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Chapter 2 Smelling after total laryngectomy Total laryngectomy Total laryngectomy is a surgical procedure during which the entire larynx, consisting of the hyoid bone, the epiglottis, the thyroid cartilage, the cricoid cartilage, the laryngeal strap muscles and the first two or three tracheal rings are removed. The larynx separates the respiratory and the digestive tract and consequently, after removing the larynx, the two tracts must be reconstructed to preserve their functions. This is why during the operation the trachea is bent forward and sutured to the skin of the neck, which has been fenestrated for that purpose. This more or less round, percutaneous opening is the tracheostoma, the entrance to the trachea. After surgery the patient will thus breathe through this tracheostoma. The digestive tract is reconstructed by suturing the pharyngeal musculature and mucosa formerly attached to the dorsal side of the larynx. For some patients the resection must be more extensive, leaving too little or even no pharyngeal tissue for primary closure of the pharyngeal defect and restoration of the digestive tract. Then, tissues from elsewhere in the body will be used for reconstruction: this may be skin or muscles from the chest, arm or leg, or even part of the stomach or jejunum. The respiratory tract and the digestive tract are thus, with or without the use of tissues from other parts of the body, permanently separated. The respiratory tract becomes a separate route from the tracheostoma in the neck to the lungs, while the digestive tract from mouth to stomach remains as it was. The route of the respiratory tract is not the only change following total laryngectomy. All other pre-operative laryngeal functions such as manner of phonation, voice-sound, coughing, sneezing, straining, blowing and smelling alter as well. A total laryngectomy thus has many diverse consequences. 13