laryngectomy

Images    (Click to view larger image)



Definition
A laryngectomy is an operation to remove the larynx. The larynx, or voice box, is the organ that produces the sound that allows us to speak. It also prevents food from entering the air passage.

Who is a candidate for the procedure? 
A person with cancer of the larynx is a candidate for this procedure.

How is the procedure performed? 
A laryngectomy is done through an incision in the neck. The larynx is removed. Air can no longer pass from the lungs into the mouth, because the connection between the mouth and the windpipe no longer exists. So a new opening for air to enter the lungs must be made in the front of the neck.

The upper portion of the trachea, or windpipe, is brought out to the front of the neck to create a permanent opening. This opening is called a stoma. A tracheostomy tube is placed in the stoma to keep it open until it heals.

Often, an operation called a radical neck dissection is done at the same time as a laryngectomy. This is done to remove the lymph nodes in the neck, to which cancer may have spread.

What happens right after the procedure? 
After the laryngectomy surgery, the person will be taken to the surgery recovery room to be watched closely for a short time. Vital signs, blood pressure, pulse, and breathing will be checked frequently. A small mask with humidified air will be placed over the stoma. This helps to keep the secretions thin and prevent blockage of the airway. The head of the bed will be elevated to promote drainage from the surgical site. A suction drain may have been placed under the skin to catch any fluid that collects at the incision. The nose, mouth, and the tracheostomy tube will be suctioned gently.

What happens later at home? 
The person usually spends a few nights in the intensive care unit after a laryngectomy. Fluids are given through an intravenous line. A stomach tube may be inserted in the nose into the stomach to supply nutrition until the throat has healed. The total hospital stay after a laryngectomy is usually about a week.

Before discharge, the person is taught how to care for the stoma. It is very important that the person and the family understand stoma care. The stoma is the person's only airway. It must be kept free of fluids, mucous, and anything else that can block the flow of air. Any blockage of the stoma can be very serious.

The person will need to learn a new way of speaking. Speech therapy can help to provide alternative ways of speaking. These alternative ways to speak include using artificial voice aids, oesophageal speech, and voice prosthesis. It may be helpful to talk with someone who has undergone this procedure. The International Association of Laryngectomees can help provide support.

What are the potential complications after the procedure? 
Surgery carries the risk of bleeding, infection, and allergic reactions to anaesthesia. Keeping the new airway open is essential to prevent airway complications.

Author: Gail Hendrickson, RN, BS
Reviewer: eknowhow Medical Review Panel
Editor: Dr John hearne

Last Updated: 16/09/2004
Contributors
Potential conflict of interest information for reviewers available on request