Laryngectomy





Definition

A laryngectomy is the partial or complete surgical removal of the voice box (larynx).


Purpose

Because of its location, the voice box, or larynx, plays a critical role in breathing, swallowing, and speaking. The larynx is located above the windpipe (trachea) and in front of the food pipe (esophagus). It contains two small bands of muscle called the vocal cords that close to prevent food from entering the lungs and vibrate to produce the voice. If cancer of the larynx develops, a laryngectomy is performed to remove tumors or cancerous tissue. In rare cases, the procedure may also be performed when the larynx is badly damaged by gunshot, automobile injuries, or other traumatic accidents.

Demographics

The American Cancer Society estimates that, in 2003, about 9,500 people in the United States will be found to have laryngeal cancer. Laryngeal cancer occurs 4.4 times more frequently in men than in women, although, like lung cancer, it is becoming increasingly common in women. Tobacco smoking is by far the greatest risk factor for laryngeal cancer. Others include alcohol abuse, radiation exposure, asbestos exposure, and genetic factors. In the United Kingdom, cancer of the larynx is quite rare, affecting under 3,000 people each year.


Description

Laryngectomies may be total or partial. In a total laryngectomy, the entire larynx is removed. If the cancer has spread to other surrounding structures in the neck, such as the lymph nodes, they are removed at the same time. If the tumor is small, a partial laryngectomy is performed, by which only a part of the larynx, usually one vocal chord, is removed. Partial laryngectomies are also often performed in conjunction with other cancer treatments, such as radiation therapy or chemotherapy.

During a laryngectomy, the surgeon removes the larynx through an incision in the neck. The procedure also requires the surgeon to perform a tracheotomy, because air can no longer flow into the lungs. He makes an artificial opening called a stoma in the front of the neck. The upper portion of the trachea is brought to the stoma and secured, making a permanent alternate way for air to get to the lungs. The connection between the throat and the esophagus is not normally affected, so after healing, the person whose larynx has been removed (called a laryngectomee) can eat normally.


Diagnosis/Preparation

A laryngectomy is performed after cancer of the larynx has been diagnosed by a series of tests that allow the otolaryngologist (a physician often called an ear, nose & throat or ENT specialist) to examine the throat and take tissue samples (biopsies) to confirm and stage the cancer. People need to be in good general health to undergo a laryngectomy, and will have standard pre-operative blood work and tests to make sure they are able to safely withstand the operation.

As with any surgical procedure, the patient is required to sign a consent form after the procedure is thoroughly explained. Blood and urine studies, along with chest x ray and EKG may be ordered as required. If a total laryngectomy is planned, the patient meets with a speech pathologist for discussion of post-operative expectations and support.

Aftercare

A person undergoing a laryngectomy spends several days in intensive care (ICU) and receives intravenous (IV) fluids and medication. As with any major surgery, blood pressure, pulse, and respiration are monitored regularly. The patient is encouraged to turn, cough, and deep-breathe to help mobilize secretions in the lungs. One or more drains are usually inserted in the neck to remove any fluids that collect. These drains are removed after several days.

It takes two to three weeks for the tissues of the throat to heal. During this time, the laryngectomee cannot swallow food and must receive nutrition through a tube inserted through the nose and down the throat into the stomach. Normal speech is also no longer possible and patients are instructed in alternate means of vocal communication by a speech pathologist.

When air is drawn in normally through the nose, it is warmed and moistened before it reaches the lungs. When air is drawn in through the stoma, it does not have the opportunity to be warmed and humidified. In order to keep the stoma from drying out and becoming crusty, laryngectomees are encouraged to breathe artificially humidified air. The stoma is usually covered with a light cloth to keep it clean and to keep unwanted particles from accidentally entering the lungs. Care of the stoma is extremely important, since it is the person's only way to get air to the lungs. After a laryngectomy, a health-care professional will teach the laryngectomee and his or her caregivers how to care for the stoma.

There are three main methods of vocalizing after a total laryngectomy. In esophageal speech, patients learn how to "swallow" air down into the esophagus and create sounds by releasing the air. Tracheoesophageal speech diverts air through a hole in the trachea made by the surgeon. The air then passes through an implanted artificial voice. The third method involves using a hand-held electronic device that translates vibrations into sounds. The choice of vocalization method depends on several factors including the age and health of the laryngectomee, and whether other parts of the mouth, such as the tongue, have also been removed ( glossectomy ).


Risks

Laryngectomy is often successful in curing early-stage cancers. However, it requires major lifestyle changes and there is a risk of severe psychological stress from unsuccessful adaptations. Laryngectomees must learn new ways of speaking, they must be constantly concerned about the care of their stoma. Serious problems can occur if water or other foreign material enters the lungs through an unprotected stoma. Also, women who undergo partial laryngectomy or who learn some types of artificial speech will have a deep voice similar to that of a man. For some women this presents psychological challenges. As with any major operation, there is a risk of infection. Infection is of particular concern to laryngectomees who have chosen to have a voice prosthesis implanted, and is one of the major reasons for having to remove the device.


Normal results

Ideally, removal of the larynx will remove all cancerous material. The person will recover from the operation, make lifestyle adjustments, and return to an active life.


Morbidity and mortality rates

For 2003, the American Cancer Society estimates a 40% mortality rate for laryngeal cancer, meaning that about 3,800 people will die of this disease.

Alternatives

There are two alternatives forms of treatment:

  • Radiation therapy, a treatment that uses high-energy rays (such as x rays) to kill or shrink cancer cells.
  • Chemotherapy, a treatment that uses drugs to kill cancer cells. Usually the drugs are given into a vein or by mouth. Once the drugs enter the bloodstream, they spread throughout the body to the cancer site.

See also Glossectomy ; Tracheotomy .


Resources

BOOKS

Algaba, J., ed. Surgery and Prosthetic Voice Restoration after Total and Subtotal Laryngectomy. New York: Excerpta Medica, 1996.

Casper, J. K. and R. H. Colton. Clinical Manual For Laryngectomy And Head/Neck Cancer Rehabilitation. Independence, KY: Singular Publishing, 1998.

Singer, M. I. and R. C. Hamaker. Tracheoesophageal Voice Restoration Following Total Laryngectomy. Independence, KY: Singular Publishing, 1998.

Weinstein, G. S., O. Laccourreye, D. Brasnu, and H. Laccourreye. Organ Preservation Surgery For Laryngeal Cancer. Independence, KY: Singular Publishing, 1999.


PERIODICALS

King, A. I., B. E. Stout, and J. K. Ashby. "The Stout prosthesis: an alternate means of restoring speech in selected laryngectomy patients." Ear Nose and Throat Journal 82 (February 2003): 113–116.

Landis, B. N., R. Giger, J. S. Lacroix, and P. Dulguerov. "Swimming, snorkeling, breathing, smelling, and motorcycling after total laryngectomy." American Journal of Medicine 114 (March 2003): 341–342.

Nakahira, M., K. Higashiyama, H. Nakatani, and T. Takeda. "Staple-assisted laryngectomy for intractable aspiration." American Journal of Otolaryngology 24 (January-February 2003): 70–74.


ORGANIZATIONS

American Academy of Otolaryngology - Head and Neck Surgery. One Prince Street, Alexandria, VA 22314. (703) 806-4444. http://www.entnet.org .

American Cancer Society. National Headquarters. 1599 Clifton Road NE, Atlanta, GA 30329. (800) ACS -2345. http://www.cancer.org .

Cancer Information Service. National Cancer Institute. Building 31, Room 10A19, 9000 Rockville Pike, Bethesda, MD 20892. (800)4-CANCER. http://www.nci.nih.gov/cancerinfo/index.html .

International Association of Laryngectomees (IAL). http://www.larynxlink.com/ .

National Institute on Deafness and Other Communication Disorders. National Institutes of Health. 31 Center Drive, MSC 2320, Bethesda, MD 20892-2320. http://www.nidcd.nih.gov .

The Voice Center at Eastern Virginia Medical School. Norfolk, VA 23507. http://www.voice-center.com .


OTHER

"Laryngectomy: The Operation." The Voice Center. http://www.voice-center.com/laryngectomy.html .


Kathleen Dredge Wright
Tish Davidson, A.M.
Monique Laberge, Ph.D.

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?


A laryngectomy is usually performed by an otolaryngologist in a hospital operating room. In the case of trauma to the throat, the procedure may be performed by an emergency room physician.

QUESTIONS TO ASK THE DOCTOR


  • Is laryngectomy my only viable treatment option?
  • How will drinking and eating be affected?
  • How will I talk without my larynx?
  • How will my breathing be affected?
  • What about my usual activities?
  • Is there a support group in the area that can assist me after surgery?
  • How long will it be until I can verbally communicate? What are my options?
  • What is the risk of recurring cancer?


User Contributions:

jon
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Feb 5, 2006 @ 8:20 pm
very helpful..thank you!!! i really need a site this basic for my project on the vocal cord..... this is exactly what i was looking for. thank you very much.......fantabulous....a+
tina
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Jan 29, 2010 @ 5:17 pm
The article reads that 40% of the people with this disease die. Did that mean people who did not get the voice box removed? How long is the hospital stay after the surgery
tina
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Jan 29, 2010 @ 6:18 pm
how long does this surgery take? the removal of the voice box
tina
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Jan 30, 2010 @ 2:02 am
how long does this surgery take? the removal of the voice box
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Feb 17, 2010 @ 10:22 pm
this surgery usually takes 5 to 9 hours and is done under general anesthesia.
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Feb 27, 2010 @ 11:11 am
I had my larynx tumor removed by transoral laser surgery (Hosp.Clinic, Barcelona), where hey have an experience of over 850 tumors treated without tracheostomy. Wonderful!
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Aug 18, 2010 @ 9:09 am
DO YOU STILL HAVE YOUR SENSE OF TASTE AFTER HEALING FROM A LARYNGECTOMEE
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Oct 27, 2010 @ 4:04 am
Is it always that a patient will go to icu as standard procedure after a full laryngectomy.
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Jan 19, 2011 @ 7:07 am
My father recently underwent full laryngectomy surgery and was sent home with the ng tube for feeding. We had to return to the Dr. to undergo dynamic swallow studdy and learned he has a leak from his esophagus out through his neck, next to his stoma, which meant he is still unable to swallow or eat anything normally; only through the tube. They told him it may or may not heal and suggested a tube be inserted gastrically,(in his stomach,) so that he wouldn't have the nuisance of the tube in his nose. He agreed to this procedure, and we have an appointment next week. As for the leak they told us they could do surgery to repair it but it was a major invasive surgery, and in his health very risky at this time. I hope this information is helpful to anyone else caring for a laryngectomy patient.
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Feb 22, 2011 @ 1:13 pm
I just got over a case of bronchitis but feel it has returned and I also a quizzy stomach today.

I had a complete larengentomy in Dec. 2009, I also have COPD that complicates matters even more as I have a constant cough. I have no warning when these coughing seizures will come on and when they do they sometimes last from five to ten minutes. At least twice during these I gag and almost vomit...can a person with my trec vomit as a normal person would???

Also during these coughing spells I void a lot of mucus but I think that is due to the COPD?

Thank you for any info you can share with me.

Brenda Tripp
Cape Coral, FL
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Mar 12, 2011 @ 9:09 am
My father underwent a total larengectomy operation in 2003. He has always coughed and coughed and has also vomited. What is COPD? Could this be the reason for his coughing. The mucas nearly chocks him at times. He is now struggling to talk with his valve and has gone back to using his microphone which he dislikes and we do too!

He is 86 and has coped extremely well, however I am worried about him. Any information would be greatly appreciated

Sally
Kent UK
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Nov 4, 2011 @ 12:12 pm
My father went through total laryngectomy. 30 sessions of radiotherapy and two sessions of chemo. Is ther still any chance of reoccurance of cancer in larynx. As he got blood from his mouth and nose. The doctor performed EGD and reported " Necrotic fragile inflammatory (carcinomatous!) tissue in the Larynx with contact bleeding most likely the bleeding source." Wheteher this statement shows that the cancer has reappeared.
Rani
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Nov 12, 2011 @ 7:19 pm
My grand father went through total laryngectomey before 20 years .. now he can not even drink water.. he has gone through so many surgeries so that he could drink at least water but he is getting ill day by day.. please refer me a good doctor in canada.
Tom
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Feb 25, 2012 @ 6:18 pm
I had my left vocal cord cut during surgery to facilitate removal of a large tumor. I have found a great resource also at Web Whispers support blog. Great experience among the participants, very supportive and excellent source of ideas and solutions. Stay with it and never give up. It took me 1 yr to eat food (I aspirated everything!)and two yrs to swallow liquids well enough to remove my g-tube...had for 2 yrs. Good luck, Tom
Robert
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Mar 3, 2012 @ 2:14 pm
I am tring to locate information on the ball used by a laryngectemee patient to swim

Thank you
donna
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May 24, 2012 @ 9:21 pm
My uncle is going to have a laryngectomey Im not sure if his body is strong enough to do it. He is just 48yrs old but is 90lbs. I ask if they thought he would be able to recover from the surgery or not. They said no way to tell. I don't know if he should have it and try to make it threw or just live out his life the best he can. I feel that if he has it he will not make it. If he don't he will dye. I think he is as good as he will ever be if he has the surgery and cant get well then he will always be worse. So what do you do??? What can I say to make him see it is not easy and he is never going to be any better than he is now
Jessie Williams
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Jun 25, 2012 @ 12:00 am
I had a total laryngectomy in 2005. I did very well and now it has been 7 yrs. cancer free. I use a electra larynx, which I have no problem with and people understand me quite well. I keep my stoma clean and debris free. I am working as a CNA and get to talk a lot. I am 69 yrs. old and I am doing very well.
alf
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Aug 21, 2012 @ 5:17 pm
I have had several operations to the throat, I havent been able to eat or drink
for the last three years. before these operations i had 16 cemos and 30 radiotherapys
I have also lost my speach 2 to 3 months, I am 72 years old.I feel okay, but i am worried
if i have a laryngectomey I will be worse off
Ron
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Oct 20, 2012 @ 10:10 am
My father was diagnosed with throat cancer last year. He went threw radiation treatments. Recently the found new cancer in the larynx, about a peanut size. My father is 82yrs old,and very week. Is it a good idea that he should go for the removal of his larynx at his age? I heard that its a big surgery,and recovery. What options does he have?
Jack Hardman
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Jan 16, 2013 @ 8:20 pm
I had a total laryngectomy Dec. 22, 2011, had a lot of trouble with the healing process. I had to spend 2 weeks in hospital about a month after the surgery, due to not healing correctly. I ended up having to have skin graph done and having a flap done. I had a feeding tube in my nose for approximately 10 weeks, lost about 40 pounds. I know have the voice prothesis, and am doing fairly well except for one problem. I have GERD, and have problems sometimes being able to eat, and keep the food down. The doctor's at MCG in Augusta, GA have put me on medicine for acid reflux, but lately feel as though it isn't working. Can anyone tell me if this is normal? Will I always have this problem? Thanks!
maria
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Feb 8, 2013 @ 6:18 pm
This really helped me with my school paper. Thanks a million!
Laura
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Feb 20, 2013 @ 4:16 pm
Hi, I'm 33 and had a total laryngectomy and the recovery is awful. I have pain swallowing and I cough constantly. I also have painful swelling in my neck. My Dr says its normal, but its driving me crazy. Any advice?
kelly kinsey
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Sep 17, 2013 @ 10:22 pm
My husband has the surgery done several months ago he has leaking but rr is putting a new speak vave in and the problem is he has copd and hes coughing alot and has alot of musac coming up what should I do to help him and does the hole in his throat go directly to his lungs
sharon
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Nov 7, 2013 @ 11:11 am
My brother just had a total laryngectomy and thyroid removed after 35 radiation treatments and 8 chemos. He has a "g" tube and is going for his swallow test tomorrow. What happens if he does not pass? He has a tremendous amount of adhesions and scar tissue and is having trouble with tube feeding. seems he is always nauseated and has not been able to pass urine either, therefore he also still has a cath. He is so depressed and makes motions like he wants to blow his brains out. It is heart breaking for those of us caring for him. Is this normal? and what can we do?
Derek
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Apr 11, 2014 @ 3:15 pm
My husband has had a full larengectomy and is coping ok he cannot speak as his stoma is a funny shape and nothing fits also when he puts his Larry tube in it causes bleeding do many patients get bleeding with this tube he lubricates it we'll but it still happens any suggestions why this is happening
Charlie
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Jun 8, 2014 @ 3:15 pm
I had throat cancer in 1993 did radiation was cancer free till 2014 had total laryngectomy laryngectomy April 24th still can't talk speech therapy not sure why

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