What Is a Laryngectomy?
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.
Why Is Laryngectomy Done?
Removing the voice box is a radical
yet necessary treatment method for people who:
- have cancer of
- have sustained
severe injury to the neck, such as a gunshot wound
radiation necrosis (damage to the larynx stemming from radiation treatment)
Depending on your condition, your
doctor will perform a partial or complete laryngectomy.
Anatomy of the Neck
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
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.
Preparing for Laryngectomy
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
cessation counseling, if necessary
counseling to help you learn how to eat healthily after surgery
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
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.
Physical Recovery After
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
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
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
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.