What is a laryngectomy?
A laryngectomy is surgery to remove all or part of the larynx (voice box) to treat cancer of the larynx or severe trauma to the larynx. The larynx is a part of the respiratory tract and contains the vocal cords. It is located at the top of the trachea (windpipe) in the upper part of the neck. It allows air to pass from your mouth into your lungs.
Removing the larynx will permanently affect your voice and change the way you breathe. After a laryngectomy, you will breathe through a tracheostomy. This is an opening (stoma) in the front of your neck to allow air to move in and out of the lungs. The stoma may be permanent or temporary depending on the type of laryngectomy you have.
Laryngectomy is a common but major surgery with serious risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about your treatment options before having a laryngectomy.
Types of laryngectomy
The types of laryngectomy include:
Total laryngectomy is surgery to remove the entire larynx. It requires a permanent tracheostomy stoma.
Partial laryngectomy is surgery to remove part of the larynx. The tracheostomy stoma may be temporary in some cases.
Hemilaryngectomy is a type of partial laryngectomy that involves removing only one of the two vocal cords.
Supraglottic laryngectomy is a type of partial laryngectomy that involves removing the portion of the larynx located above the vocal cords (supraglottis). Speech remains normal after this surgery.
Other procedures that may be performed
Your doctor may perform other procedures in addition to laryngectomy. These include:
Gastrostomy is surgery to place a feeding tube, or G tube, through the skin and muscle of your abdomen directly in your stomach to provide nutrition during recovery.
Neck dissection is the removal of lymph glands and other tissues in your neck that may have cancer.
Reconstruction is surgery to restore the structure and function of your throat.
Tracheostomy is surgery to create an opening (stoma) about the size of a nickel through the front of the neck to provide a pathway for breathing. A tracheostomy tube or trach tube allows air to move in and out of the lungs through the opening. The tracheostomy may be permanent for a total laryngectomy or temporary for a partial laryngectomy.
Tracheo-esophageal puncture (TEP) is surgery to restore speech in people who have total laryngectomy. During TEP a small puncture is created between the windpipe and esophagus. A valve in the puncture site allows air to move from your lungs to your mouth creating speech. Your doctor may perform TEP during laryngectomy or at a later time.
Why is a laryngectomy performed?
Your doctor may recommend laryngectomy to treat cancer of the larynx. Your doctor will only consider a laryngectomy for you if other treatment options that involve less risk of complications have been ineffective. Laryngectomy may also be necessary to treat severe injury to the larynx from trauma or as a consequence of radiation therapy. Ask your doctor about all of your treatment options and consider getting a second opinion.
Who performs laryngectomy?
Otolaryngologists usually perform laryngectomies. An otolaryngologist specializes in the medical and surgical treatment of diseases and disorders of the ear, nose, throat, and related structures of the head and neck. They are also known as ear, nose and throat, or ENT doctors. Some ENTs further specialize in head and neck surgery.
How is a laryngectomy performed?
Your doctor will perform a laryngectomy in a hospital. It involves making a cut in the skin on your neck and separating the muscles attached to your larynx. Your doctor will remove either the entire larynx and surrounding tissue or only the tumor and part of the larynx. Your doctor will create an opening (stoma) in the neck, connect the trachea, and insert a tracheostomy tube. You will also have drainage tubes to drain blood and fluid.
Your doctor will advise you on how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference.
Types of anesthesia that may be used
Your doctor will perform a laryngectomy using general anesthesia. General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain.
What to expect the day of your laryngectomy
The day of your surgery, you can expect to:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure that you understand and sign the surgical consent.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member if possible. The surgical team will give you blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have.
A surgical team member will start an IV.
The anesthesiologist or nurse anesthetist will start your anesthesia.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of a laryngectomy?
As with all surgeries, a laryngectomy involves risks and potential complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock
Infection
Potential complications of a laryngectomy
Complications of a laryngectomy can be serious and include:
Aspiration of food or liquid into the airways
Excessive swelling or bleeding
Fistulas (abnormal connections between tissues) requiring additional surgery
Infection or wound healing problems
Injury to the trachea (windpipe) or esophagus
Narrowing of the stoma, which may affect breathing
Problems speaking, swallowing and eating
Problems with the thyroid and parathyroid glands (rare)
Rupture of the carotid artery, the large artery on the sides of the neck (rare)
Saliva leaking out on the skin
Weight loss
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before your procedure and during recovery
Informing your doctor if you are nursing or if there is any possibility that you may be pregnant
Notifying your doctor immediately of any concerns, such as bleeding, breathing and swallowing problems, fever, or increase in pain
Taking your medications exactly as directed
Telling all members of your care team if you have allergies
How do I prepare for my laryngectomy?
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome. You can prepare for a laryngectomy by:
Answering all questions about your medical history, allergies, and medications you take. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Losing excess weight before the surgery through a healthy diet and exercise plan.
Meeting with a nutritional counselor and speech and swallowing therapist before surgery.
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of your surgery because you can choke on stomach contents during general anesthesia.
Stopping smoking as soon as possible.
Taking or stopping medications exactly as directed. For a laryngectomy, this may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. Your doctor will give you instructions for taking your specific medications and supplements.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your surgeon with concerns and questions before surgery and between appointments.
It is also a good idea to bring a list of questions to your preoperative appointments. Questions can include:
Why do I need a laryngectomy? Are there any other options for treating my condition?
What type of laryngectomy procedure do I need?
If you find a problem or another condition during surgery, will you treat it right away or will I need more surgery later?
How long will the surgery take? When can I go home?
What kind of restrictions will I have after the procedure? When can I return to work and other activities?
What kind of assistance will I need at home?
What medications will I need before and after the surgery?
How will you manage my pain?
How will laryngectomy affect my voice? What options are available for restoring my speech?
When should I follow-up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
Where can I find more information and support?
What can I expect after my laryngectomy?
Knowing what to expect can help make your road to recovery after laryngectomy as smooth as possible.
How long will it take to recover?
You will go to an intensive care unit (ICU) after surgery and initial recovery. ICUs provide 24-hour specialized monitoring and care.
It will take a few hours until the major effects of anesthesia wear off and you are alert. You will not be able to speak. An oxygen mask will be over your stoma and you will have a number of tubes attached to your body. These allow your team to monitor your vital signs, drain bodily fluids, take blood, and give medications and fluids.
You will get nutrition through an IV or feeding tube at first. You will start eating through your mouth about five to seven days after surgery or sooner if you are able to swallow.
You will need to wear boots or special socks to help prevent blood clots from developing in your legs. You will need to move your legs and arms as much as possible to increase circulation.
You will stay in the hospital about one to two weeks after a laryngectomy. Typically, your care team will remove your trachea drains after five days. Your stitches will come out about one week after surgery.
Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, your age, and other factors. It may take two to three weeks for your wound to heal. Full recovery takes about a month.
Your healthcare team will explain how to care for your stoma to prevent airway blockage and infection. This may include:
- Cleaning and suctioning the stoma
- Keeping water out of your stoma. You will be given a shower hood to cover the stoma when showering.
- Using a mist hood over your stoma
You will need to avoid heavy lifting and strenuous activity for six weeks or as directed by your doctor.
Your doctor will recommend a speech rehabilitation program to help you regain speech.
Will I feel pain?
Pain control is an important element to healing and a smooth recovery. There will be discomfort after your surgery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes because it can be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after laryngectomy. Call your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
- Bleeding
- Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
- Change in alertness, such as passing out, unresponsiveness, or confusion
- Chest pain, chest tightness, chest pressure, or palpitations
- Difficulty swallowing or eating
- Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery. It is not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
- Headache, muscle aches or lightheadedness
- Inability to urinate or have a bowel movement
- Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot
- Nausea and vomiting that does not respond to your medication or lasts longer than two days after hospital discharge
- Pain that is not controlled by your pain medication
- Reduction in size of your tracheostomy
- Saliva leaking through your incision
- Unexpected drainage, pus, redness or swelling of your incision
How might a laryngectomy affect my everyday life?
A laryngectomy may cure your condition. However, a laryngectomy can cause significant changes to your body that can affect your everyday life, such as:
- Changes in your ability to speak normally. Speech rehabilitation and the use of speaking aids can help you regain your ability to speak, although your voice will sound different.
- Depression as a result of changes to your voice and appearance
- Problems with breathing that may require additional surgery and the placement of a permanent tracheostomy
- Problems with swallowing that may require the placement of a permanent feeding tube
- Reduction in your ability to smell and taste
Support groups are available to help you cope with these changes.
