Laryngectomy is the surgical removal of the larynx. The larynx is your voice box, the organ in your throat. Your voice box houses your vocal cords. That’s what allows you to produce sound. The larynx also lets air travel from your lungs to your mouth.
If you have a laryngectomy, it will affect your speech, swallowing, and breathing. You’ll need to learn new ways to perform all three tasks after surgery.
Removing the voice box is a radical yet necessary treatment method for people who:
- have cancer of the larynx
- have sustained severe injury to the neck, such as a gunshot wound
- develop radiation necrosis (damage to the larynx stemming from radiation treatment)
Depending on your condition, your doctor will perform a partial or complete laryngectomy.
The throat contains a few different tubes, including the esophagus, the trachea, and the larynx. The esophagus is the tube through which you eat. The trachea is the tube through which you breathe. The larynx contains the voice box.
When you have a functioning voice box, the tubes have a joined section. The voice box is located in the middle section of the trachea which links up your lungs and mouth. Laryngectomy removes the voice box, cutting off the connection between your lungs and mouth.
After a laryngectomy, the esophagus and trachea are no longer joined at any point. You’ll need to learn a new way of swallowing to account for this change. You’ll breathe through a hole in your neck called a stoma. The stoma is a substitute for the normal airway that’s destroyed during surgery.
Laryngectomy is a lengthy procedure that typically lasts between five and nine hours. The surgery is performed under general anesthesia. That means you’ll be asleep and won’t feel pain during the procedure.
Your healthcare team will perform a number of tests prior to your surgery to assess your health. You'll also meet with consultants, like speech therapists and swallowing specialists who’ll help you adjust to life after laryngectomy.
Preparation measures include:
- routine blood work
- physical exam
- smoking cessation counseling, if necessary
- nutritional counseling to help you learn how to eat healthily after surgery
- temporarily stopping medication use, including aspirin, ibuprofen, and blood thinners
- fasting after midnight the night before surgery
Let your doctor know if you’re allergic to any medications, including anesthesia and pain relievers.
The surgeon begins the procedure by making an incision in your neck through which they'll remove your voice box. Lymph nodes and part of your pharynx may also be removed, depending on the underlying cause of your laryngectomy. Lymph nodes are small organs located throughout your body that help fight infection, but can be affected by cancer.
Cancerous nodes from your neck will be removed, if needed.
Your pharynx is an air tube that connects your nose, larynx, and lungs. Cancer or radiation necrosis, a condition in which tissues in the pharynx have died, might require partial removal of your pharynx.
After removing the voice box, the doctor will create the stoma, a permanent hole about the size of a nickel in the front of the trachea. It links directly to your lungs so you can breathe.
Some people who have laryngectomies also have a tracheoesophageal puncture (TEP). A TEP is a small hole created in both the trachea and the esophagus. Once you’ve healed, a prosthetic voice box is inserted into the TEP so you can speak. Ask your doctor if you’re an ideal candidate for a TEP.
Your throat muscles and the skin on your neck will be closed with surgical stitches. You might have drainage tubes placed in your neck before you’re taken to the recovery room. The tubes drain the wounds of fluids and blood for several days after a laryngectomy.
Most laryngectomy patients spend the first couple of days after surgery in the intensive care unit (ICU). There, your healthcare provider will closely monitor your blood pressure, heart rate, breathing, and other vital signs. You'll receive oxygen through your stoma right after surgery.
You won't be able to eat through your mouth while your throat heals. A feeding tube that runs from your nose to your stomach or that’s inserted directly into your stomach will provide you with nutrition. Your neck will be swollen and painful. You’ll receive pain medication, as needed.
When your condition stabilizes, you’ll move to a regular hospital room. Expect to stay in the hospital for roughly a week after surgery. During this time, you’ll continue to heal, learn how to swallow again, and begin to learn how to communicate without a voice box.
Your doctor and nurses will encourage you to move around to prevent blood clots and muscle tone during recovery. They'll ask you to do things like stretch your arms and legs while in bed, turn your ankles and wrists in circles, and bend your elbows and knees.
Deep breathing exercises can reduce the likelihood of congestion in your lungs. You'll want to take 10 deep breaths every hour.
Learning to care for your stoma is part of the recovery process after a laryngectomy. The stoma opening can introduce bacteria and viruses into your body that lead to infection. Proper care can avoid this type of complication.
You'll want to clean the edges of the stoma with a cotton swab dipped in hydrogen peroxide. Use a swab to gently remove crusting and excess mucus. Crusting can impede the airflow to your lungs.
Coughing can help clear your stoma of mucus. If you're not strong enough to cough forcefully, you may need to manually suction out the stoma. Your healthcare provider can show you how to suction properly.
Humid air helps prevent crusting of the stoma. Use a humidifier in your home, especially in your bedroom at night. Your doctor might recommend you use a special mask that delivers humidified air directly to your stoma for a period of time. This is more common when a stoma is new. Once the skin around your stoma “matures,” or becomes used to the dry air, you’ll no longer need the mask.
Communicating after laryngectomy can be very challenging. Since your voice box is no longer in your body, you can't make sounds in the same way. Any person who’s had this form of surgery can learn to communicate. There are several different methods for communicating.
Nonverbal communication includes gestures, facial expressions, and mouthing words without using your voice. Writing is also a kind of nonverbal communication. Every laryngectomy patient must use nonverbal communication during the physical recovery process.
Some people learn “esophageal speech.” This form of speech uses the esophagus to produce vibrations in the same way as the vocal cords. Esophageal speech can be difficult to learn, but it's effective.
TEP speech uses the tracheoesophageal puncture that was created during your surgery. A second surgery is required to make a second hole within your stoma. A voice prosthesis, called a “communication hole,” is inserted into the hole. Cover your stoma with your finger when using TEP speech to produce sounds.
Long-term outlook for laryngectomy patients is promising. The most significant risk factor is blockage of the stoma, which cuts off air supply to the lungs.
Learning to live without a voice box can be scary, frustrating, and difficult, but it can be done with success.