Without a larynx
BMJ 2008; 336 doi: https://doi.org/10.1136/sbmj.0803124 (Published 01 March 2008) Cite this as: BMJ 2008;336:0803124
- Hannah Blagnys, fourth year medical student,
- Paul Montgomery, consultant ear, nose, and throat surgeon
In 2003 more than 1700 people were diagnosed with cancer of the larynx in England.1 Many of these with advanced or recurrent disease will go on to have a laryngectomy (removal of the larynx). How is it possible to communicate without a voicebox? This article discusses the communication options available to someone who has had a laryngectomy (a laryngectomee) and the techniques needed for resuscitation.
The larynx is a specialised organ responsible for maintaining a patent airway and providing a protective sphincter at the top of the airway during swallowing to prevent aspiration of food and drink. It is also responsible for the generation of the sound that is shaped into intelligible speech by movement of the lips and tongue. The larynx lies in the anterior neck from C3 to C6 and connects the inferior part of the pharynx to the trachea. It is split anatomically into three parts, the supraglottic, glottic, and subglottic areas, which are used in the description of laryngeal cancer.
Laryngeal cancer
In the United Kingdom laryngeal cancer is currently the 17th most common cancer in men and the 23rd in women.1 It is by far the most common indication for laryngectomy.2 Smoking is the greatest risk factor for laryngeal cancer2 because the carcinogens in smoke are in contact with the epithelial cellular surfaces of the upper aerodigestive tract. Gastro-oesophageal reflux,3 alcohol, diet, occupation, and genetic susceptibility also increase a person's chance of laryngeal cancer.2
Hoarseness of the voice is a common sign of laryngeal cancer, which shows that the pathology has glottic involvement. Supraglottic involvement may present as ill defined throat irritation and may go undetected, therefore, for long periods of time.3 Guidelines …
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