Laryngectomy

Definition

Laryngectomy is surgery to remove the larynx (voice box) in your throat. All or part of the larynx may be removed in a laryngectomy.

Alternative Names

Complete laryngectomy; Partial laryngectomy

Description

Total laryngectomy is major surgery that is done in the hospital. Before surgery you will receive general anesthesia. This will make you unconscious and unable to feel pain.

In a total laryngectomy, first your surgeon will make an incision (cut) in your neck to open up the area. Important parts of this surgery are:

• Your surgeon may remove the lymph nodes.
• Your surgeon may do a tracheoesophageal puncture (TEP). A TEP is a small hole made in your trachea (wind pipe) and esophagus (the tube that moves food from your throat to your stomach). Your surgeon will place a small prosthesis (a man-made part) into this opening. The prosthesis will allow you to speak after your voice box has been removed.
• Your surgeon will remove your larynx and the tissues around it.
• Your surgeon will make an opening in your trachea and a hole in front of your neck. Your trachea will be brought up and attached to this hole. The hole is called a stoma. After surgery you will breathe through your stoma. It will never be removed.
• Your muscles and skin will be closed with stitches or clips. You may have tubes coming from your wound for a while after surgery.

There are many less invasive surgeries to remove part of the larynx.

• These may work for some people. The surgery you have may depend on how much your cancer has spread and what type of cancer you have.
• The names of some of these less invasive procedures are endoscopic (or transoral resection), vertical partial laryngectomy, horizontal or supraglottic partial laryngectomy, and supracricoid partial laryngectomy.

Part of your pharynx may be removed in a total laryngectomy. Your pharynx is the tube air moves through from your nose. It connects with your larynx.

The surgery takes 5 to 9 hours.

Why the Procedure Is Performed

Usually laryngectomy is done to treat cancer of the larynx. It is also done to treat:

• Severe trauma, such as a gunshot wound or other physical injury.
• Severe damage to the larynx from radiation treatment. This is called radiation necrosis.

Risks

Risks for any surgery are:

• Allergic reactions to medicines
• Breathing problems
• Heart problems
• Bleeding
• Infection

Risks for this surgery are:

• Hematoma (a buildup of blood outside the blood vessels)
• Wound infection
• Fistulas (tissue connections that form between the pharynx and the skin that are not normally there)
• The stoma opening may become too small or tight. This is called stomal stenosis.
• Leaking around the tracheoesophageal puncture (TEP) and prosthesis
• Damage to other areas of the esophagus or trachea
• Problems swallowing and eating
• Problems speaking

Before the Procedure

You will have many doctor visits and medical tests before you have surgery. Some of these are:

• A complete physical exam and blood tests
• A visit with a speech therapist and a swallowing therapist to prepare for changes after surgery
• Nutritional counseling
• Stop-smoking counseling, if you are a smoker and have not quit

Always tell your doctor or nurse:

• If you are or could be pregnant
• What drugs you are taking, even drugs, supplements, or herbs you bought without a prescription
• If you have been drinking a lot of alcohol, more than 1 or 2 drinks a day

During the days before your surgery:

• You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), clopidogrel (Plavix), warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
• Ask your doctor which drugs you should still take on the day of your surgery.

On the day of your surgery:

• You will be asked not to drink or eat anything after midnight the night before your surgery.
• Take your drugs your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

You will need to stay in the hospital for several days after surgery.

After the procedure, you will be groggy and will not be able to speak. An oxygen mask will be on your stoma. It’s important to keep your head raised, rest a lot, and move your legs from time to time to improve blood flow. Keeping blood moving reduces your risk of getting a blood clot.

You can use warm compresses to reduce pain around your incision. Your nurse will give you pain medicine.

You will receive nutrition through an IV (a tube that goes into a vein) and tube feedings. Tube feedings are given through a tube that goes through your stoma and into your esophagus (swallowing tube).

You may be allowed to swallow food as soon as 2 to 3 days after surgery. But, it is more common to wait 5 to 7 days after your surgery to start eating through your mouth.

Your trachea drain will be removed in 2 to 3 days. You will be taught how to care for your tracheostomy tube and stoma. You will learn how to safely shower or swim. You must be careful not to let water enter through your stoma.

Speech rehabilitation with a speech therapist will help you relearn how to speak.

You will need to avoid heavy lifting or strenuous activity for about 6 weeks. You may slowly resume your normal, light activities.

Follow up with your doctor as often as your doctor says you need to.

Outlook (Prognosis)

Your wounds will take about 2 to 3 weeks to heal. You can expect full recovery in about a month. Many times, removal of the larynx will take out all the cancer or injured material. People learn how to change their lifestyle and live without their voice box.

References

Rassekh H, Haughey BH. Total Laryngectomy and laryngopharyngectomy. In: Cummings CW, Flint PW, Haughey BH, et al, eds. Otolaryngology: Head & Neck Surgery. 4th ed. Philadelphia, Pa: Mosby Elsevier; 2005:chap 103.

Agrawal N, Goldberg D. Primary and Salvage Total Laryngectomy. Otolaryngologic Clinics of North America. August 2008;41(4).