Laryngectomy

What is a Laryngectomy?

A Laryngectomy is a surgical operation in which all or part of the larynx is removed. People have a laryngectomy if the voice box (larynx) needs removing. This is mainly due to a malignant tumour (cancer) or, more rarely, a severe mechanical problem.

This results in two major changes following the operation:

  • A new way of breathing.
  • Loss of voice.

The operation is undertaken with the aim of curing the cancer. This operation is often the first stage of treatment and is usually followed with radiotherapy treatment to ensure that all the cancer is removed.

What is the voice box (larynx) and what does it do? The voice box is the area at the top of the windpipe (trachea) through which air passes in order to breathe. The vocal cords stretch across the voice box and vibrate in order to make sounds for speech. The voice box also prevents food, drinks, saliva or any particles from going into your windpipe (trachea).

What does the operation involve?

The operation can differ from person to person depending upon the position of the cancer in the larynx in relation to the surrounding structures, for example the thyroid gland( which sits in font of the larynx) or the pharynx (the upper part of the gullet through which food enters the oesophagus). Your consultant will discuss this with you.

The operation usually involves removal of the voice box and part or all of the thyroid gland which sits in front of the larynx. Some neck glands on either side of the neck are usually removed also to ensure the cancer is completely taken away. This is called a neck dissection, it can vary from person to person and your consultant will discuss this with you.

What will I look like after the operation?

Once the voice box has been removed, your windpipe is separated at the top from in front of your food pipe (oesophagus) and bent over to open on the front, lower, middle part of your neck. The opening is called a stoma.

Most people find the stoma a lot smaller and less of a problem than they first thought. It is safe and the stoma (opening) will not close down.

Once the surgery has settled you will be advised what to wear on your neck, to protect your stoma, by the hospital staff looking after you.

Following the operation you will not breathe through your mouth or nose or cough up mucus from your chest into your mouth. Instead you will breathe through the opening (stoma) at the lower front of your neck which extends into your windpipe (trachea) and down into your lungs.

You will be able to breathe and cough comfortably through this opening. Because air is no longer going through the nose you are no longer able to sniff effectively or purposefully smell.

Once you have recovered from the operation you should not have any problems when eating or drinking after your voice box has been removed.

How will I be able to communicate after the operation?

When your voice box is removed you will not be able to talk as before. However once the surgery has settled down there are different ways by which you may be able to regain a form of voice.

Your consultant and the Speech Therapist will discuss this with you. The method you use will depend on the type of surgery you have and your individual circumstances.

Some of the different ways of communicating are:

  • Use oesophageal voice.
  • Use an artificial larynx.
  • Use mouthing.
  • Have surgical voice restoration.

There will always be a way in which you can communicate, such as sound, gestures, writing or other people reading your lips. All the hospital and community staff are dedicated to help and support you and your family to a new way of communication.

Preparation for surgical voice restoration is usually done at the time of your laryngectomy. A small opening is made at the back of the windpipe so that a voicing valve can be inserted when you have recovered from your surgery.

Straight away after surgery you will have a small tube through this opening into your foodpipe. This tube will be used to provide you with liquid food while you are unable to take anything by mouth.

In some hospitals valves are inserted straight away and you will have a tube through your nose which passes into the stomach. This tube then allows you to receive liquid food while you are unable to take anything by mouth. Your speech and language therapist will talk to you about this and give more information so you know exactly what to expect after your operation.

Who will be involved in my care?

You and your family may like to find out about what having a laryngectomy really means. You will meet several health professionals before your operation as well as the doctors and nurses.

Head and Neck Macmillan Nurses / Airway specialist Nurses will provide both you and your family with information, support and advice concerning all aspects of your illness, treatment and recovery.

Speech and Language Therapists will help you develop new ways of communicating and teach you new skills. You will be invited to meet with a person who has already gone through this operation and this may help you and your family more fully understand what to expect.

Dieticians will give you advice on all your nutrition needs throughout your treatment and ensure these are met while you are recovering from your surgery.

Physiotherapists will help you with your breathing whilst recovering from your laryngectomy.
He/She will also help with neck and shoulder exercises.

Head and Neck Counsellors will help give you and your family psychological support through your surgery and treatment and give opportunity for structured counseling if necessary.

How long does the operation take?

Pre-Treatment Assessment

You may be asked to attend a pre-treatment assessment where you will have a chance to meet and talk to the professionals involved in your care and discuss any issues you have with your treatment and recovery plan.
You may be asked to complete some questionnaires in order for your professional team to assess any immediate needs, both physical and psychological, to prepare you and your family for surgery.

Pre-Admission

You may be invited to attend a pre-admission assessment one or two weeks before your operation. This enables both the doctors and the nurses to assess your health needs and carry out tests such as, blood tests, heart tracings (ECG) and chest X-rays. This ensures that it is safe for you to undergo a general anaesthetic. It is important that you bring any medication that you are taking for the medial staff to see.

The pre-admission assessment clinic is an opportunity for you to meet the ward staff and see where you will be admitted on the day of your operation. It is also a time when you can ask questions and discuss any queries you may have concerning your operation

Hospital appointments before your surgery

Your operation will be carried out under a general anaesthetic which means that you are fully unconscious for the whole operation. Because having a laryngectomy involves delicate surgery the operation can last between 5 – 12 hours.

To prevent vomiting and other complications during the operations it is necessary for you to starve (have nothing by mouth or no chewing gum) for at least 6 hours before the operation. You will be advised of what time to starve from when you attend the pre-admission assessment.

How long can I expect to be in hospital?

You should expect to be in hospital for at least 2 – 3 weeks or longer if complications arise.

What are the complications of Laryngectomy?

The main problem following a laryngectomy is wound infection or poor healing. This can delay normal eating and drinking as the wounds need to be fully healed so that food and drink can enter the stomach and not the tissues in the neck.
A small tract from the windpipe into the new gullet (called a fistula) can sometimes develop. This needs longer healing time and prevents you taking any food or drink by mouth. There is no immediate operation for this it just needs more healing time.

Bleeding is a risk after any operation and you will be closely observed for this following your surgery. You and your family will be fully informed of any problems.