Abstract
The anatomic site for respiratory exchange following total laryngectomy is the tracheostoma, which plays a key role in restoring pulmonary function in all laryngectomized patients and in restoring speech in patients who use tracheoesophageal (TE) voice production. Variations in stomal size, shape, and location are challenges in restoring speech and pulmonary function following total laryngectomy and TE puncture. A large, irregularly shaped, or recessed stoma that prevents adequate stomal occlusion or a small stoma that inhibits placement of a TE voice prosthesis is frustrating to the patient and requires creative management strategies. This article discusses the problems of stomal size, configuration, and location as they relate to TE voice restoration and reviews the nonsurgical strategies and techniques used to manage these problems.
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