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The complex physiological functions of the laryngopharynx have always caused wise surgeons to approach this area with caution. It is probably for this reason, that is, concern for disturbing the delicate balance between swallowing, respiration, and phonation, that early attempts at partial (conservation) laryngeal surgery during the late 19th century were abandoned in favor of total laryngectomy. Patients who heal properly after total laryngectomy do not aspirate, the major problem following partial laryngeal surgery. Unfortunately, the patient undergoing total laryngectomy generally has the ultimate in phonatory disorders (no speech at all in many cases), as well as inspired air that is not warmed or humidified and the social readjustments necessary with breathing through a hole at the base of the neck. Consider the effect of a permanent tracheostoma on the person's sex life, or when there is a possibility of falling into deep water.
Many laryngeal surgeons have tried to
Cantrell RW. Surgery for Phonatory Disorders. JAMA. 1982;247(23):3269–3270. doi:10.1001/jama.1982.03320480075040
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