Definition

Laryngectomy is surgery to remove all or part of the larynx (voice box).

Alternative Names

Complete laryngectomy; Total laryngectomy; Partial laryngectomy

Description

Laryngectomy is major surgery that is done in the hospital. Before surgery you will receive general anesthesia. You will be asleep and pain-free.

Total laryngectomy removes the whole larynx. Part of your pharynx may be taken out as well. Your pharynx is the mucous membrane-lined passage between your nasal passages and esophagus.

• The surgeon will make a cut in your neck to open up the area. Care is taken to preserve major blood vessels and other important structures.
• The larynx and tissue around it will be removed. The lymph nodes may also be removed.
• The surgeon will then make an opening in your trachea and a hole in front of your neck. Your trachea will be attached to this hole. The hole is called a stoma. After surgery you will breathe through your stoma. It will never be removed.
• Your esophagus, muscles, and skin will be closed with stitches or clips. You may have tubes coming from your wound for a while after surgery.

The surgeon may also do a tracheoesophageal puncture (TEP).

• A TEP is a small hole in your windpipe (trachea) and the tube that moves food from your throat to your stomach (esophagus).
• Your surgeon will place a small man-made part (prosthesis) into this opening. The prosthesis will allow you to speak after your voice box has been removed.

There are many less invasive surgeries to remove part of the larynx.

• The names of some of these procedures are endoscopic (or transoral resection), vertical partial laryngectomy, horizontal or supraglottic partial laryngectomy, and supracricoid partial laryngectomy.
• These procedures may work for some people. The surgery you have depends on how much your cancer has spread and what type of cancer you have.

The surgery can take 5 to 9 hours.

Why the Procedure Is Performed

Most often, laryngectomy is done to treat cancer of the larynx. It is also done to treat:

• Severe trauma, such as a gunshot wound or other injury.
• Severe damage to the larynx from radiation treatment. This is called radiation necrosis.

Risks

Risks for any surgery are:

• Allergic reactions to medicines
• Breathing problems
• Heart problems
• Bleeding
• Infection

Risks for this surgery are:

• Hematoma (a buildup of blood outside the blood vessels)
• Wound infection
• Fistulas (tissue connections that form between the pharynx and the skin that are not normally there)
• The stoma opening may become too small or tight. This is called stomal stenosis.
• Leaking around the tracheoesophageal puncture (TEP) and prosthesis
• Damage to other areas of the esophagus or trachea
• Problems swallowing and eating
• Problems speaking

Before the Procedure

You will have medical visits and tests before you have surgery. Some of these are:

• A complete physical exam and blood tests. Imaging studies may be performed.
• A visit with a speech therapist and a swallowing therapist to prepare for changes after surgery.
• Nutritional counseling.
• Stop-smoking - counseling, if you are a smoker and have not quit.

Always tell your health care provider:

• If you are or could be pregnant
• What medicines you are taking, even drugs, supplements, or herbs you bought without a prescription
• If you have been drinking, more than 1 or 2 alcohol-containing drinks a day

During the days before your surgery:

• You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), clopidogrel (Plavix), warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
• Ask which drugs you should still take on the day of your surgery.

On the day of your surgery:

• You will be asked not to drink or eat anything after midnight the night before your surgery.
• Take the drugs your provider told you to take with a small sip of water.
• You will be told when to arrive at the hospital.

After the Procedure

You will need to stay in the hospital for several days after surgery.

After the procedure, you will be groggy and will not be able to speak. An oxygen mask will be on your stoma. It's important to keep your head raised, rest a lot, and move your legs from time to time to improve blood flow. Keeping blood moving reduces your risk of getting a blood clot.

You can use warm compresses to reduce pain around your incisions. You will get pain medicine.

You will receive nutrition through an IV (a tube that goes into a vein) and tube feedings. Tube feedings are given through a tube that goes through your nose and into your esophagus (feeding tube).

You may be allowed to swallow food as soon as 2 to 3 days after surgery. However, it is more common to wait 5 to 7 days after your surgery to start eating through your mouth. You may have a swallow study, in which an x-ray is taken while you drink contrast material. This is done to make sure there is no leakage prior to starting to eat.

Your surgical drain may be removed in 2 to 3 days. You will be taught how to care for your laryngectomy tube and stoma. You will learn how to safely shower. You must be careful not to let water enter through your stoma.

Speech rehabilitation with a speech therapist will help you relearn how to speak.

You will need to avoid heavy lifting or strenuous activity for about 6 weeks. You may slowly resume your normal, light activities.

Follow up with your provider as you are told.

Outlook (Prognosis)

Your wounds will take about 2 to 3 weeks to heal. You can expect full recovery in about a month. Many times, removal of the larynx will take out all the cancer or injured material. People learn how to change their lifestyle and live without their voice box. You may need other treatments, such as radiotherapy or chemotherapy. About 2 weeks after the procedure, you will most likely be able to return to an oral diet. You also may start working with a speech therapist to develop speech.

References

Rassekh H, Haughey BH. Total laryngectomy and laryngopharyngectomy. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 109.

Shah JP, Patel SG, Sing B, Wong RJ. Larnyx and trachea. In: Shah JP, Patel SG, Sing B, Wong RJ, eds. Jatin Shah's Head and Neck Surgery and Oncology. 5th ed. Philadelphia, PA: Elsevier; 2020:chap 10.

Yarbrough WG, Zanation A, Patel S, Mehra S. Head and neck. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. St Louis, MO: Elsevier; 2022:chap 34.