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Partial laryngectomy may be suitable for a few patients, who are left with a compromised, but often satisfactory, oral airway. Some patients may also require a permanent tracheostomy. For these fortunate patients speech is retained, but even if altered it is at least immediately understandable. Many more patients lose their larynx completely; to preserve any part would compromise their chance of survival. For them, no matter how well counselled before operation, there is the intense frustration of waking from their surgery aphonic and able to express themselves only by gestures, writing, or mouthing messages. The rehabilitation of voice was discussed fully in a previous editorial,2
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