1- The patient is presented with severe dysphonia, dysphagia and/ or stridor (conditional recommendation).

2- Patient interview and data collection are needed followed by detailed endoscopic, radiological and laboratory investigations (conditional recommendation).

3- If assessment revealed the presence of extensive malignant laryngeal mass, patient should be informed about the possible lines of intervention, including total laryngectomy (conditional recommendation).

4- Pre-operative assessment of voice and swallowing is done (conditional recommendation).

5- Total laryngectomy decision is taken, based on all pre-operative assessment lines and the surgery is done (strong recommendation).

6- The post-operative anatomical and physiological changes have to be discussed with the patient as well as the expected communication and swallowing problems   after intervention (conditional recommendation). 

7- Post-intervention detailed assessment is needed (conditional recommendation) including:

▪️  Patient interview and case history.

▪️  Baseline assessments of communication and swallowing are done & instrumental assessments may be needed for evaluation of the oro-pharyngeal swallow using video-Fluoroscopic swallowing Study (VFSS).

▪️  Questionnaires about quality of life may be administered.

8- Then the rehabilitation plan is tailored according to the patient conditions and preferences (strong recommendation):

a. Voice and speech rehabilitation is done by any of the following methods:

▪️ Tracheo-esophageal puncture using speech valve e.g., Provox or Blom & Singer speech valves.

▪️ Esophageal speech (unaided) training sessions

▪️ Electro-larynx or external vibrator.

b. Swallowing and smell rehabilitation may be needed according to the difficulty (conditional recommendation).

c. Care of the neck stoma includes measures of protection against dust, dryness and droplet infection. The use of Heat and Moisture Exchanger (HME) system may help protection of the air way (conditional recommendation).