Keeping the trach "just in case" he has radiation seems excessive, especially since he didn't have throat cancer. The surgeon thinks that between being previously irradiated *and* having a large flap reconstruction (David had his entire tongue and floor of mouth reconstructed) that he's at risk of inflammation causing airway obstruction during any subsequent radiation. David is home today and has no trouble breathing through his nose and mouth when the trach hole is closed off. If the specter of further radiation wasn't out there, his trach would be out and he was told as much by the ENT residents (he had his surgery done at a teaching hospital). They are waiting to hear what the tumor board will recommend. David had perineural and lymphovascular invasion, so everyone expects at least further radiation to be recommended. David is going for proton therapy if he gets any more radiation.

(Nearly?) Everyone who has a total glossectomy will require radiation due to advanced disease and high risk of reoccurrence. However, I'm having a hard time finding where keeping a trach in place long-term is normative, even for repeat cases. David still has his larynx and some of the base of his tongue. He can swallow and speak, even if his articulation isn't great. He has a PEG as well, and we fully expected that to stay for a while.

So why am I posting? I know no one here is a doctor and can give medical advice, only personal observations and experiences. If anyone here kept their trach for a long time after a total glossectomy or large oral cancer surgery and reconstruction I'd like to hear your personal experience, particularly if you still have your larynx. We did not go through a CCC for surgery, though we did go through a medical school ENT department. David's surgeon is excellent and the residents he precepts are a fine group as well. The reason we went local was because time was of the essence...I haven't told the full story of David's reoccurrence and how his original oncology team dropped the ball; I'll save that for another day, another thread, another forum category.

Thank you for reading. I'm happy to report David is recovering amazingly well and this trach tube is "just another thang."