What is a laryngectomy?
Laryngectomy is the surgical removal of the larynx. The larynx is the portion of your throat that houses your vocal cords, which allow you to produce sound. The larynx connects your nose and mouth to your lungs. It also protects your breathing system by keeping the things you eat or drink in your esophagus and out of your lungs.
If you have a laryngectomy, it will affect your speaking, swallowing, and breathing. You’ll need to learn new ways to perform all three tasks after surgery.
Removing the larynx is a serious yet necessary treatment 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.
There are two different pathways within your throat, one to your stomach and one to your lungs. The esophagus is the pathway to your stomach, and the larynx and trachea (windpipe) lead to your lungs.
When your larynx is in place, it shares a common space with the esophagus known as the pharynx. Laryngectomy removes the larynx, cutting off the connection between your mouth and lungs.
After a laryngectomy, the esophagus and trachea no longer share the common space. You’ll need to learn a new way of swallowing to account for this change. You’ll breathe through a surgical hole in your neck called a stoma. The stoma is a substitute for the normal breathing pathway that’s modified during surgery.
Laryngectomy is a lengthy procedure that typically lasts between five and twelve 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 prepare you for life after laryngectomy.
Preparation measures include:
- routine blood work and tests
- physical exam
- smoking cessation counseling, if necessary
- nutritional counseling to help you eat a healthy diet after surgery
- temporarily stopping certain medications, like aspirin, ibuprofen, and blood thinners
- fasting the night before surgery
Let your doctor know if you’re allergic to any medications, including antibiotics, anesthesia, and pain relievers.
The surgeon begins the procedure by making incisions in your neck through which he or she will remove your larynx. Lymph nodes and part of your pharynx may also be removed, depending on the underlying cause of your laryngectomy. Lymph nodes are part of your immune system and located throughout your body. They help fight infection, but they can also be affected by cancer.
Your pharynx is the common space in the back of your throat where your nasal passages, mouth, upper esophagus, and your larynx all meet. Treatment for cancer of your pharynx might involve partial removal of your pharynx. This is called a pharyngectomy.
After removing the larynx, the doctor will create the stoma, a permanent hole about the size of a nickel in the front of the trachea. It links directly from the outside to your lungs so you can breathe.
Some people who have laryngectomies also have a tracheoesophageal puncture (TEP) performed. By going through the stoma, a small hole is created in both the trachea and the esophagus. This can be done at the time as the laryngectomy surgery or during a second procedure afterwards. Something must always remain in place within the TEP in order to keep it open.
Once the surgery is complete, 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 surgical site 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). Your doctors 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 ten days after surgery. During this time, you’ll continue to heal, learn how to swallow again, and begin to learn how to communicate without your larynx.
Your doctor and nurses will encourage you to move around to prevent blood clots, decrease the risk of pneumonia, and help you get accustomed to your stoma and new ways of breathing. Getting up and out of bed is important for recovery. You may receive physical therapy, as well as speech and language therapy.
Learning to care for your stoma is an essential part of the recovery process after a laryngectomy. The stoma opening can introduce bacteria and viruses into your body that can lead to infection. Proper care can limit this type of complication.
You’ll want to clean the edges of the stoma with gauze and mild soap and water. Gently remove crusting and excess mucus. Salt water spray can help with this. Crusting can impede the airflow to your lungs. Your healthcare provider should provide you with detailed instructions, as well as information on what to do in case of emergencies.
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 so as not to cause infection.
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. Without your larynx, you can’t make sounds the same way. Any individual 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 picture boards, or mouthing words without using your voice. Writing by hand or typing on a computer are also kinds of nonverbal communication. Every laryngectomy patient must use nonverbal communication at some point during the physical recovery process.
Some people learn “esophageal speech.” In this form of speech, a person uses air from the mouth and traps it in the throat and upper esophagus. The controlled release of air produces vibrations and speech can be performed using the mouth, tongue, and lips. Esophageal speech can be difficult to learn, but it’s effective.
This type of speech can be used as soon as 3-5 days after surgery. You place the device against your neck or use an adapter for your mouth. It enhances your speech when you talk. The voice produced will sound automated and robotic but it is easy to learn and use. It can serve as a good short-term solution for some people and can remain a long-term solution as well.
TEP speech uses the surgically created tracheoesophageal puncture (TEP). A one-way valve is inserted through the TEP. This valve allows for air from the trachea to enter the esophagus, but material from the esophagus, like food and liquids, can’t enter the lungs. Often these devices are attached to a voice prosthesis, which helps you to speak. The prosthesis sits over the stoma.
With training, by covering the hole from the outside, people can learn to direct air from the lungs into the esophagus so that the vibrations can be heard as speech. “Hands free” voice prostheses have been developed which work based on varying amounts of air pressure to form speech. If interested, ask your doctor to see if a voice prosthesis is right for you.
The long-term outlook for laryngectomy patients is promising. The most significant risk factor is blockage of the stoma, which can cut off air supply to the lungs. Good education and consistent care are important in order to maintain a high quality of life after surgery.
Learning to live without a larynx can be scary, frustrating, and difficult, but it can be done with success. Many medical centers have support groups for people after laryngectomy surgery.