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Laryngology

There are several ways that people can lose the use of their voice box. This can result from injury to the larynx or removal of the larynx due to cancer or laryngeal stenosis.

Cleveland Clinic's Head and Neck Institute specializes in several laryngeal and tracheal reconstructions, including laryngeal airway obstruction, esophageal reflux, tracheal aspiration, laryngoscopy and voice preservation and rehabilitation and removal of upper and lower respiratory foreign bodies. Cleveland Clinic expertise in this area led to the world’s first total laryngeal transplant in 1998.

Tube-Free Tracheostomy

Who can be considered Long Term Tracheostomy?

What is involved in the tracheostomy procedure?

During a two-hour inpatient surgery, skin and muscle flaps are raised and mobilized; therefore, creating an opening in the trachea, which is secured to remain permanently open and tube-free. Functionally, this opening may be regarded as a “third nostril.”

Who can be considered for LTT?

Patients who suffer from persistent serious airway obstruction from any of the following reasons can be eligible for long term tube-free tracheostomy:

  • Tracheal stenosis
  • Obstructive sleep apnea
  • Laryngeal stenosis
  • Local cord paralysis or impairment
  • Post radiation treatment to the neck
  • Chronic lung disease
  • Traditional tracheotomy
  • Neurological disorders

The above conditions must be severe for the patient to be eligible for this tracheostomy procedure.

An Improved Technique

A traditional tracheostomy must be maintained by a tube or stent. The opening, created in the windpipe, allows a patient to breathe and retain a serviceable voice, but the tube or stent may create complications, including the risk of infection. Conversely, Long Term Tracheostomy is designed to establish a long-term or permanent opening into the cervical airway, which is tube free and essentially complication free.

Voluntary Constriction of the Stoma

Recent refinement in the surgical technique has enabled the majority of recent patients to achieve intentional timely constriction and closure of the stoma for the production of voice and speech. This eliminates the need to finger occlude the stoma during speech or to use a stent with a one way valve. These patients also develop a more effective cough mechanism by closing the stoma and forcing the air and secretions up through the vocal cords and in the pharynx in an almost normal way.

What are the benefits of Long-Term Tracheostomy?

LTT offers many benefits to patients, including:

  • Safe, secure and normal breathing
  • Hands-free and device-free speech
  • Ease and comfort in tolerating the tracheal opening
  • Ability to retain normal voice and swallowing capacity, yet still breathe without restriction and communicate comfortably and effectively
  • Improved quality of life
  • Almost normal coughing in some cases

What can I expect after tracheostomy surgery?

Long-term tracheostomy is performed on an inpatient basis, under general anesthesia. The patient can expect the surgical area to heal within a month, after which he or she will be able to speak efficiently. With time and practice, most patients no longer need a valve. They learn to talk with their natural voice by contracting their neck muscles. Patients may consider scarves or bibs for a comfortable, aesthetically pleasing solution to filter and humidify air and protect the lower airway.

This information is for educational purposes only and should not be relied upon as medical advice. It has not been designed to replace a physician’s independent judgment about the appropriateness or risks of a procedure for a given patient.

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To find a head and neck specialist for your needs, contact the Head & Neck Institute at 216.444.8500 (or toll-free 1.800.223.2273, ext. 48500)

This information is provided by Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

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