**2. Total laryngectomy**

The standard options of laryngeal carcinoma treatment are surgery, radiotherapy, chemotherapy, or a combination of these modalities. When a conservation surgery is not indicated due to the tumor stage and localization, or due to patient's general medical condition, then total laryngectomy is considered. This surgical procedure implies a surgical removal of the entire larynx, from the hyoid bone to the second tracheal ring, and the lymph nodes on the ipsilateral or bilateral side. After removal of the larynx, the circular defect in the anterior wall of the pharynx is reconstructed and sutured to the base of the tongue. Inferiorly, resected distal part of trachea is brought forward and sutured to the skin edges forming permanent tracheostoma. Postoperative care after total laryngectomy includes nasogastric tube feedings and maintenance of tracheostoma. If the tracheostoma is satisfactory in size and shape, it is preferable not to use laryngectomy tube in the tracheostoma. Alaryngeal speech training may begin as early as 3 weeks after operation. Postlaryngectomy aphonia is one of the most devastating outcomes of total laryngectomy, and effective voice is critical to the successful prevention of psychological, social and economic consequences of totally laryngectomized individuals [4].

After total laryngectomy, there is a defect of hypopharynx that needs to be reconstructed. The base of tongue then makes anastomosis with neopharynx. Sometimes there is a retraction of the base of tongue, changed tonus of the pharyngoesophageal segment, an extension of a part of pharynx and esophageal stenosis, which can cause dysphagia in 10–58% of cases [5]. Reconstruction of the upper esophageal segment and the hypopharynx is essential for the swallowing function and alaryngeal phonation. In addition, radiotherapy and postoperative infection increases the risk of occurrence of scarring and stenosis of the oropharyngeal segment, causing dysphagia and odynophagia. Postoperative radiotherapy causes other problems such as reduced sense of taste, xerostomia, muscle fibrosis and tooth loss, which increases dysphagic disorders. Therefore, laryngectomees often need to modify their way of nutrition [6].
