Laryngectomies: A Comprehensive Guide to Airway Management

Laryngectomies represent a pivotal solution in airway management, particularly for patients who have undergone significant medical alterations due to conditions like cancer.

The Need for Laryngectomies

Laryngectomies are typically used in cases where individuals have suffered from cancers of the voice box, resulting in a modified airway. These changes mean:

• The trachea, which usually extends to the mouth and nose, gets sealed off post removal of the voice box.
• The only entry and exit for air and oxygen becomes the laryngectomy.
• Oxygen supplied to the mouth and nose doesn't reach the lungs as the connection is severed.

Laryngectomies vs Tracheostomies

It's crucial to differentiate between a laryngectomy and a tracheostomy. However, if in doubt:

• Employ the same procedures for both.
• Place an oxygen mask over both the mouth and nose, and another over the stoma.
• Note: In laryngectomies, oxygen won't reach the lungs through the mouth and nose, but it will in tracheostomies.

Key Points in Airway Management with Laryngectomies

• Usage: Bag and masks function similarly on laryngectomies and tracheostomies as they would on the mouth and nose.
• Tip: A paediatric face shield on an adult bag and mask can provide an effective seal around the laryngectomy or tracheostomy site, aiding in oxygen delivery to the lungs.
• Caution: Given the proximity of the lungs to the site, be gentle. Use suction judiciously and avoid excessive manipulation around the airway.

Conclusion

Laryngectomies cater to those with irreversible airway challenges. The airway is relocated to the neck's exterior, with the laryngectomy serving as the new route for breathing, superseding the traditional roles of the mouth and nose.