Morphofunctional features of rehabilitation after total laryngectomy and relationship with the olfactory function

Total laryngectomy is a radical surgery that has to be performed for advanced laryngeal cancer. Although this surgical therapy is really life-saving, however it radically changes the anatomical features of the cervical tracts of both the respiratory and the digestive tracts with serious implications in the psychology of the patients, due to loss of normal speech, normal swallowing, as well as loss of breathing through the nasal cavities. Therefore, not only speech and swallowing rehabilitation is really necessary, but also that one of the olfactory functions. Speech rehabilitation consists in the development of either the pharyngeal voice or the oesophageal one. Particular relevance should involve also the recovery of the olfactory function that is compromised (hyposmia and anosmia), since air does not transit through the nasal cavities, but it reaches the lower respiratory tracts through the surgically built tracheostomy. It causes an atrophy of the neurons of the olfactory mucosa and sometimes also of the olfactory bulb in the anterior cranial fossa. Olfactory rehabilitation consists in logopedic exercises involving the lowering of the jaw, the oral floor, the root of the tongue and the soft palate. In the present investigation, laryngectomized patients underwent prior nasal endoscopy to verify the normal morphology of the nasal mucosa. Subsequently olfactometric tests were done in order to identify twenty-six different smells. After the rehabilitation phase, new olfactometric tests revealed that there was an improvement in smell identification by all the examined patients. Such results showed that the rehabilitation of the olfactory activity should be performed in addition of speech and swallowing recovery in laryngectomized patients in order to improve the quality of their life.