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By Dr Alankrita Bansal
Consultant ENT- Head And Neck Surgery
Overview Procedure Benefits Risks Care at Medicover Frequently Asked Questions

Laryngectomy

A laryngectomy is the most commonly performed surgery to remove cancer of the larynx. It may also be performed when gunshot wounds, severe fractures, or other trauma affect the larynx. Either the whole larynx (total laryngectomy) or part of the larynx (partial laryngectomy) can be removed. The surgery involves creating a new airway that opens in the lower neck for breathing. This new airway is permanent following a total laryngectomy, and temporary after a partial laryngectomy.

The larynx is situated at the point where the single tube that makes up the throat which is also known as the pharynx divides into a separate tract for food going through the esophagus to the stomach and air going to the through trachea(windpipe) to the lungs. The larynx serves an important function to protect the airway by ensuring that swallowed foods and liquids pass down to the esophagus rather than into the lungs.

The vocal folds which are responsible for sound generation in speech and singing, are also located in the larynx. The vocal folds vibrate and produce the sounds heard in voiced speech as air is exhaled through them. If the larynx is removed, air cannot pass from the lungs into the mouth. The surgeon will create a stoma in front of the trachea that will be linked directly to the lungs. The stoma allows the patient to breathe air on their own after the surgery.

Procedure

Before the procedure

  • Preprocedural evaluation includes a complete physical examination, blood tests and imaging studies.
  • A visit to a speech and swallowing therapist to prepare for changes following surgery.
  • Nutritional counseling.
  • Quit smoking before the procedure.
  • You may be asked to discontinue the use of aspirin, ibuprofen, clopidogrel, warfarin, and any other medications that make it difficult for your blood to clot.
  • You will be informed not to eat or drink anything 8 hours before your surgery.
  • Take the drugs your doctor told you to take with a small sip of water.

During the procedure

  • The operation is performed by administration of general anesthesia and depending on your diagnosis, your doctor may recommend either a partial laryngectomy or a total laryngectomy.
  • A total laryngectomy removes the entire larynx with its strap muscles and lymphoned in the jugular chain (Level II, III, and IV). Your surgeon will create an incision in the front of your neck during the procedure. Your surgeon will use careful and precise incisions to separate the larynx from the trachea and surrounding tissue.
  • Total laryngectomies will also necessitate a tracheostomy as the trachea is not attached to the larynx. The trachea (windpipe) is brought up to the skin in the front of the neck after the larynx is removed. The surgeon will then create a stoma (hole) through which you will be able to breathe. A tracheostomy tube is inserted into the stoma to keep the airway open. Once the stoma has healed, the tube is removed.
  • A partial laryngectomy is used for smaller laryngeal cancers where only a portion of the voice box needs to be removed. Partial laryngectomies are performed in the same way as total laryngectomies, due to localized swelling with this procedure, a temporary tracheostomy is required to maintain adequate airway.
  • Several types of partial laryngectomy procedures can be performed depending on the location of cancerous tissue. Only the top portion of the larynx is removed if cancer is present above the vocal cords. This enables the patient to retain normal speech.
  • In severe cases, surgeons will remove a single vocal cord from within the larynx (cordectomy). This allows the patient to retain some of the speech after surgery.
  • Despite the different approaches of the partial laryngectomies, the goal of the surgery is to preserve the vitality of the larynx as much as possible.

After the procedure

  • You may need to stay back in the hospital for several days after surgery.
  • You will be unable to speak after the procedure. Your stoma will be fitted with an oxygen mask.
  • To improve blood flow, keep your head raised, rest and frequently move your legs. Keeping your blood moving decreases your risk of blood clot.
  • Warm compresses can help relieve pain around incisions. You will be given pain medication.
  • An IV line(a tube that goes into a vein) and tube feedings will be provided for nutrition. Tube feedings are administered through a tube that is inserted through the nose into your esophagus (feeding tube).
  • You may be able to swallow food 2-3 days after surgery. However, 5 -7 days after surgery before beginning to eat through your mouth is advised. A swallow study is performed, in which contrast material is used to take an x-ray. This is done to ensure that there is no leakage before initiating to eat.
  • Your drain could be removed in two to three days. You are shown how to care for your stoma and laryngectomy tube. You must be careful not to allow water to enter your stoma.
  • Speech therapy with a speech therapist will assist you to relearn how to speak.
  • Heavy lifting, vigorous and strenuous activity should be avoided for 6 weeks. You can gradually resume your usual, light activities.
  • Attend the follow up appointments with your doctor as you are instructed.

Benefits and Risks of Laryngectomy

Benefits

A laryngectomy is benefitted by laryngeal cancer patients whose condition does not respond to other forms of conservative treatment and if there is already significant damage to the larynx that prevents normal function.

Risks

As with any other surgery, there are risks and possible complications involved with a laryngectomy. The risks and complications involved include:

  • Allergic reactions to medicines
  • Difficulty in breathing
  • Infection
  • Loss of voice
  • Swelling
  • Bleeding
  • Formation of Hematoma
  • Injury to the trachea or esophagus
  • Leakage around the tracheoesophageal puncture (TEP) and prosthesis
  • Fistula(connections of tissues that form between the pharynx and the skin)
  • The stoma opening may narrow or become too tight. This is known as stomal stenosis.
  • This procedure may result in nerve damage of the lower lip, tongue, palate, face, throat, shoulder, diaphragm, and skin sensation.
  • Complications from anesthesia
  • Problems swallowing and eating
  • Problems speaking
  • Recurrence of cancer

Laryngectomy Care at Medicover

At Medicover Hospital, we have an expert team of ENT surgeons to ensure the most accurate and timely diagnosis and treatment procedures for all our patients. We offer top notch facilities, latest evidence based treatment protocols and advanced technologies which has made us one of the best hospitals in India. We are one of the best laryngectomy hospitals providing best treatments at affordable costs in India.

Citations

https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/laryngectomy
https://www.healthdirect.gov.au/laryngectomy
https://www.swedish.org/services/head-and-neck-surgery/our-services/laryngectomy
https://www.providence.org/treatments/Laryngectomy

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Frequently Asked Questions

1. What happens when you get a laryngectomy?

The esophagus and trachea do not share the same space following laryngectomy. To account for this change, you'll need to learn a new swallowing technique. You'll be able to breathe through a surgical hole in your neck known as a stoma.

2. How long after a laryngectomy can you speak?

You may not be able to speak normally if you had a total laryngectomy because you will no longer have vocal cords. You can learn to speak again in a variety of ways, though it may take weeks or months.

3. What is the difference between a tracheostomy and laryngectomy?

A tracheostomy is used to assist in breathing, whereas a laryngectomy is used when the larynx must be removed and separated from the airway.

4. Can you choke after a laryngectomy?

Yes. Following surgery, food or liquid may enter your airway rather than your esophagus. This is known as aspiration, and it can cause you to cough or choke.

5. Who performs laryngectomy surgery?

ENT surgeons or otolaryngologists perform laryngectomy surgery.