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    Laryngectomy

    Complete laryngectomy; Partial laryngectomy

    Laryngectomy is surgery to remove all or part of the larynx (voice box) in your throat.

    Description

    Laryngectomy is major surgery that is done in the hospital. Before surgery you will receive general anesthesia. This will make you asleep and unable to feel pain.

    Total laryngectomy removes the whole larynx. Part of your pharynx my be taken out as well. Your pharynx is the tube air moves through from your nose. It connects with your larynx.

    • The surgeon will make a cut in your neck to open up the area.
    • The larynx and tissue around it will be removed, The lymph noses may also be taken out.
    • The surgeon will then make an opening in your trachea and a hole in front of your neck. Your trachea will be attached to this hole. The hole is called a stoma. After surgery you will breathe through your stoma. It will never be removed.
    • Your muscles and skin will be closed with stitches or clips. You may have tubes coming from your wound for a while after surgery.
    • A TEP is a small hole in your windpipe (trachea) and the tube that moves food from your throat to your stomach (esophagus).
    • Your surgeon will place a small man-made part (prosthesis) into this opening. The prosthesis will allow you to speak after your voice box has been removed.

    There are many less invasive surgeries to remove part of the larynx.

    • The names of some of these procedures are endoscopic (or transoral resection), vertical partial laryngectomy, horizontal or supraglottic partial laryngectomy, and supracricoid partial laryngectomy.
    • These procedures may work for some people. The surgery you have depends on how much your cancer has spread and what type of cancer you have.

    The surgery takes 5 to 9 hours.

    Why the Procedure Is Performed

    Most often, laryngectomy is done to treat cancer of the larynx. It is also done to treat:

    • Severe trauma, such as a gunshot wound or other injury.
    • Severe damage to the larynx from radiation treatment. This is called radiation necrosis.

    Risks

    Risks for any surgery are:

    • Allergic reactions to medicines
    • Breathing problems
    • Heart problems
    • Bleeding
    • Infection

    Risks for this surgery are:

    • Hematoma (a buildup of blood outside the blood vessels)
    • Wound infection
    • Fistulas (tissue connections that form between the pharynx and the skin that are not normally there)
    • The stoma opening may become too small or tight. This is called stomal stenosis.
    • Leaking around the tracheoesophageal puncture (TEP) and prosthesis
    • Damage to other areas of the esophagus or trachea
    • Problems swallowing and eating
    • Problems speaking

    Before the Procedure

    You will have many doctor visits and medical tests before you have surgery. Some of these are:

    • A complete physical exam and blood tests
    • A visit with a speech therapist and a swallowing therapist to prepare for changes after surgery
    • Nutritional counseling
    • Stop-smoking counseling, if you are a smoker and have not quit

    Always tell your doctor or nurse:

    • If you are or could be pregnant
    • What drugs you are taking, even drugs, supplements, or herbs you bought without a prescription
    • If you have been drinking a lot of alcohol, more than 1 or 2 drinks a day

    During the days before your surgery:

    • You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), clopidogrel (Plavix), warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
    • Ask your doctor which drugs you should still take on the day of your surgery.

    On the day of your surgery:

    • You will be asked not to drink or eat anything after midnight the night before your surgery.
    • Take your drugs your doctor told you to take with a small sip of water.
    • Your doctor or nurse will tell you when to arrive at the hospital.

    After the Procedure

    You will need to stay in the hospital for several days after surgery.

    After the procedure, you will be groggy and will not be able to speak. An oxygen mask will be on your stoma. It's important to keep your head raised, rest a lot, and move your legs from time to time to improve blood flow. Keeping blood moving reduces your risk of getting a blood clot.

    You can use warm compresses to reduce pain around your cut. Your nurse will give you pain medicine.

    You will receive nutrition through an IV (a tube that goes into a vein) and tube feedings. Tube feedings are given through a tube that goes through your nose and into your esophagus (feeding tube).

    You may be allowed to swallow food as soon as 2 to 3 days after surgery. But, it is more common to wait 5 to 7 days after your surgery to start eating through your mouth.

    Your trachea drain will be removed in 2 to 3 days. You will be taught how to care for your tracheostomy tube and stoma. You will learn how to safely shower and swim. You must be careful not to let water enter through your stoma.

    Speech rehabilitation with a speech therapist will help you relearn how to speak.

    You will need to avoid heavy lifting or strenuous activity for about 6 weeks. You may slowly resume your normal, light activities.

    Follow up with your doctor as often as your doctor says you need to.

    Outlook (Prognosis)

    Your wounds will take about 2 to 3 weeks to heal. You can expect full recovery in about a month. Many times, removal of the larynx will take out all the cancer or injured material. People learn how to change their lifestyle and live without their voice box.

    References

    Rassekh H, Haughey BH. Total Laryngectomy and laryngopharyngectomy. In: Cummings CW, Flint PW, Haughey BH, et al, eds. Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2010:chap 111.

    Agrawal N, Goldberg D. Primary and Salvage Total Laryngectomy. Otolaryngologic Clinics of North America. August 2008;41(4).

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          Review Date: 3/22/2013

          Reviewed By: Ashutosh Kacker, MD, BS, Associate Professor of Otolaryngology, Weill Cornell Medical College, and Associate Attending Otolaryngologist, New York-Presbyterian Hospital, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.

          The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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