26 | Chapter 1 Once a treatment plan, such as a total laryngectomy for advanced laryngeal cancer, has been chosen, patients will enter a rehabilitation phase. The following section of this introduction will explore particular aspects of rehabilitation tailored to laryngectomized patients. Rehabilitation after Total Laryngectomy Rehabilitation after TL presents a profound challenge for patients, affecting their ability to speak, breathe, and swallow. This multifaceted rehabilitation process aims to address these challenges, focusing on restoring respiratory function, facilitating communication, and ensuring nutritional support. In addition, physical rehabilitation is also an important aspect to take into account. Essential components of the first challenges involves the use of voice prostheses (VP) and Heat and Moisture Exchangers (HMEs)62 Voice prosthesis Vocal rehabilitation after TL is a crucial component of post-surgical care, aimed at restoring the patient’s ability to communicate verbally. In the Western world, tracheoesophageal puncture (TEP) with voice prosthesis (VP) insertion has emerged as the gold standard for voice restoration following TL. This method significantly surpasses other techniques in providing patients with more intelligible speech and better voice quality63. Indwelling voice prostheses, including the Provox, Fahl and Blom-Singer models, are the most common types used, categorized into regular VPs for standard cases and problem-solving VPs for those with specific issues such as short device lifetimes or periprosthetic leakage36,64. The device lifetime of VPs varies, typically ranging from 2 to 6 months, depending on several factors such as the type of VP, patient’s ability to maintain the device, biological factors like biofilm formation on the prosthesis as well as reimbursement and other barriers for the patient. The primary reason for VP replacement is transprosthetic leakage, occurring in 55% to 80% of cases, followed by periprosthetic leakage affecting 5% to 30% of patients64. These frequent replacements can significantly impact a patient’s quality of life, leading to feelings of insecurity and unplanned hospital visits65,66. Despite the challenges associated with VPs, the use of tracheoesophageal voice prosthesis remains a highly effective method for vocal rehabilitation post-TL. Research and development continue to aim for VPs with longer lifetimes and fewer complications, improving patient satisfaction and quality of life. The ongoing innovation in this field underscores the importance of tailored approaches to vocal rehabilitation, ensuring that each patient receives the most suitable device based on their individual needs and circumstances67.
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