What is a Laryngectomy?
ENT Specialist, Jaslok Hospital, 13 years of experience
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What is a Laryngectomy?
Laryngectomy is the surgery performed to remove the larynx (voice box) and to separate the airway from the mouth, nose, and esophagus (food pipe). This surgery is performed in cases of cancer of the larynx or severe injury to the neck.
The larynx is the part of our throat that contains the vocal cords, which help us to produce sound. The larynx connects our nose and mouth to the lungs. It prevents the entry of food into the lungs and protects the respiratory system.
It affects a person’s ability to swallow, speak and breathe. Thus, after surgery, a person has to adopt some new methods to perform all these tasks. Let us explain in detail about laryngectomy in today’s article.
- What are the causes for Laryngectomy?
- Preparation before Laryngectomy
- What is the procedure of Laryngectomy?
- How to take care after a Laryngectomy?
- What are the methods of communication in Laryngectomized patients?
- What are the complications of Laryngectomy?
- What is the cost of a Laryngectomy in India?
What are the causes of Laryngectomy?
Removal of the larynx is a serious yet necessary treatment in the following cases-
- Cancer of the larynx. In conditions where cancer has progressed such that it prevents the normal functioning of the larynx or when the other conservative treatments fail to work.
- Severe injury to the neck such as a gunshot wound
- Radiation necrosis is damage to the larynx arising from radiation treatment ( Know more about- What is Thyroid Cancer? )
Preparation before Laryngectomy
Laryngectomy is a lengthy procedure and usually lasts between 5 to 12 hours. It is performed under general anesthesia.
Preparation measures are as follows:
- Physical examination and history taking with complete details of allergies
- Routine blood investigations
- Imaging techniques- CT scan and MRI
- Fasting the night before surgery
- The doctor may ask you to temporarily stop some medications
What is the procedure of Laryngectomy?
Laryngectomy is a surgical procedure that is done to remove the larynx. It can be done in two ways-Total Laryngectomy and Partial Laryngectomy; depending upon the location and extent of cancer.
- Total Laryngectomy – This procedure involves the removal of the entire voice box (larynx) including the vocal cords, hyoid bone, epiglottis, thyroid, and cricoid cartilage. An incision (cut) is made in the neck to get full access to your larynx for removing the voice box and surrounding lymph nodes. The lobes of the thyroid gland are removed as well. After removing the larynx, a permanent hole is created in front of the trachea (windpipe) called a stoma. This is known as Tracheostomy. It directly links the outside to the lungs to facilitate breathing. After a total laryngectomy, the tracheostomy remains permanently. Total laryngectomy is done in advanced cancers of the larynx or its recurrence even after chemotherapy/radiotherapy and occasionally even in advanced thyroid cancer that invades the larynx. (Know more about: What is throat cancer? )
- Partial Laryngectomy – This involves removing only those parts of the larynx that are affected by cancer. In this type, the person’s ability to speak and swallow is maintained. After a partial laryngectomy, the tracheostomy (hole in the trachea) will usually be temporary. There are various types of partial laryngectomy depending on the structures removed. These include:
- Cordectomy- removal of the vocal cords
- Frontolateral laryngectomy- removal of vocal cords along with the anterior parts of the contralateral cord
- Hemilaryngectomy- removal of one side of the voice box
Following the surgery (either total or partial laryngectomy), the person breathes through the opening created in the neck called the Stoma.
In some cases of laryngectomy, a Tracheoesophageal Puncture (TEP) is also performed. It is the most common way to restore speech after the removal of the larynx. This can be done as a part of the laryngectomy operation or later as a minor operation usually at least 8 weeks after the laryngectomy.
After the surgery is complete, the patient’s throat muscles and the skin on the neck are packed with stitches. There will be drainage tubes placed in the neck that drain the surgical site of fluids and blood for some days after the surgery.
There are many specialized general surgeons and hospitals in India where Thyroidectomy, Laryngectomy procedures, etc are done with great success.
How to take care after a Laryngectomy?
- After surgery, the patient is usually kept in the Intensive Care Unit (ICU) for a couple of days. The patient’s heart rate, blood pressure, breathing, and other vital signs are monitored closely.
- Oxygen will be given through the stoma right after the surgery.
- The patient is unable to eat through the mouth during the healing period. So, a feeding tube is inserted through the mouth which carries food directly into the stomach and the patient slowly learns how to swallow again.
- After some days, the patient should walk around a little to prevent the formation of blood clots.
- Speech rehabilitation is advised for the patient to learn how to speak again without the larynx. ( Know more about- What is Hoarseness in Voice? )
- Taking care of the stoma is of utmost importance as this opening can let bacteria and viruses enter the body and cause infections. Thus, the patient must learn how to take care of the stoma by cleaning it regularly using mild soap with water or salt water spray. (Know more about: How to clean throat)
- Use a humidifier at home as humid air helps prevent crusting of the stoma and thus, will not hamper the airflow to the lungs. A special mask may be suggested for the same in the initial days.
- The patient may receive speech and language therapy along with physical therapy to get used to the new ways of swallowing, speaking and breathing. (Read more: What is Speech Therapy)
What are the methods of communication in Laryngectomized patients?
- Nonverbal communication like gestures, facial expressions, pen, and paper.
- Aphonic lip speech. This is done by trapping air in the buccal cavity and is often combined with sign language.
- Esophageal speech. In this, the person uses air from the mouth and traps it in the throat and upper part of the esophagus. This form of speech is difficult to learn but it is effective.
- Electrolarynx. It is a device placed against the neck that enhances the speech when the patient talks. It can be used after 3 to 5 days of surgery. It is easy to learn and use although the voice produced will sound robotic.
What are the complications of Laryngectomy?
The risks associated with laryngectomy are as follows-
- Extreme blood loss during the surgery
- Infection at the site of stoma or incision
- Formation of a salivary fistula in which saliva leaks from the pharynx to the neck
- Removal of the parathyroid and thyroid glands can result in temporary Hypocalcemia (low levels of Calcium in the blood) and Hypothyroidism (deficiency of Thyroid hormone) respectively (Know more about: What is Hypothyroidism?)
- Stomal stenosis i.e. blockage of the stoma which will affect the air supply to the lungs
What is the cost of a Laryngectomy in India?
The total cost of a Laryngectomy surgery in India can range from around INR 2,00,000 to INR 3,00,000. In addition to this, speech rehabilitation will also add up to the existing expenses. The cost may differ across various hospitals and cities.
If you are coming from abroad, in addition to the cost of laryngectomy, there will be an additional cost of accommodation and food, the cost of local travel, etc. So the total cost of a Laryngectomy can range around INR 350,000.
We hope that we could answer your questions regarding Laryngectomy through this article.
If you want more information and treatment of Laryngectomy, you can contact an ENT Specialist.
We only aim to give you information through this article. We do not recommend medication, treatment in any way. Only a doctor can give you the best advice.
