What is Laryngectomy

Laryngectomy is the partial or total removal of the voice box (larynx). The larynx allows air to pass through the vocal cords, which allows you to speak and breathe.

After having a laryngectomy, you will no longer be able to speak normally or breathe out of your nose and mouth. Instead, you will have an opening (stoma) in the front of your neck that you will use to breathe and communicate.

Laryngectomy is commonly done to treat cancer of the larynx. If cancer has spread (metastasized) to the lymph nodes in the neck, lymph nodes may be removed from one or both sides of the neck. Lymph nodes are part of the body’s disease-fighting (immune) system.

LET YOUR HEALTH CARE PROVIDER KNOW ABOUT:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Previous problems you or members of your family have had with the use of anesthetics.
• Previous surgeries you have had.
• Any blood disorders you have, such as a history of bleeding problems or blood clots.
• Any medical conditions you have, including diabetes and kidney problems.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines or dyes.
• Damage to other structures or organs.
• Difficulty swallowing, speaking, or breathing.
• Problems with your stoma.

What happens before the procedure?

• Ask your health care provider about:

• Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
• Do not smoke or use any tobacco products for as long as told by your health care provider. This includes cigarettes, chewing tobacco, and e-cigarettes. If you need help quitting, ask your health care provider.
• Follow instructions from your health care provider about eating or drinking restrictions.
• Ask your health care provider how your surgical site will be marked or identified.
• You may be given antibiotic medicine to help prevent infection.
• You may have blood tests.
• You may have imaging tests, such as:
  • X-rays.
  • CT scan.
  • PET scan.
  • MRI.
• Plan to have someone take you home after the procedure.
• If you will be going home right after the procedure, plan to have someone with you for 24 hours.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
• An IV tube will be inserted into one of your veins.
• You will be given a medicine to make you fall sleep (general anesthetic). You may also be given medicine to help you relax (sedative).
• A flexible tube (catheter) will be put into your bladder to drain urine.
• You may have a tube put through your nose or mouth and into your stomach (nasogastric tube). The nasogastric tube removes digestive fluids and prevents you from throwing up or feeling nauseous. It may be kept in after the procedure to give you nutrition while your incision heals.
• A U-shaped incision will be made in your neck. The incision will start just below your ear, and will go below your larynx and up to the other side of your neck.
• Your larynx will be separated from your windpipe (trachea) and removed.
• An incision will be made in your trachea.
• Your trachea will be attached to the skin of your neck to create a stoma.
• One or more of your lymph nodes may be removed from your neck.
• Your incision will be closed with stitches (sutures) or surgical glue.
• One or more small tubes (drains) may be placed near your incision to drain excess fluid.
• Your incision may be covered with a bandage (dressing).

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• You will have some pain. Pain medicines will be available to help you.
• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored often until the medicines you were given have worn off.
• Do not drive for 24 hours if you received a sedative.
• You will continue to receive fluids, nutrition, and medicine through an IV tube.
• You may continue to have:
  • A nasogastric tube in your nose or mouth.
  • A catheter draining urine from your bladder.
  • One or more drains draining excess fluid.
• The head of your bed will be kept at an upright angle.
• You will have a humidified oxygen mask over your stoma.

Laryngectomy, Care After

Refer to this sheet in the next few weeks. These instructions provide you with information about caring for yourself after your procedure. Your health care provider may also give you more specific instructions. Your treatment has been planned according to current medical practices, but problems sometimes occur. Call your health care provider if you have any problems or questions after your procedure.

What can I expect after the procedure?

After the procedure, it is common to have:

• Difficulty breathing and swallowing.
• Inability to speak normally.
• Pain and soreness when swallowing and trying to communicate.

Follow these instructions at home:

Incision and stoma care

• Keep the skin around the stoma clean and dry. Keep water out of the stoma.
• Use a clean, soft washcloth to gently wash around the stoma.
  • Use warm water and only use cleansers recommended by your health care provider.
  • Dry the area well.
• Use stoma powder or ointment on your skin only as told by your health care provider. Do not use any other powders, gels, wipes, or creams on your skin.
• Check your incision area and stoma every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.
• Measure the stoma opening regularly and record the size. Watch for changes. Share this information with your health care provider.
• Ask your health care provider about stoma covers. These are worn over your stoma to warm, moisten, and filter the air that you breathe.
• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to be in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.

Bathing

• Do not take baths, swim, or use a hot tub until your health care provider approves.
• Do not take a shower until your health care provider approves. When you are able to shower, put a waterproof cover over your stoma that will still allow you to breathe.

Eating and drinking

• Follow instructions from your health care provider about eating or drinking restrictions.
• When your feeding tube is removed and you are able to swallow liquids, you may slowly begin to drink liquids.
• You may gradually start eating soft foods as told by your health care provider. You may eat other foods when the muscles that help you swallow are working well enough to allow you to swallow solid food.

Driving

• Do not drive or operate heavy machinery while taking prescription pain medicine.
• Do not drive for 24 hours if you received a medicine to help you relax (sedative).

General instructions

• You will need to learn to communicate through your stoma. Options for producing speech without your larynx may include:
  • A voice prosthesis. This is a device that is placed inside of your throat to help you speak. It may be placed in your throat during your laryngectomy, or weeks or months after the procedure, depending on your condition.
  • An electronic device that can help you speak (electrolarynx).
  • Speaking through your esophagus (esophageal speech). Your health care provider can refer you to a speech therapist to learn this technique.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do not smoke or use any tobacco products, such as cigarettes, chewing tobacco, and e-cigarettes. If you need help quitting, ask your health care provider.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Wear compression stockings as told by your health care provider. These stockings help prevent blood clots and reduce swelling in your legs.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have problems with your stoma or voice prosthesis.
• You have pain that does not get better with medicine.
• You have difficulty swallowing or feel pain when you swallow.
• You have more redness, swelling, or pain around your incision or stoma.
• You have more fluid or blood coming from your incision or stoma.
• Your incision or stoma feels warm to the touch.
• You have pus or a bad smell coming from your incision or stoma.
• You have a fever.

Get help right away if:

• Fluid leaks from your stoma. If this happens, do not put anything in your mouth until you visit your health care provider.
• You cannot swallow.
• You hear noise coming from your throat when you breathe.
• Your stoma opening is getting smaller.
• You have severe crusting around your stoma.