Laryngectomy

Overview

A laryngectomy is a surgical intervention aimed at the removal of either a portion or the entirety of the larynx, commonly known as the voice box. Situated above the trachea, the larynx serves as a conduit connecting the nose and mouth to the lungs, facilitating functions such as speech, respiration, and swallowing.

Reasons for undergoing the procedure

Laryngectomy surgery may be warranted in cases of:

• Laryngeal cancer.
• Laryngeal fracture.
• Extensive larynx damage resulting from trauma or injury.
• Chondronecrosis of the larynx (an uncommon condition where radiation therapy induces damage to the larynx).

The recommended surgical approach, either partial laryngectomy (removal of a portion of the larynx) or total laryngectomy (complete removal of the larynx), depends on the severity of your specific condition as determined by your doctor.

Risks

Similar to any surgical procedure, laryngectomy carries inherent risks, which include:

• Infection.
• Blood clots.
• Heart conditions.
• Breathing issues.

Specific complications related to laryngectomy include:

• Damage to the trachea or esophagus.
• Reduced thyroid gland function.
• Challenges with eating, swallowing, and speaking.
• Restricted movement in the neck and shoulders.
• Formation of fistulas (abnormal connections between the throat and skin).
• Problems associated with the laryngectomy stoma.

Before the procedure

Before undergoing a laryngectomy, your healthcare provider will conduct a thorough physical examination and recommend various tests, including:

• Complete blood count or other routine blood tests.
• Chest X-ray to assess your suitability for surgery.
• Electrocardiogram (EKG) to evaluate your heart rhythm.

Your provider will also arrange consultations with other medical professionals such as speech-language pathologists and swallowing specialists to assist you in preparing for post-surgery recovery and adjustment to life after a laryngectomy.

If needed, counseling services are available to aid in smoking cessation before the laryngectomy. Additionally, most providers offer nutritional counseling to promote healthy habits following the surgery.

Before your procedure, your healthcare provider will provide you with detailed preoperative instructions. Typically, this involves temporarily discontinuing blood-thinning medications and fasting the night before the laryngectomy surgery.

During the procedure

Your surgeon will conduct a laryngectomy procedure while you are under general anesthesia. Once you are comfortably sedated, the following steps will be performed:

• Incision: Your surgeon begins by making a precise incision on your neck.
• Larynx removal: Following the incision, the surgeon carefully removes part or all of your larynx, potentially including lymph nodes and portions of the pharynx.
• Stoma ceation: An opening is then created in your neck and the front of your windpipe to form a stoma. A laryngectomy tube is inserted into the stoma to facilitate breathing post-surgery.
• Tracheoesophageal puncture (TEP): Depending on the case, a TEP may be performed, creating a small hole between the trachea and esophagus. This allows for the insertion of a voice prosthesis, although suitability varies for each patient.
• Closure: Finally, the incision is meticulously closed with sutures.

After the procedure

Following a laryngectomy, patients typically stay in the hospital for one to two weeks, during which their recovery is closely monitored by the medical team. Initially, nutritional support is provided through a feeding tube, which is removed once the ability to swallow liquids is regained.

The removal of vocal cords during laryngectomy surgery requires the adoption of new methods for speaking and communicating. A speech-language pathologist can help identify an effective approach customized to the individual’s needs.

Voice prosthesis

A laryngectomy speaking device, known as a voice prosthesis, is positioned over your stoma. Through training, you can acquire the skill to channel air from your lungs into your esophagus, generating speech through the resulting vibrations.

Various types of voice prostheses are available. Consult your doctor to determine if this option is suitable for your needs.

Electrolarynx

To improve your speech, you apply an electrolarynx (artificial larynx) against your neck. Many individuals can master its use within just a few days, making it one of the quickest techniques to learn.

Although the words generated by an electrolarynx may sound robotic and artificial, it serves as an effective short- or long-term solution following laryngectomy surgery.

Esophageal speech

After undergoing a laryngectomy, certain individuals adopt esophageal speech as a means of communication. This technique involves redirecting air from the mouth, trapping it in the throat and esophagus, and utilizing it to articulate speech.

Nonverbal communication

Individuals recovering from a laryngectomy will inevitably resort to nonverbal communication at various stages. Nonverbal communication methods may encompass:

• Gestures.
• Mouthing words.
• Facial expressions.
• Handwriting.
• Typing on a computer or tablet.
• Sign language.

Outcome

The typical recovery period following laryngectomy surgery spans from two to three weeks on average. However, this duration can vary depending on factors such as the extent of the surgery and individual healing capabilities, potentially requiring a longer recovery for some patients. While laryngectomy surgery is generally successful in eradicating cancer, additional treatments like chemotherapy or radiation therapy may be necessary to reduce the risk of recurrence. Regular follow-up appointments with your physician are crucial.

After undergoing laryngectomy surgery, your medical team will work with you to teach new techniques for breathing, speaking, and swallowing. A speech-language pathologist will provide support for effective communication, and you’ll receive guidance on caring for your laryngectomy stoma. Your doctor will furnish you with detailed post-operative instructions that are vital to adhere to for a successful recovery. Many individuals who undergo total laryngectomy report a good quality of life. Long-term survival rates for those recovering from laryngeal cancer depend on factors such as tumor stage, location, metastasis, and overall health. For more precise information on survival rates after laryngectomy, consulting with your doctor is recommended.