management of Total Laryngectomy: Rehabilitation to Survivorship
Presented by Kelly Salmon
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Nonfinancial: Kelly Salmon is a member of the American Speech-Language-Hearing Association, the Dysphagia Research Society, and the Pennsylvania Speech and Hearing Association. She is a Professional Development Manager (PDM) for ASHA Special Interest Group 13. She is also a member of the Pennsylvania Academy of Otolaryngology – Head and Neck Surgery and the Lymphology Association of North America. Kelly Salmon has no competing nonfinancial interests or relationships with regard to the content presented in this course.
For individuals diagnosed with laryngeal cancer in the United States, five-year survival rates are 61% for localized disease, 48% for regional disease, and 42% for distant disease (American Cancer Society, 2019). As a result, speech-language pathologists (SLPs) play a critical role in managing issues unique to total laryngectomy (TL) for many years post surgery. Management of individuals post TL through the various stages of survivorship requires a specific set of knowledge and skills to effectively manage the unique challenges affecting respiration, communication, and swallowing in this population. This course will provide the participant with practical knowledge on the topic of managing the issues unique to individuals post TL that can be applied immediately in the clinical setting. This course is recommended for speech-language pathologists, physical therapists, registered nurses, occupational therapists, and social workers practicing in a hospital, outpatient, skilled nursing, home care, private practice, or outpatient setting who are interested in learning more about the care of the individual undergoing total laryngectomy during the rehabilitation and survivorship phases. Participants will gain insight and actionable steps to take toward mastering the skills necessary to manage breathing, communication, and swallowing differences post TL.
Meet your instructor
Kelly Salmon
Kelly is a speech-language pathologist specializing in the treatment of adults with communication and swallowing disorders across the continuum of care. She has been a Board Certified Specialist in Swallowing and Swallowing Disorders (BCS-S) since 2011 and earned designation in 2014 as a Lymphology Association of North…
Chapters & learning objectives
1. Survivorship Post TL and the Role of the SLP
This chapter provides an overview of what constitutes survivorship post TL. In addition, a review of the role of the SLP in managing the unique changes to the processes of respiration, phonation, and deglutition post TL is provided. Finally, the types of supplies related to the management of breathing, communication, and swallowing issues that are typically present in the clinic to assist the SLP with patient education, training, and troubleshooting are discussed.
2. Clinician Perspectives in Treating Total Laryngectomies
This chapter includes a brief discussion with a physical therapist who has expertise in treating individuals post TL. In addition, a brief discussion with an occupational therapist who has expertise in treating individuals post TL is highlighted.
3. Patient Perspective: Survivorship Experience
This chapter includes a brief discussion with an individual who has been a long-term HNC survivor post TL. The guest is asked to respond to questions related to his experience during the phases of survivorship post TL.
4. Stoma Management and HME Use
This chapter discusses how TL surgical and reconstructive techniques can impact the contour of the anterior neck and the size, shape, and integrity of the stoma and how the uniqueness of each patient’s anatomy may impact how we manage the optimization of their respiratory and/or communication function. A background and rationale for why heat and moisture exchange (HME) filters are a critical component of pulmonary health post TL is provided. A demonstration of the options and the process for selecting a stomal appliance for use of an HME filter is completed.
5. Alaryngeal Communication Options Post TL
This chapter reviews the three main options for voice restoration post TL: electrolarynx, esophageal speech, and tracheoesophageal speech. Advantages and disadvantages of each alaryngeal communication option and the factors that should be evaluated and taken into account when determining candidacy for tracheoesophageal puncture (TEP; primary or secondary) are discussed. Common patient concerns surrounding the TEP procedure and long-term maintenance of a voice prosthesis are identified.
6. Dysphagia Post TL
This chapter discusses options for evaluation of swallowing function post TL as well as the most common structural and functional issues impacting swallow function post TL (e.g., flap reconstruction of the pharynx, stricture, spasm, and pseudo-vallecula/epiglottis). Options for optimizing swallow function post TL are explained.
