Laryngectomy

Definition

This is surgery to remove the larynx, more commonly known as the voice box. In some cases, a partial laryngectomy may be possible.

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Possible Complications

Problems from the procedure are common. Your doctor will review potential problems, like:

• Infection
• Breathing difficulties
• Excessive swelling or bleeding
• Opening of the incision or poor wound healing
• Injury to the trachea, also known as the windpipe, or esophagus
• Blood clots
• Anesthesia-related problems
• Saliva leaking out to the skin
• Inability to speak or aphonia
• Cancer occurs again

Some factors that may increase the risk of complications include:

• Pre-existing medical condition
• Increased age
• Obesity
• Smoking
• Previous surgical procedure to the larynx
• Prior radiation or chemotherapy
• Poor nutrition
• Diabetes

Be sure to discuss these risks with your doctor before the surgery.

Reasons for Procedure

Laryngectomy is usually done to treat cancer of the larynx. This surgery may also be done to treat severe damage of the larynx due to trauma.

What to Expect

Prior to Procedure

Your doctor may do the following:

• Physical exam
• Laryngoscopy—the use of a long, thin, lighted tube to examine the larynx
• Radiation or chemotherapy—to treat cancer

Leading up to your surgery:

• Talk to your doctor about your medications. You may be asked to stop taking some medications up to 1 week before the procedure.
• Also talk to your doctor about ways to restore 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 during the procedure.

Description of the Procedure

A cut will be made in the skin on your neck. The muscles that are attached to the larynx will be divided. The larynx and surrounding tissue will then be removed. Sometimes, a partial laryngectomy will be done. In this case, the doctor will remove the tumor and only part of the larynx. If you have this type of surgery, you may retain some normal speech and more of your normal swallowing function.

An opening called a stoma will be created through the skin in the neck. Next, the trachea will be connected to the opening. This will enable you to breathe through the hole. In some cases, a tracheostomy tube will be inserted. This tube, which fits into the stoma, will act as an airway, helping you to breathe. Drainage tubes will be inserted to drain blood and fluid. Lastly, the muscles and skin will be brought together and closed with stitches or clips.

How Long Will It Take?

5-9 hours

How Much Will It Hurt?

Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.

Average Hospital Stay

This surgery is done in a hospital. The usual length of stay is 7-14 days. Your doctor may choose to keep you longer if complications arise.

Post-procedure Care

At the Hospital

While you are recovering at the hospital, you will:

• Have an oxygen mask over the stoma.
• Be given nutrition through an IV or a feeding tube. A speech pathologist or doctor will 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
• Have the drains removed in about 5 days. The stitches will be removed in about one week.

At Home

When you return home, do the following to help ensure a smooth recovery:

• 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 larynx
  • 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

It is important for you to monitor your recovery after you leave the hospital. Alert your doctor to any problems right away. If any of the following occur, call your doctor:

• Signs of infection, including fever and chills
• Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
• Persistent nausea and/or vomiting
• Pain that you cannot control with the medications you've been given
• Cough, shortness of breath, or chest pain
• Difficulty swallowing
• Difficulty eating
• Headache, muscle aches, or lightheadedness
• Tracheostoma is getting smaller
• Saliva is leaking through your incision
• New, unexplained symptoms

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