Our Summary

This paper covers a case where a patient with Duchenne muscular dystrophy (DMD) - a severe type of muscular disease - was suffering from chronic aspiration pneumonia and excessive oral secretions, which made him dependent on a ventilator. The medical team tried to resolve his issues with a tracheostomy (a procedure to create an opening in the neck to place a tube into a person’s windpipe). However, this led to additional problems such as worsened swallowing dysfunction and tracheoinnominate fistula (an abnormal connection between the trachea and the innominate artery).

Given these complications, the doctors considered a total laryngectomy, a surgical procedure to remove the voice box. This procedure was successful. After the surgery, the patient’s quality of life improved: he was able to eat orally, had fewer secretions around his tracheostoma (the hole in the neck after a laryngectomy), and likely needed less frequent suctioning.

The paper concludes by emphasizing the importance of considering quality of life for DMD patients, as many are now living into their 30s thanks to mechanical ventilation. The authors suggest that laryngectomy could be a viable surgical option to definitively correct chronic aspiration while still allowing for oral intake.

FAQs

  1. What complications can occur from a tracheostomy procedure as experienced by the patient with Duchenne muscular dystrophy?
  2. How did the total laryngectomy procedure improve the patient’s quality of life?
  3. Is laryngectomy a recommended surgical procedure for DMD patients suffering from chronic aspiration?

Doctor’s Tip

A helpful tip a doctor might tell a patient about laryngectomy is to follow all post-operative care instructions carefully to ensure proper healing and to minimize the risk of complications. This may include avoiding smoking, maintaining good oral hygiene, and attending follow-up appointments as scheduled. Additionally, patients should be aware of potential changes in their voice and speech after the procedure and may benefit from speech therapy to help adjust to these changes.

Suitable For

Patients who are typically recommended laryngectomy include those with:

  1. Chronic aspiration pneumonia: Laryngectomy can help prevent aspiration of food or liquids into the lungs, reducing the risk of pneumonia.

  2. Excessive oral secretions: Laryngectomy can help manage excessive oral secretions that can be difficult to handle, especially in patients who are dependent on a ventilator.

  3. Swallowing dysfunction: Laryngectomy can improve swallowing function in patients with severe swallowing difficulties, as was the case in the patient with DMD mentioned in the paper.

  4. Tracheoinnominate fistula: In cases where a tracheostomy has led to complications such as tracheoinnominate fistula, laryngectomy may be considered to address these issues.

Overall, laryngectomy may be recommended for patients who are experiencing significant respiratory or swallowing issues that cannot be effectively managed with other treatments. It is important for healthcare providers to carefully assess each individual case and consider the potential benefits and risks of laryngectomy in order to make the best recommendation for the patient’s overall health and quality of life.

Timeline

  • Before laryngectomy: The patient with Duchenne muscular dystrophy was suffering from chronic aspiration pneumonia and excessive oral secretions, leading to dependency on a ventilator. Tracheostomy was attempted to address these issues but resulted in worsened swallowing dysfunction and tracheoinnominate fistula.

  • Laryngectomy procedure: The medical team performed a total laryngectomy to remove the voice box, successfully resolving the patient’s issues with chronic aspiration and excessive secretions.

  • After laryngectomy: The patient experienced improvements in quality of life, including the ability to eat orally, reduced secretions around the tracheostoma, and potentially less need for suctioning.

  • Conclusion: The authors highlight the importance of considering quality of life for DMD patients and suggest that laryngectomy could be a beneficial surgical option to definitively address chronic aspiration while still allowing for oral intake.

What to Ask Your Doctor

Some questions a patient should ask their doctor about laryngectomy include:

  1. What is a total laryngectomy and why is it being recommended for me?
  2. What are the potential risks and complications associated with a laryngectomy?
  3. How will the surgery impact my ability to speak and communicate?
  4. What changes can I expect in terms of eating and swallowing post-surgery?
  5. How will I breathe after the surgery and will I still need a tracheostomy tube?
  6. What is the recovery process like and how long is the hospital stay typically?
  7. Will I need any additional treatments or therapies after the surgery?
  8. How will my quality of life be affected by a laryngectomy?
  9. Are there any alternative treatments or procedures that I should consider?
  10. What long-term follow-up care will be needed after the surgery?

Reference

Authors: Peleman J, Lin JS, Lin HS. Journal: Laryngoscope. 2024 Aug;134(8):3677-3678. doi: 10.1002/lary.31357. Epub 2024 Feb 24. PMID: 38400802