Patients who have undergone a total laryngectomy may require a cuffed tracheostomy tube for the first 24 hours following their operation or until they have been weaned off ventilation. Once the tracheostomy tube has been removed, the ear, nose and throat (ENT) surgeon will decide whether a laryngectomy tube is required for stoma patency. For patients with no laryngectomy tube in place, the nurse must be extremely vigilant, assessing the bare stoma frequently to ensure that it is not at risk of stenosis. A stenosed stoma will restrict the patient's breathing and hinder the removal of secretions (Sharma et al. [253]). The stoma should be sufficiently large, ideally 15 × 15 mm in diameter. Less than 10 mm is deemed critical (Sharma et al. [253]). There are various stoma patency devices available, including laryngectomy tubes, stoma studs and stoma buttons (Figure 12.54). The ENT surgical team, clinical nurse specialist and speech and language therapist (SLT) can help to guide which device should be used.