A laryngectomy is a surgical procedure to remove all or part of the larynx (voice box). This procedure is commonly performed to treat cancer of the larynx, or to remove tissue that has become necrotic as a result of radiation treatment. A laryngectomy may also be performed to repair traumatic injury to the larynx caused by an accident or a criminal attack. After a partial laryngectomy, most patients will still be able to speak, although the voice may be softer or more raspy after the surgery. If a full laryngectomy is performed, the patient will have to learn to speak artificially through a prosthesis.
The Laryngectomy Procedure
A laryngectomy procedure is performed in a hospital under general anesthesia. The surgeon makes an incision in the neck to expose the area, providing a full view of the larynx. The malignant or damaged part of the larynx is surgically removed and healthy tissue is, as much as possible, left intact. If all of the larynx must be removed because of a cancer, part of the pharynx, or throat, and some nearby lymph nodes may also be removed. If the entire larynx has been removed, a tracheoesophaheal puncture (TEP) will also be performed. The TEP is a procedure during which a small hole is made in the trachea and in the esophagus into which the surgeon inserts a miniature prosthesis that will allow the patient to speak mechanically without a voice box.
A tracheostomy is necessary during a laryngectomy to provide a pathway for air directly into the trachea. During a partial laryngectomy, the tracheostomy will be temporarily left in place for several days after the surgery. After a full laryngectomy, the tracheostomy will remain permanently, and the patient will continue to breathe through the stoma, the hole in the trachea.
After the Laryngectomy Procedure
A laryngectomy is a major surgical procedure and the patient is required to stay in the hospital for several days after the operation. During this time, the patient will receive intravenous fluids and medications and will be unable to speak. Nutrition will be administered through a nasal tube. After 2 to 3 days, the drain which has been inserted in the trachea will be removed. After a week or less, the patient will be able to begin consuming soft foods and liquids. If a full laryngectomy has been performed, the patient will be taught to care for the stoma and tracheostomy tube. Since it is imperative that water be kept out of the stoma, the patient will be carefully instructed in a safe protocol for showering and swimming.
Following a laryngectomy, the patient will have to avoid heavy lifting and strenuous activity for 6 weeks. Voice rehabilitation therapy will also be necessary.
Risks of the Laryngectomy
While this procedure is considered safe for most patients, there are certain risks associated with any type of surgical procedure. Some of these risks may include:
- Excessive Bleeding
- Allergic reaction to anesthesia or medications
- Breathing problems
Specific risks related to the laryngectomy procedure may include:
- Difficulty swallowing and eating
- Leaking around the stoma
- Stomal stenosis, a tightening of the stoma
- Damage to the esophagus or trachea
There are serious readjustments necessary for patients who have undergone a laryngectomy, including relearning speech, adjusting to differences in voice quality, caring for the stoma, and dealing with the response of others to their new condition. Women may experience voice deepening after this procedure.