Surgical Procedures: Partial and Total Laryngectomy

A laryngectomy is surgery to remove part or all of your larynx. Your larynx, or voice box, is in your throat, at the front of your neck. The larynx is made of cartilage. It has three main parts:

• The supraglottis.
• The glottis.
• The subglottis.

The larynx has many jobs:

• Your voice and other sounds are made from the vocal cords that are in your larynx.
• Your epiglottis (cartilage on top of the glottis) is closed to keep food or drink from getting into your lungs when swallowing.
• Letting air you breathe in get to your lungs.

A laryngectomy may be used to treat some cases of:

• Laryngeal cancer.
• Injury.
• Radiation necrosis (cell death) from radiation treatment.

A person who had a laryngectomy is called a “larengectomee.”

There are a few types of laryngectomy surgeries:

• Total Laryngectomy: The whole larynx (voice box) is removed.
  • A permanent stoma (small opening) is made to create a new way for you to breathe, through a procedure called a tracheostomy.
  • A part of the pharynx (the tube connecting the nose, larynx, and lungs), some lymph nodes, and some nearby muscles may be removed.
  • The surgeon may do a transesophageal puncture (TEP). During a TEP, a hole is made in the trachea and esophagus for future prosthetic voice box placement.
• Partial Laryngectomy: Part of the larynx (voice box) is removed. A temporary (short term) tracheostomy may be placed, which can be removed at a later time.

What are the risks of a laryngectomy?

The risks and side effects of having a laryngectomy are:

• Reaction to anesthesia. (Anesthesia is the medication you are given to help you sleep through the surgery, not remember it and to manage pain. Reactions could be wheezing, rash, swelling, and low blood pressure.)
• Bleeding.
• Blood clots.
• Infection.
• Pneumonia.
• Heart or lung problems.
• Loss of normal speech.
• Nerve injury.
• Swelling.
• Throat or larynx narrowing (called stenosis). You may need a tracheostomy if this happens.
• Narrowing of the stoma, known as stoma stenosis.
• Trouble swallowing, which may cause you to need a feeding tube.
• Fistula (abnormal connection between the pharynx and the skin) that may need corrective surgery.
• Damage to nearby organs, like the thyroid and parathyroid glands. This can lead to hypothyroidism and/or calcium changes in your body. The trachea and esophagus may also be damaged.
• Hematoma (collection of blood).

What is recovery like?

Recovery from a laryngectomy depends on the type of procedure you had. At times, a longer hospital stay is needed. You may need a feeding tube to get nutrition until your throat heals.

You will be told how to care for your incisions (surgical cuts), tracheostomy, feeding tube, and other drains. You will be given any other instructions before leaving the hospital. Your healthcare team will talk to you about the need for nebulizers (a device that gives off mist) to humidify (moisten) the air you breathe through your tracheostomy.

Your care team will talk with you about the medications you will be taking, like those for pain, blood clot, infection, constipation prevention, and/or other conditions.

Most likely, you will meet with a speech pathologist who will teach you about the best ways to speak and swallow.

Your provider will talk to you about any changes in activity and daily life you will have. Often, you should:

• Not lift anything heavy or do strenuous exercise for 6 weeks.
• Not bend or strain until your care team tells you it is safe to do so.
• Care for your stoma and wound as taught by your care team.
• Talk with your care team about when you can shower and how to protect your stoma from getting wet or getting water in it.
• Not wear tight clothing around your neck.
• Stay away from second-hand smoke and other people who have respiratory (lung) infections.
• Not play contact sports.

What will I need at home?

• Thermometer to check for fever, which can be a sign of infection. Your care team will tell you at what temperature you should call them.
• Wound and stoma care supplies.
• Humidifier.
• A medical alert bracelet that states you are a laryngectomy patient and that you breathe through your neck.

When should I contact my provider?

Call your provider if you have:

• Swelling, bleeding, blistering, scabbing or discharge at the incision.
• New or worsening pain.
• Nausea and/or vomiting.
• Change in color and/or thickness of sputum (saliva and mucus that can come out of your stoma).
• A hard time swallowing.
• Change in the size of your stoma.
• Coughing, shortness of breath, chest pain and/or any other concerning symptoms.

How can I care for myself?

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.

Be sure to take your prescribed medications as told to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms.

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation.

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.

• Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.