Laryngectomy

Definition

This is surgery to remove the voice box (larynx). In some cases, a partial laryngectomy may be possible.

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Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review possible problems such as:

• Infection
• Breathing problems
• Excess swelling or bleeding
• Wound opens
• Wound heals poorly
• Damage to nearby structures
• Blood clots
• Reaction to anesthesia
• Saliva leaking out to the skin
• Unable to speak—aphonia
• Cancer comes back

Your chances of problems may be higher for:

• Smoking
• Drinking
• Chronic diseases such as diabetes or obesity

Reasons for Procedure

Laryngectomy treats cancer of the voice box. It can also treat trauma to voice box.

What to Expect

Prior to Procedure

You may have:

• A physical exam
• Laryngoscopy—the use of a long, thin, lighted tube to examine the voice box
• Imaging tests such as:
  • MRI scan
  • CT scan

Leading up to your surgery, talk to your doctor about:

• Your medicines. You may be asked to stop some up to 1 week in advance.
• Ways to regain your speech such as:
  • Tracheoesophageal puncture
  • Hand-held speech aids

Eat a light meal the night before the surgery. Do not eat or drink anything after midnight.

Anesthesia

General anesthesia will be used. You will be asleep.

Description of the Procedure

A cut will be made in the skin on your neck. The muscles that are attached to the voice box will be separated. The voice box and tissue around it will be removed.

A partial laryngectomy may be done. The doctor will remove the tumor and only part of the voice box. If you have this, you may keep some normal speech or swallowing ability.

A tracheostomy will allow you to breathe during and after surgery. This is an opening (called a stoma) from the outside of your neck to your windpipe. A tube is placed into the stoma so you can breathe. Drainage tubes will be inserted to drain blood and fluid. Lastly, the muscles and skin closed with stitches or clips.

How Long Will It Take?

5-9 hours

How Much Will It Hurt?

Anesthesia will prevent pain during surgery. Medicines will ease pain afterwards.

Average Hospital Stay

The usual length of stay is 7-14 days. Your doctor may choose to keep you longer if you have problems.

Post-procedure Care

At the Hospital

You may have:

• An oxygen mask over the stoma.
• Nutrition and medicines through an IV.
• A speech pathologist or doctor assess your ability to swallow. Depending on the results, you will progress to soft foods.
• You may need to wear boots or special socks to help prevent blood clot formation in your legs.
• Learn how to:
  • Use a call bell and message board to communicate.
  • Keep the head of your bed raised.
  • Move your legs while in bed to increase circulation.
• Learn to care for your stoma and tracheostomy tube, which includes:
  • Using a mist hood over the stoma
  • Keeping water out of the stoma
  • Covering the stoma with a shower hood when showering
  • Suctioning secretions
• The drains removed in about 5 days. The stitches will be removed in about 1 week.

At Home

To help you heal faster at home:

• Avoid lifting heavy objects and doing strenuous activity for up to 6 weeks.
• Participate in a speech rehabilitation program. You will need to learn how to speak again. The program may involve speaking by:
  • Swallowing air and expelling it—esophageal speech
  • Using an electronic device—artificial voice box
  • Installing a valve in the stoma to allow air from the lungs to reach the esophagus—tracheoesophageal speech

The throat tissue will heal in about 2-3 weeks. Complete recovery will take at least a month. You may notice a reduction in your sense of taste and smell. You will continue to use the stoma for breathing.

Most people are able to return to their jobs and past activities, except for swimming.

You may be referred to a support group to help you to cope with the surgery.

Call Your Doctor

Call your doctor if any of these occur:

• Fever or chills
• Redness, swelling, pain, excess bleeding, or pus from the wound
• Nausea or vomiting
• Pain that you cannot control with the medicines you were given
• Coughing, breathing problems, or chest pain
• Swallowing problems
• Eating problems
• Headache, muscle aches, or lightheadedness
• Stoma is getting smaller
• Saliva is leaking through your wound

If you think you have an emergency, call for emergency medical services right away.