Khalid Iqbal, Mohammad Rafique Gooda, Khalid Hussain Mahida.
Funnel Neck - deformity of the neck: an unusual sequel after total Laryngectomy.
J Pak Med Assoc Jan ;54(12):637-8.

A 75 year old male was referred to the speech and language therapy unit with the intention of learning oesophageal speech. He was operated for total laryngectomy about a month ago. It was the 14th day of post-operative radiotherapy when he developed a sudden difficulty in breathing through the tracheostome. He was unable to retain the metallic tracheostomy tube due to the gradually descending and narrowing tracheostome. An uncuffed endotracheal tube of 6.5 mm size was passed and kept in situ to maintain the patency of the tracheostome. During the following weeks the tracheostome adopted a horizontal position with respect to the neck and continually descended downwards behind the manubrium, carrying with it the attached skin and subcutaneous tissue. Simultaneously the front of the neck caved inwards deeply due to the prominence of stermomastoid muscles bilaterally. The radiotherapy had to be discontinued and the endotracheal tube was removed after six weeks. By then the tracheostome was able to retain its patency without any support. A superadded respiratory distress prompted a consultation. He had a moderated differentiated squamous cell carcinoma of the larynx with T4N0M0 status. Total laryngectomy was performed and postoperative radiotherapy started. Clinical examination showed a deep-seated cavity in the front of the neck that tapers to end in a tracheostome placed horizontally behind the sternum. It was about 3.5cm below the upper level of the manubrium sterni. Carina could be seen 2.5 cms below, through the tracheostome that was rounded with a maximum diameter of 1.4 cms. The entire picture of the neck had resemblance to a funnel. In the depth of the hollowed neck there was a prominence created by the pharynx, which became more obvious with the swallowing movements. There was nothing significant in the rest of the clinical examination. Chest X-rays were normal.

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