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, through which you produce sound. The larynx also lets air travel from your lungs to your mouth.
Laryngectomy affects your speech, swallowing, and breathing. You will need to learn new ways to perform all three tasks after a laryngectomy.
Surgical removal of 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, a partial or complete laryngectomy will be performed.
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 what’s known as your voice box.
The tubes have a joined section that is shared when you have a functioning voice box. The voice box is located in the middle section of the trachea, linking up your lungs and mouth. Larygectomy 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 will need to learn a new way of swallowing to account for this change. You will breathe through a hole in your neck called a stoma. The stoma is a substitute for the normal airway that is destroyed during surgery.
Preparing for Laryngectomy
Laryngectomy is a lengthy procedure that lasts between five and nine hours on average. The surgery is performed under general anesthesia, meaning you will be asleep and won’t feel pain during the procedure.
Your healthcare team will perform a number of tests and consultations prior to your surgery date to assess your health. Some of the consultants include speech therapists and swallowing specialists who will help you adjust to life after laryngectomy.
Preparation measures include:
- routine bloodwork
- 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 he or she will remove your voice box. Lymph nodes and part of your pharynx may also be removed, depending on the underlying cause of your larygenctomy. 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 during your laryngectomy.
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 have healed, a prosthetic voice box is inserted into the TEP so you can speak. Ask your doctor if you are 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 are taken to the recovery room. The tubes drain the wounds of fluids and blood for several days after a laryngectomy.
Physical Recovery After 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 will be given oxygen through your stoma immediately following the surgery.
You will not be able to eat orally while your throat heals. A feeding tube that runs from your nose to your stomach or that is inserted directly into your stomach will provide you with nutrition. Your neck will be swollen and painful. You will be given pain medication as needed.
When your condition proves to be stable, you will be moved to a regular hospital room. Expect to stay in the hospital for approximately a week after surgery. During this time, you will 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. Stretching your arms and legs while you are in bed can help. Turn your ankles and wrists in circles. Bend your elbows and knees.
Deep breathing exercises can reduce the likelihood of congestion in your lungs. 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. Care for your stoma properly to avoid this type of complication.
Clean the edges of the stoma with a cotton swab dipped in hydrogen peroxide. Gently remove crusting and excess mucus with the swab as well. Crusting can impede the airflow to your lungs.
Coughing can help clear your stoma of mucus. If you are 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 delivery system is usually needed when a stoma is new. Once the skin around your stoma “matures,” or becomes used to the dry air, you will no longer need the mask.
Communicating after laryngectomy can be one of the hardest challenges you will face. Because your voice box is no longer in your body, you cannot make sounds in the same way. Any person who has this form of surgery can learn to communicate. Comfort levels regarding the types of communication will vary.
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 is 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.