A lary tube is a medical device designed to maintain an open airway, particularly after a surgical procedure called a laryngectomy. A laryngectomy involves the removal of the larynx, or voice box, which fundamentally changes how an individual breathes. Instead of breathing through the nose and mouth, air enters and exits the body through a new opening in the neck, known as a stoma. The lary tube is placed within this stoma to ensure it remains open, allowing for continuous airflow to the lungs. This device provides a stable breathing pathway for individuals whose natural airway has been permanently altered.
Anatomy and Mechanism
A lary tube is a flexible, soft silicone tube, although some variations may use other biocompatible plastics. Its design features a curvature that aligns with the natural shape of the trachea after a laryngectomy. This design ensures an optimal fit and helps prevent accidental dislodgement.
The tube’s primary function is mechanical, acting as a stent to keep the stoma from narrowing or closing. Some lary tubes feature a flange or neck plate that rests against the skin of the neck, securing the tube in place. While some lary tubes may have an inflatable cuff, many are uncuffed, relying on their precise fit within the stoma. Different sizes and lengths are available to accommodate patient anatomy.
Conditions Requiring a Lary Tube
The primary medical condition necessitating a lary tube is a total laryngectomy, a surgical procedure where the entire larynx is removed. This surgery is performed for advanced laryngeal cancer. Following a total laryngectomy, the windpipe is permanently disconnected from the nose, mouth, and throat, requiring a new breathing passage through a stoma in the neck.
Other instances where a lary tube may be used include severe trauma to the larynx or radiation necrosis, which is damage to the larynx resulting from cancer treatment. In some cases, intractable infections or advanced laryngeal stenosis, leading to severe narrowing or obstruction of the airway, may also necessitate this intervention.
Procedure and Ongoing Care
The insertion of a lary tube occurs a few days after a total laryngectomy. Initially, a tracheostomy tube might be used, which is then replaced by a lary tube once the stoma begins to heal. The process involves gently inserting the lubricated tube into the stoma, aligning its curvature with the trachea. Patients may experience some coughing during insertion, which usually subsides quickly.
Ongoing care of a lary tube is important for maintaining a clear airway and preventing complications. The tube requires cleaning at least once or twice daily, or more frequently if mucus accumulates. This involves removing the tube, cleaning it with mild soap and water using a small brush, and then thoroughly rinsing and reinserting it. Regular cleaning helps prevent infection.
Managing daily life with a lary tube involves several adjustments. Patients must protect the stoma from water during showering by using a shower guard and avoid swimming. Humidification is also important, as the air breathed in no longer passes through the nose and mouth for natural warming and moistening. This is achieved through a heat and moisture exchanger (HME) device that attaches to the lary tube, or by using a room humidifier.
While speech is altered, individuals learn new communication methods, such as using a voice prosthesis or an electrolarynx. Regular medical check-ups monitor the stoma and tube.