{{YIELDBOT INTENT TAGS}} {{RUBICON REAL TIME}}
Laryngectomy

Definition

A surgical procedure to remove the larynx (voice box). This is usually done to treat cancer . Depending on the extent of the cancer, a partial laryngectomy may be possible.

Laryngectomy

nucleus fact sheet image

© 2008 Nucleus Medical Art, Inc.

Parts of the Body Involved

  • Throat
  • Neck

Reasons for Procedure

Laryngectomy is done to treat cancer of the larynx. This procedure may also be performed to treat gunshot wounds, severe fractures, or other trauma.

Risk Factors for Complications During the Procedure

What to Expect

Prior to Procedure

Your doctor will likely do the following:

  • Physical exam
  • Laryngoscopy—the use of a long, thin, lighted tube (laryngoscope) to examine the larynx
  • Radiation therapy—to treat cancer

In the time leading up to your procedure:

  • Review your regular medications with the surgeon; you may be asked to discontinue some drugs.
  • Discuss with your doctor possible options to restore speech, including tracheoesophageal puncture and hand-held speech aids.
  • The night before, eat a light meal and do not eat or drink anything after midnight unless told otherwise by your doctor.

During Procedure

You will be given IV fluids and anesthesia.

Anesthesia

General anesthesia is required for this surgery.

Description of the Procedure

Laryngectomy has two main parts:

  • Removal of the diseased or injured larynx
  • Creation of a new opening, called a stoma, through which breathing will take place

The surgeon makes an incision in the neck and divides the muscles that are attached to the larynx. The larynx and surrounding tissue are removed. Sometimes, a partial laryngectomy is possible. In this case, the surgeon removes the tumor and only a portion of the larynx. If you have a partial laryngectomy, you may retain some normal speech and more of your normal swallowing function.

Next, a stoma is created through the skin in the neck, and the trachea (windpipe) is connected to the opening, enabling you to breathe. Your doctor might insert a tracheostomy tube to help you breathe. A tracheostomy tube, which will act as an airway, is fit in the stoma. Sometimes there is no need for a tracheotomy tube to be placed in the stoma. Drains are inserted to allow for adequate drainage. The muscles and skin are brought together and closed with stitches or clips.

Drains will be removed in about five days, stitches in about one week.

After Procedure

Laboratory exam of removed fluid or tissue

How Long Will It Take?

The procedure takes about 5-9 hours.

Will It Hurt?

Anesthesia prevents pain during surgery. You may have pain during recovery but you will receive pain medication to relieve this discomfort.

Possible Complications

  • Infection
  • Breathing difficulties
  • Excessive swelling or bleeding
  • Injury to the trachea or esophagus
  • Blood clots in a vein (phlebitis)
  • Anesthesia-related problems
  • Wound infection and breakdown
  • Saliva leaking out to the skin (saliva fistula)

Average Hospital Stay

The surgery may require 7-14 days in the hospital.

Postoperative Care

  • You'll probably wake up with an oxygen mask over your stoma.
  • Use a call bell and message board to communicate.
  • Keep the head of your bed raised.
  • Move your legs while in bed to increase circulation.
  • Use warm compresses to help relieve pain at the incision.
  • At first, you'll be fed through an IV or a feeding tube. A speech pathologist or doctor will assess your ability to swallow, and depending on the results, you will progress to soft foods.
  • Do not lift heavy things or participate in strenuous activity until approved by your doctor, usually after about six weeks.
  • Drains are removed after 2-3 days.

You'll be taught to care for your stoma and tracheostomy tube, this includes:

  • Using a mist hood over the stoma
  • Keeping water out of the stoma
  • Covering the stoma with a shower hood when showering
  • Suctioning crusty secretions that develop due to breathing in drier, more irritating air—During normal respiration, the nose and mouth will warm, moisten, and filter the air, but air passing through the stoma is cooler and drier.

Outcome

The throat tissue heals in about 2-3 weeks, and complete physical recovery occurs in about a month. You may, though, notice a reduction in your sense of taste and smell. You'll continue to use the stoma for breathing.

Speech rehabilitation will help you learn how to talk in one of several ways:

  • By swallowing air and expelling it (esophageal speech)
  • Through the use of an electronic device (artificial larynx)
  • By installing a valve in the stoma to allow air from the lung to reach the esophagus (tracheoesophageal speech)

Your doctor may consider other available options to restore your speech.

If you had a partial laryngectomy, your voice may sound weak or hoarse.

Most patients are able to return to their jobs and past activities, except for swimming. Many people find joining a support group beneficial.

Call Your Doctor If Any of the Following Occurs

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
  • Cough, shortness of breath, chest pain, or severe nausea or vomiting
  • Headache, muscle aches, or dizziness
  • New, unexplained symptoms

RESOURCES:

American Cancer Society
http://www.cancer.org

National Cancer Institute
http://www.cancer.gov

CANADIAN RESOURCES:

BC Cancer Agency
http://www.bccancer.bc.ca/default.htm

Canadian Cancer Society
http://www.cancer.ca

References:

American Cancer Society website. Available at: http://www.cancer.org .

Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice . 16th ed. WB Saunders Co; 2001.



Last reviewed March 2008 by Elie Rebeiz, MD, FACS

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


Your Health and Happiness


DiggDeliciousNewsvineRedditStumbleTechnoratiFacebook