Laryngectomy
Halfpoint Images / Getty Images
A laryngectomy is a surgery in which either part of or the entire larynx (voice box) is removed. It may be performed on people with laryngeal cancer, trauma to the larynx, or damage to the larynx from radiation. When the entire larynx is removed, the person will need to breathe through a hole made in the neck called a stoma.
This article will discuss what a laryngectomy is and its risks. It will also cover recovery and long-term care.
Halfpoint Images / Getty Images
What Is a Laryngectomy?
A laryngectomy is a surgical procedure to remove a part of or the entire larynx. It is an inpatient procedure under general anesthesia done when someone has:
Severe larynx trauma
Larynx damage from radiation
A total laryngectomy involves removing the entire larynx. This includes removing the epiglottis, vocal folds, hyoid bone, and the thyroid and cricoid cartilage. The mouth, nose, and esophagus are surgically separated from the airway. The trachea is stitched to the front of the neck to permit breathing, and a hole is made to the outside (stoma).
A partial laryngectomy removes part of the larynx and preserves the voice. The nose and mouth are not surgically separated from the airway.
A laryngectomy removes the larynx. Breathing is then done through a stoma. A tracheostomy gives access to the windpipe (trachea) through the skin but leaves the voice box intact.
Various Surgical Techniques
A total laryngectomy is an open surgical procedure performed through an incision. Partial laryngectomies may be performed via endoscopic surgery in which a thin tube with a camera and surgical tools attached is inserted through the mouth.
A surgeon may create a tracheoesophageal puncture (TEP) during or after a laryngectomy. This is a small hole made in the trachea and the esophagus. Then a small one-way valve called a tracheoesophageal voice prosthesis is placed into the TEP. This allows people to have a voice after a complete laryngectomy.
Contraindications
A laryngectomy is a significant surgery that may not be right for everyone. Reasons someone may not be a good candidate for the surgery include:
Incurable synchronous tumors (a second primary cancer or metastasis diagnosed within a few months of the first tumor)
Incurable distant metastasized cancer (cancer that has spread from its origin)
Cancer that involves the common or internal carotid artery
Potential Risks
There are many risks associated with surgery. A laryngectomy carries additional risks that those considering the surgery need to know. These risks are:
Inability to speak
Difficulty swallowing and eating
Fistulas (an abnormal connection between two body cavities)
Infection
Hematoma (an abnormal pooling of blood)
Tracheal or esophageal damage
Leaking around the TEP
Purpose of Laryngectomy
A laryngectomy removes a damaged or cancerous larynx. It is performed when other treatments are unsuccessful at treating the cancer or unable to repair the damage. The goal is to remove the damaged or cancerous areas and restore breathing.
How to Prepare
A laryngectomy is a major surgery and will require preparation before the day of the procedure. A healthcare provider will schedule necessary tests and appointments before the surgery. These can include:
Physical exam
Diagnostic imaging, which can include X-ray, acomputed tomography (CT) scan, or magnetic resonance imaging (MRI)
Smoking cessation counseling
Nutritional counseling
The healthcare provider may recommend meeting with a speech therapist before the surgery to discuss modifications to your swallowing, eating, and speaking.
Before surgery, changes may be made to your medications. Always inform your healthcare provider of your current medications, herbal supplements, and recreational substances. Medications like aspirin, ibuprofen, and blood thinners may need to be stopped or adjusted according to the surgery schedule.
What to Expect the Day of Surgery
On the day of surgery, you will not be allowed to eat or drink anything. Sips of water to take medications are permitted.
Once you have arrived at the hospital, you will be taken into a preoperative area. The medical team will ask you questions and prepare you for the surgery. This includes having you change into a hospital gown and inserting an intravenous line (IV). From the pre-op area, you will be brought into the operating room (OR).
The surgery itself takes anywhere from five to nine hours.
Recovery
After surgery for a total laryngectomy, you will not be able to speak. You will breathe through the stoma that is created. An oxygen mask or tube will be inserted in the stoma to provide oxygen. The tube inserted in the stoma may be removed, and you will be able to breathe just through the stoma and without assistance.
Immediately after surgery, you will not be allowed to eat and will receive nutrition through an IV. Liquid food, like formula, may be given through a tube inserted into your nose that extends down into the stomach.
Approximately five to seven days after the surgery, the healthcare provider will have you do a swallow study. This diagnostic imaging procedure uses an X-ray to see if food goes down correctly when swallowed.
After a laryngectomy, a speech therapist will teach you how to speak. Your speech will be different since the voice box has been removed.
Before discharge, you will be taught how to care for the stoma properly. Since the stoma is the only way air can enter your lungs, you'll need to learn how to shower without allowing water to get into the stoma.
Long-Term Care
A laryngectomy will come with many major life changes. Long-term care will involve maintaining the stoma, relearning how to speak, and relearning how to swallow.
The stoma will need to be cleaned regularly. This can be done with a gauze pad dipped in soapy water. Try to remove any crusts that form on the stoma. The air entering the stoma can be dry. There are a few ways to humidify the air, one way is with a heat moisture exchange (HME) that is placed over the stoma.
Relearning how to speak can be frustrating. There are a few ways people who have had a total laryngectomy speak. Esophageal speech is one method. In it, air is pushed down into the esophagus. The air then moves back up and vibrates in the throat to speak.
Another speech option is with a voice prosthesis valve in the TEP. When air moves through the valve it allows the user to speak.
The last option for speaking is with an electrolarynx. This is an electronic device that is held up to the throat and turns the vibrations into speech.
Summary
A laryngectomy is a surgical procedure that removes either part of or the entire larynx. It is done on people with laryngeal cancer, trauma to the larynx, or damage to the larynx from radiation treatment.
After a total laryngectomy, you will need to breathe through a hole in your neck called a stoma. You will need to relearn how to speak and swallow.
