Pulmonary Infection or Pneumonia in Patients Who Undergo Total Laryngectomy

Cheng-Ming Hsu ； Meng-Chang Ding

《International Journal of Head and Neck Science》 2卷4期 (2018/12) Pp. 176-180

https://doi.org/10.6696/IJHNS.201812_2(4).0006

摘要

Background: Total laryngectomy (TL) is the removal of the entire larynx. Changes in the anatomy and physiology of airways after TL cause not only loss of laryngeal speech but also of cough effectiveness, which can lead to life-threatening complications. TL patients have high risks of severe tracheobronchitis and pneumonia. Methods: A literature review. Results: To maintain effective airway clearance, adequate shearing forces must be produced by cough expiratory airflow. Antitussives reduce the cough reflex, causing accumulation of mucous in small airways. An extremely small tracheostoma can cause retention of sputum and crust, and an extremely large tracheostoma can cause entry of more exogenous material into airways but production of less expiratory force. Thus, an appropriate size of tracheostoma should be maintained. Patients who undergo TL should always maintain satisfactory cardiopulmonary function. Favorable lung function indicates powerful expiratory function, including coughing force. Exercise can result in patients drinking more water. Hydration can in turn help reduce the development of sticky sputum and crust. Conclusions: Pulmonary infections do not appear to increase the mortality rate in patients who undergo TL. Thus, most physicians are unaware of the risks of pneumonia among patients who undergo TL. If uncertain pulmonary or atypical infection is suspected, a chest doctor or doctor specializing in infections should be consulted. Antitussives shpuld not always be administered to patients with cough.

關鍵字

total laryngectomy ； laryngeal cancer ； pneumonia ； pulmonary infection ； tracheostoma