Laryngectomy

The following diagnostic tests may be performed before a laryngectomy procedure:

1. Physical examination: The doctor evaluates the physical health of the patient. The symptoms and medical history of the patient are noted.
2. Chest x-ray: It helps in checking the condition of the internal organs in the chest region, that is, the heart and lungs.
3. Blood tests: These tests are done to evaluate the various blood parameters and check for underlying medical conditions like diabetes and thyroid disorders.
4. Electrocardiogram (ECG): This test helps in measuring the electrical activity of the heart and checking for various heart problems.

• The procedure is performed under general anesthesia, that is, the patient is put to sleep during the procedure.
• The surgeon first makes incisions or cuts in the neck area to remove the larynx.
• Lymph nodes (a part of the immune system that helps to fight infection, and can be affected by cancer) and a part of the pharynx (throat) may also be removed by the surgeon, depending on the purpose of laryngectomy.
• The doctor may remove a part of the pharynx to treat cancer of the pharynx. This procedure is known as pharyngectomy.
• Once the larynx is removed, the doctor creates a stoma or permanent hole in front of the trachea.
• The stoma links directly from the outside to the lungs so that the patient can breathe.
• Certain people who have had laryngectomies may also have a tracheoesophageal puncture (TEP) performed, either at the same time or as a second procedure afterward.
• TEP involves the creation of a small hole in both the trachea and esophagus.
• A man-made prosthesis is placed into the opening of a TEP. This prosthesis allows a person to speak after the removal of the voice box.
• After the surgical procedure is complete, the throat muscles and the skin on the neck are closed using surgical stitches.
• Drainage tubes may be placed in the neck before the patient is taken to the recovery room.
• The drainage tubes help in draining the surgical site of blood and fluids for many days following a laryngectomy.
• The entire procedure may take five to nine hours to complete.

The complications associated with laryngectomy include:

• Bleeding
• Infection
• Blood clot formation
• Allergic reaction to anesthesia
• Aspiration of liquid or food into the airways
• Excessive swelling
• Depression
• Fistula formation (an abnormal connection between tissues) that may need an additional surgery
• Wound healing problems
• Injury to the esophagus (food pipe) or trachea (windpipe)
• Problems in swallowing, speaking, and eating
• Stoma narrowing, which may affect breathing 
• Loss of weight
• Saliva that leaks out on the skin
• Thyroid problems 
• Carotid artery (which is the large artery on the sides of the neck) rupture

• The patient needs to stay in the hospital for many days after the procedure.
• It is normal for the patient to feel groggy and not be able to speak after the procedure.
• An oxygen mask is placed on the stoma.
• It is important for the patient to keep his/her head raised, take adequate rest, and move his/her legs from time to time to improve the flow of blood.
• The movement of blood reduces the chances of developing a blood clot.
• Warm compresses may be used by the patient to reduce the pain around the incisions.
• The doctor may recommend pain-relieving medications to relieve the pain and discomfort of the patient.
• The patient is provided nutrition through an IV, which is a tube that goes into a vein, and tube feedings.
• The tube feedings are given through a feeding tube that goes through the nose into the esophagus.
• The patient is allowed to swallow food 2 to 3 days after the procedure. However, it is recommended to wait for 5 to 7 days after the surgery before the patient can start eating through his/her mouth.
• The doctor may recommend a barium swallow test before a patient starts to eat. This test involves taking an x-ray while drinking barium containing contrast material. This test ensures that there is no leakage before the party starts to eat.
• The drain may be removed approximately 2 to 3 days after the surgery.
• The patient is taught how to care for the stoma and laryngectomy tube. The patient is taught how to shower safely so that no water enters through the stoma.
• A speech therapist provides the patient with speech rehabilitation and helps the patient in relearning how to speak.
• The patient is instructed to avoid heavy lifting and strenuous activities for approximately 6 weeks after the procedure. 
• The patient may slowly resume light, normal activities.
• The wounds may take approximately 2 to 3 weeks to heal. Full recovery may take about a month.
• The patient eventually learns how to make lifestyle changes and live without a voice box.
• Other forms of treatments like chemotherapy or radiation therapy may be needed after the procedure in case of suspected cancer.
• The patient can usually resume his/her oral diet about two weeks after the surgery and also start working with a speech therapist for the development of speech.