Rehabilitation and followup after total laryngectomy

The greatest handicap for the patients after a total laryngectomy is the loss of voice. 40% of patients acquire socially useful oesophageal speech. Some people use the artificial larynx. Fistula operations with insertion of speech valvulas are increasingly performed and well tolerated. Heat and moisture exchangers are commonly used to lower the risk of respiratory problems and can be positioned in front of the stoma.

Follow-up should be strict—90% of recurrences occur within three years. The high risk of multiple primary malignancies (12-20%) should be considered, making routine chest X-rays and bronchoscopies part of the follow-up programme. All patients should be advised to stop smoking.

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