This page is a brief description of the surgical procedure called a laryngectomy. This procedure is most often done as treatment for cancer of the larynx. Anatomy and Physiology
The largest cartilage (thyroid cartilage) of the larynx can be felt in the neck as the Adam's apple. (Figure 1) The larynx is almost cylindrical in shape and is made up of various segments of cartilage surrounded by fibrous membranes. The larynx contains the vocal cords (Figure 2), which are important for speech
A laryngectomy is surgical removal of the larynx, also called the voice box. The diagram to the right shows a cross sectional view of the normal throat and the larynx. You can see that the larynx is located at the point where a division occurs from the single tube that makes up the throat (also called the pharynx) into a separate tube for food going to the stomach (the esophagus) and air going to the lungs (trachea, or windpipe).
One important function of the larynx is to protect the airway by ensuring that swallowed foods and liquids pass down the esophagus instead of going into the lungs.
The vocal folds, responsible for sound generation in speech and singing, are also located in the larynx. As air is exhaled past the vocal folds, they vibrate and produce the sounds heard in voiced speech.
If the larynx is removed, air can no longer pass from the lungs into the mouth. The connection between the mouth and the windpipe no longer exists. In order to allow air to get into the lungs, an new opening must be made in the front of the neck. The upper portion of the trachea (windpipe) is brought out to the front of the neck to create a permanent opening called a stoma.
When a laryngectomy patient inhales, air passes directly through the stoma into the trachea and then into the lungs. The connection between the mouth and the esophagus is usually not affected, so food and liquid can be swallowed just as they were before the operation. Removal of the vocal cords means that a laryngectomy patient will no longer have laryngeal speech. This does not mean that speech is lost, as there are ways to talk without a larynx.
The operation itself is done through an incision in the neck. Many times a operation called a neck dissection is done at the same time to remove lymph nodes in the neck that may be involved with cancer.
What to expect immediately after a laryngectomy
The first couple nights after a laryngectomy are usually spent in the intensive care unit (ICU). As with most other operations for head and neck cancer, the patient will have one or more suction drains under the skin to collect any small amount of fluid collection in the neck. The drains are removed after several days. There also will be intravenous lines (IVs) in order to give fluids and medicine.
While the lower portion of the throat is healing after a laryngectomy, the patient will not be able to swallow food or liquids. In order to supply nutrition, a small flexible plastic feeding tube will be usually placed into the stomach through the nose. If all goes well, the patient will be able to start swallowing about one week after the operation, and the feeding tube can be removed at that time.
If there is concern that the tube may be needed for a much longer time, a tube can be placed through the skin of the abdomen directly into the stomach. Placement of this tube, called a PEG, is more involved, but once in it is easier to take care of and less conspicuous.
In some cases a tracheotomy tube is placed into the stoma after the operation. However, this is usually done on a temporary basis until the stoma will stay open on its own.
Total hospital stay after a laryngectomy is usually about a week.
What to expect on a long-term basis after a laryngectomy
When we breathe, air normally passes through our nose or mouth and is both warmed and humidified before reaching the windpipe, or trachea. After a laryngectomy the air will instead pass directly into the windpipe through the stoma. As a result, the lining of the windpipe will be exposed to air that is much drier and cooler than usual. The mucous that normally lines the trachea will become thicker and crusting can develop.
The crusts that form can actually block the airway, and can also lead to infection.
In order to prevent this, after a laryngectomy a small mask with humidified air will be placed over the stoma. The patient will need to use this mask as much as possible until the lining of the windpipe "matures" and can tolerate the drier air.
The stoma is the only airway for a laryngectomy patient and its care is important. The misted air mentioned above is obviously important. Also important is cleaning and suctioning of the stoma. Certain individuals will develop crusting around the stoma, and these crusts will need to be cleaned. The trachea itself may need suctioning. It is important that the patient as well as his or her family and friends become familiar with stomal care. The stoma is the patient's only airway, and any blockage of the stoma can therefore be very serious. With proper care, these blockages are very rare.
Post Laryngectomy
Restoring Speech After Total Laryngectomy : -
After a total laryngectomy, you will not be able to speak using your vocal cords. However, there are several options for restoring speech after total laryngectomy. Losing your voice box to cancer no longer means losing your ability to talk. Learning to speak again will take time and effort. You will need to see a speech therapist who is trained in the rehabilitation of people who have had a laryngectomy. The speech therapist will play a major role in helping you to learn to speak.
Esophageal Speech : -
After a laryngectomy, your windpipe (or trachea) has been separated from the mouth and food pipe, and therefore, you can no longer expel air from the lungs through your mouth to speak. With training, some patients can swallow air and force it through their mouth. As the air passes through the throat it will cause vibrations which, with training, people can turn into speech. This is the most basic form of speech rehabilitation. With the advent of new devices and surgical techniques, learning esophageal speech is often not necessary.
Tracheoesophageal Puncture (TEP) : -
This is the most common way that surgeons try to restore speech. TEP is done either at the time of surgery or later. This procedure creates a connection between the windpipe and food pipe through a small puncture at the stoma site. A small one-way shunt valve placed into this puncture restores your ability to force air from the lungs into the mouth. After this operation, you can cover your stoma with a finger to force air out of your mouth, producing sustained speech. This takes practice, but after surgery you can work closely with speech pathologists to learn this technique.
Electrolarynx : -
If you cannot have a TEP because of certain medical reasons, or while you are learning to use your TEP voice, you may use electrical devices to produce a mechanical voice. These battery-operated devices are either placed in the corner of the mouth or against the skin of the neck. When you press a button on the device, it will make a vibrating sound. By moving your mouth and tongue, you can form this sound into words. You will need training with a speech therapist to learn to use it properly.
Stoma Care Following Total Laryngectomy : -
Having a stoma instead of a larynx means that the air you breathe in and out will not pass through your nose or mouth. As air passes through the nose or mouth, it is humidified, warmed, and filtered (dust and other particles are removed). After a laryngectomy and tracheostomy, the air reaching the lungs will be dryer and cooler. This may irritate the lining of the breathing tubes and cause thick or crusty mucus to accumulate.
For this reason, you should learn how to take care of your stoma (periodic suctioning, cleaning, and use of a humidifier). Your doctors, nurses, and other health care professionals can teach you how to care for and protect your stoma, which includes precautions to keep water or small particles from falling into the windpipe. Support groups formed by other patients who have also had a laryngectomy can provide essential information on stoma care and use of products for protecting and cleaning the stoma.
Sexual Impact of Laryngectomy : -
Laryngectomy changes not only your physical appearance with the stoma but also your speech and breathing. Sexual intimacy may be affected because of uncomfortable feelings about appearance and awkwardness. However, there are things you can do to decrease these feelings during intimacy.
A scarf, ascot, or turtleneck shirt can look nice and hide the stoma cover. Even during sexual activity, a stoma cover may look more appealing than a bare stoma.
During sexual activity, a partner may be startled at first by breath that hits at a strange spot. On the positive side, one patient quipped, "Now when I kiss, I never have to come up for air!" You can lessen odors from the stoma by avoiding garlic or spicy foods and by wearing perfume, cologne, after-shave, or lotion.
Sometimes problems in speaking interfere with the communication for some couples. If you have learned esophageal speech, talking during lovemaking is not a big problem. It does take more effort, though, and you lose some of the emotional overtones. A speech aid built into the stoma might also work well. However, neither method lets you whisper romantically in your partner's ear.
If you use a hand-held speech aid, communication during sex is likely to be awkward and distracting. You can say a great deal sexually, however, by guiding your partner's hand or using body language.
Talking is not needed in many sexual situations. With a new partner, you may want to discuss the kinds of touching and positions you like before you start making love.
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A laryngectomy is surgical removal of the larynx, also called the voice box. The diagram to the right shows a cross sectional view of the normal throat and the larynx. You can see that the larynx is located at the point where a division occurs from the single tube that makes up the throat (also called the pharynx) into a separate tube for food going to the stomach (the esophagus) and air going to the lungs (trachea, or windpipe).
