,requiring a permanent tracheostomy

,requiring a permanent tracheostomy (Fig. 22-4). Occasion-ally, patients continue to have a laryngectomy tube in the stoma. Laryngectomy tube are similar in appearance to tracheostomy tube; however, a laryngectomy tub can be distinguished from a tracheostomy tube because the patient is unable to speak or breathe when the laryngectomy tube is occluded. Patients who have a total laryngectomy require alternatives to normal speech; these may include a prosthetic device, such as a Blom-Singer valve,to speak without aspirating
Surgery is more difficult when the lesion involves the mid-line structures or both vocal cords.