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Laryngectomy
Laryngectomy is a surgical procedure performed to remove all or part of the larynx or voice box.
The larynx or voice box is a part of the respiratory tract that contains the vocal cords. It is situated on the top of the trachea or windpipe in the upper portion of the neck and it allows air to pass from the mouth into the lungs.
Having a laryngectomy will permanently affect the way you speak, breath, and swallow.
A person breathes through a tracheostomy following a laryngectomy, which is an opening or stoma in the front of the neck to allow the air to move in and out of the lungs. The stoma may be temporary or permanent depending on the type of laryngectomy that a person has.
Purpose: A laryngectomy is recommended in the following cases:
-
Cancer of the larynx
-
Development of radiation necrosis (damage to the larynx due to radiation treatment)
-
Severe injury to the neck, like a gunshot wound
The following diagnostic tests may be performed before a laryngectomy procedure:
- Physical examination: The doctor evaluates the physical health of the patient. The symptoms and medical history of the patient are noted.
- Chest x-ray: It helps in checking the condition of the internal organs in the chest region, that is, the heart and lungs.
- Blood tests: These tests are done to evaluate the various blood parameters and check for underlying medical conditions like diabetes and thyroid disorders.
- 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.
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Laryngectomy
Laryngectomy is a surgical procedure performed to remove all or part of the larynx or voice box.
The larynx or voice box is a part of the respiratory tract that contains the vocal cords. It is situated on the top of the trachea or windpipe in the upper portion of the neck and it allows air to pass from the mouth into the lungs.
Having a laryngectomy will permanently affect the way you speak, breath, and swallow.
A person breathes through a tracheostomy following a laryngectomy, which is an opening or stoma in the front of the neck to allow the air to move in and out of the lungs. The stoma may be temporary or permanent depending on the type of laryngectomy that a person has.
Types:
The different types of laryngectomy procedures include:
- Total laryngectomy: It is a surgical procedure performed to remove the entire larynx. The patient requires a permanent tracheostomy stoma.
- Partial laryngectomy: It is a surgical procedure performed to remove a part of the larynx. In some cases, the tracheostomy stoma may be temporary.
- Hemilaryngectomy: It is a type of partial laryngectomy involving the removal of only one of the two vocal cords present.
- Supraglottic laryngectomy: It is a type of partial laryngectomy involving the removal of that portion of the larynx that is located above the vocal cords (known as the supraglottis). Speech tends to remain normal after this type of surgery.
Symptoms
Purpose: A laryngectomy is recommended in the following cases:
-
Cancer of the larynx
-
Development of radiation necrosis (damage to the larynx due to radiation treatment)
-
Severe injury to the neck, like a gunshot wound
Diagnosis
The following diagnostic tests may be performed before a laryngectomy procedure:
- Physical examination: The doctor evaluates the physical health of the patient. The symptoms and medical history of the patient are noted.
- Chest x-ray: It helps in checking the condition of the internal organs in the chest region, that is, the heart and lungs.
- Blood tests: These tests are done to evaluate the various blood parameters and check for underlying medical conditions like diabetes and thyroid disorders.
- Electrocardiogram (ECG): This test helps in measuring the electrical activity of the heart and checking for various heart problems.
Treatment
- 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.
Risks
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
After Procedure
- 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.
FAQ Section
The surgical removal of the larynx or voice box is known as laryngectomy.
The larynx is a portion of the throat containing vocal cords, which allows the production of sound.
The larynx connects the nose and mouth to the lungs and protects the breathing system by keeping the things that one eats and drinks in the food pipe (esophagus) and out of the lungs.
The different types of laryngectomy procedures include:
- Partial laryngectomy: This procedure involves the removal of only a part of the larynx, and is usually done in the case of smaller tumors that may be present.
- Supraglottic laryngectomy: This procedure involves the removal of some of the larynx that is located above the vocal cords. The person can still maintain their normal speaking voice after this procedure.
- Hemilaryngectomy: This procedure involves the removal of only one vocal cord and is a type of treatment for small cancers of the vocal cords. A person can have limited speech after this procedure.
- Total laryngectomy: This procedure involves the complete removal of the larynx. It affects a person’s ability to speak normally.
Laryngectomy is generally performed in the following conditions:
- Cancer of the larynx
- Severe injury or damage to the neck, for example, in case of a gunshot wound
- Chondronecrosis of the larynx (a complication in which there is damage to the larynx due to radiation exposure)
The following symptoms may indicate the need for a laryngectomy procedure:
- Persistent coughing
- Pain during swallowing
- Hoarseness in voice
- Lump in the neck region
- Difficulty in breathing
An otolaryngologist, also known as an ENT (ear, nose, throat) specialist, performs a laryngectomy procedure.
The following are some of the routine diagnostic tests that may be performed before a laryngectomy procedure:
- Physical examination: The doctor checks the patient physically. The symptoms and complete medical history of the patient are also noted.
- Chest x-ray: It helps in checking the condition of the heart and lungs.
- Blood tests: These tests are done to check the different parameters of blood and check for underlying medical conditions like diabetes and thyroid disorders.
- Electrocardiogram (ECG): This test helps in recording the electrical activity of the heart. The different heart problems can be evaluated using this test.
The following preparation may be needed for a laryngectomy procedure:
- Inform the doctor if the patient has any medical diseases.
- Inform the doctor if the patient is taking any supplements, medications, or herbs.
- If the patient is sensitive or allergic to any medicines, anesthetic agents, latex, iodine, or tape, inform the doctor about the same.
- Stop smoking as soon as possible.
- The patient needs to lose any excess weight that he/she may be having by following a proper diet and exercise plan.
- The patient needs to meet a speech and swallowing therapist, and a nutritional counselor before the surgery.
- The doctor may recommend stopping blood-thinning medications like warfarin and aspirin a few days before the procedure.
- The patient is asked to not eat or drink anything eight hours before the procedure.
The laryngectomy procedure is performed as follows:
- The surgery is done under general anesthesia, that is, the patient is made unconscious during the procedure.
- The surgeon will first make incisions or cuts in the neck region to remove the larynx.
- Lymph nodes, which are present everywhere in the body and are a part of the body’s immune system that helps to fight infection, and a part of the pharynx (throat) can also be removed by the surgeon, depending on the reason for performing laryngectomy.
- A part of the pharynx may be removed to treat pharynx cancer. This procedure is called pharyngectomy.
- After the larynx is removed, the doctor creates a permanent hole or stoma in front of the trachea or windpipe.
- This stoma links directly from the outside to the lungs, allowing the patient to breathe.
- Some people may have a tracheoesophageal puncture (TEP) performed along with laryngectomy, either at the same time or as a subsequent procedure done afterward.
- TEP involves the creation of a small hole by the surgeon in the trachea (windpipe) and esophagus (food pipe).
- A man-made device or prosthesis is placed into the TEP opening. This prosthesis helps the patient to speak after the removal of the larynx.
- T doctor uses sutures or stitches to close the throat muscles and the skin on the neck after the procedure.
- The surgeon places drainage tubes in the neck before the patient is taken to the recovery room. These drainage tubes help in draining the surgical site of fluids and blood for several days following the surgery.
- The surgery takes approximately five to nine hours to complete.
The following are the post-procedure steps following a laryngectomy:
- 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.
It is important to take care of the stoma to avoid irritation to the lungs and prevent the development of an infection. The following can be done to take care of the stoma:
1. Keep the stoma moist: In normal circumstances, when one breathes through his/her mouth and nose, the air is moistened before reaching the lungs. This does not occur when one breathes after a laryngectomy. The moisture can be replaced in any one of the following ways:
Drink lots of fluids and water
Spray a sterile salt solution into the tube
Use a filter and moisturizing system
Use humidifiers in the home
2. Protect the stoma: Protect the stoma from the following:
Extreme temperature fluctuations
Smoke
Dust
Fumes from air polluters or traffic
3. Care for the skin around the stoma: The patient needs to keep the stoma clean in the following ways:
Cleaning the edges by using a gauze pad dipped in mild soapy water.
Using a saltwater spray to loosen any crust or excess mucus that may be present, and then remove it.
Dry the skin after cleaning it.
An antibiotic cream may be prescribed by the doctor, that can be applied to the skin.
Coughing forcefully helps in clearing the stoma using a suction (soft plastic) tube. This tube should be changed and cleaned regularly.
A speech therapist will help the patient in speech rehabilitation following a laryngectomy. The different ways of communication after the removal of the larynx include:
- Nonverbal communication: This form of communication includes facial expressions, gestures, mouthing words without using voice, and picture boards.
- Esophageal speech: A person uses air from the mouth and traps it in the upper esophagus and throat. The controlled air release helps in producing vibrations and speech can be obtained using the tongue, lips, and mouth.
- Electrolarynx: This type of speech can be used 3 to 5 days after the procedure. A device is placed against the neck, or an adapter is used for the mouth. This helps in enhancing the speech on talking. The voice produced sounds robotic, but it is easy to learn as well as use.
- TEP speech: A one-way valve is inserted through the TEP to allow the air from the trachea to enter the esophagus, without the entry of food and liquids consumed. These devices are often attached to a voice prosthesis that sits over the stroma and helps one in speaking. Training is provided to the patient after covering the hole from outside to direct the air from the lungs into the food pipe, such that the vibrations can be heard as speech.
The complications associated with a laryngectomy procedure may include:
- Infection
- Bleeding
- Blood clot formation
- Allergic reaction to the anesthesia used
- Esophagus (food pipe) damage
- Trachea (windpipe) damage
- Decreased function of the thyroid gland
- Limitations in the mobility in the neck and shoulder region
- Fistula formation, which is an abnormal connection between the pharynx (throat) and skin
- Problems associated with the stoma opening
- Trouble in speaking, eating, or swallowing
The total cost of laryngectomy in India varies according to the purpose of laryngectomy, the severity of the condition, the type of laryngectomy performed, and the overall health of the patient.
The cost is different among different ENT surgeons in different hospitals. In general, the cost of a laryngectomy procedure in India varies from INR 2,10,000 to INR 3,25,000.