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The information on this page was reviewed and approved by
Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on November 29, 2021.

Laryngectomy

Your larynx, also called the voice box, helps you to breathe, eat and speak. A laryngectomy is a surgical procedure for the removal of all or part of the larynx (voice box). This is done most frequently to remove cancer that affects the larynx.

Types of laryngectomy

There are several types of laryngectomies, including:

Partial laryngectomy removes part of the larynx and is used for smaller tumors. Though there are several kinds of partial laryngectomy surgeries, the intended outcome is the same: to remove only a portion of the larynx (the entire cancerous part) so that as much of the larynx is left intact as is feasible.

Supraglottic laryngectomy removes some of the larynx located above the vocal cords. You may still maintain your normal speaking voice after a supraglottic laryngectomy.

Hemilaryngectomy is a treatment for small cancers of the vocal cords. It involves the removal of one vocal cord while maintaining the others. You’re able to speak after a hemilaryngectomy, but it’s more limited. 

Total laryngectomy takes out the larynx completely. It affects your ability to speak normally, although it’s possible to learn to speak in other ways, such as with a mechanical voice or esophageal speech training. 

Your doctor chooses which laryngectomy to perform, depending on the location of the cancer and the throat cancer stage.

How it’s done

A laryngectomy requires anesthesia and takes about five to nine hours to perform.

First, the surgeon makes a cut in the neck to access the area where surgery is needed. Next, the surgeon removes the larynx (or part of the larynx, depending on the type of laryngectomy) and surrounding tissues. Lymph nodes, bean-shaped structures that are part of the immune system, also may be removed and analyzed for cancer cells.

Additionally, the surgeon may have to remove the pharynx, which is located between the nasal passages and esophagus.

Next, the surgeon performs a tracheostomy. This involves the creation of a hole in the front of the neck and into the trachea. This hole, called a stoma, allows the patient to breathe after surgery. A tube is inserted to keep the hole open. With a total laryngectomy, the stoma is permanent. The surgeon closes the area with clips or stitches.

Five ways to prepare for a laryngectomy

  1. Quit smoking. Smoking may reduce any benefits from treatment and increase the chance of other cancers occurring. If you have trouble quitting, ask your doctor for counseling and other aids to help.
  2. Expect to complete blood work, laboratory tests and imaging studies before your surgery.
  3. Meet with a speech therapist and a swallowing therapist. These professionals may explain what to expect after surgery in terms of speaking and swallowing.
  4. Let your doctor know about medications or over-the-counter herbs, vitamins or supplements you use—and ask whether you need to stop taking any before or the day of the procedure.
  5. Be prepared to not eat or drink anything after midnight prior to surgery day. If you’re able to take any medications, do so with a small sip of water.
 

Risks from a laryngectomy

Patients should consider that there are risks associated with any type of surgery and risks that are specific to a laryngectomy.

General risks related to any type of surgery include:

  • Blood clots
  • Breathing problems
  • Heart problems
  • Infection

Complications related to a laryngectomy include:

  • Decreased thyroid gland function
  • Esophagus or trachea damage
  • Fistulas (abnormal connections between the pharynx and the skin)
  • Mobility limitations in the neck and shoulder area
  • Problems with the stoma opening
  • Trouble eating, speaking or swallowing

Results from a laryngectomy

It takes two to three weeks and sometimes longer to heal from a laryngectomy. This includes spending additional time in the hospital after surgery.

Initially, you receive nutrition through a tube that goes from your nose to the esophagus. Within a few days to a week after surgery, the doctor may permit you to eat again through your mouth.

A laryngectomy is usually successful at removing cancer, but you may require other treatments, including chemotherapy and radiation. Expect to also return for regular follow-up care to make sure there’s not a recurrence.

Follow any instructions given by your care team to help you heal. These may include resting but also moving your legs regularly to help with circulation, which may reduce your chances of a blood clot. You may be advised to avoid heavy lifting and strenuous activity for six weeks.

Your care team helps teach you how to take care of your stoma laryngectomy tube. You may also learn how to speak again with the help of a speech therapist.

Stoma care

You’ll need to take proper care of your stoma to avoid irritating your lungs or developing an infection.

Here’s what you need to do:

Keep it moist. When you breathe through your nose and mouth, it moistens the air before it reaches your lungs. That doesn’t happen when you breathe after a laryngectomy, so you must replace the moisture.

You can do this by:

  • Drinking lots of fluids
  • Spraying a sterile salt solution into your tube
  • Using a filtering and moisturizing system
  • Using humidifiers in your home, especially in the bedroom

Care for the skin around your stoma. While you’re recovering from surgery, your care team will help you clean your stoma. Once it has completely healed, you will need to clean it regularly.

Clean the edges using a gauze pad dipped in mild soapy water. You want to remove any crusting or excess mucus. Be gentle when doing so. A saltwater spray can help loosen the crust and mucus. It’s important to dry the skin after you clean it. Your doctor may prescribe an antibiotic cream, to be applied as directed.

Coughing can also help you clear your stoma. If you’re unable to cough forcefully enough, you may need to suction your stoma. This requires a soft plastic tube that your care team can show you how to use.

Plan to change and clean your tube as well. If you have a double cannula tube, you will need to clean it up to five times each day.

Ask a nurse to show you how to clean your tube before you leave the hospital. It’s a good idea to let someone with the proper experience watch as you practice. This step also can give you more confidence when you’re home and doing it on your own.

Protect your stoma. It helps to avoid extreme temperature fluctuations, fumes from traffic or air polluters, smoke and dust.

Speech rehabilitation after a laryngectomy

It may be difficult to speak after a laryngectomy. You may not be able to make sounds the same way you did before, depending on the type of surgery you underwent. If this is the case for you, there are speech rehabilitation options that can help you learn to communicate through other methods.

Nonverbal communication: It may take more time, but consider using a mini-laptop, tablet or your smartphone to write out what you would like to say.

Esophageal speech: You may wish to learn a technique called esophageal speech. Some find it easy to learn, while others have trouble mastering it. The technique requires that you squeeze air from your mouth down into your esophagus. As the air moves back up, your throat muscles vibrate, which creates sounds. You use your lips, cheeks and tongue to turn sounds into recognizable words.

Voice prosthesis valve or tracheoesophageal voice: Your surgeon may be able to make you a voice prosthesis. This requires making a small channel between your windpipe and esophagus in a procedure known as a tracheoesophageal puncture (TEP). A voice prosthesis that connects the windpipe to the esophagus is implanted in this small channel. Air passes through this valve, allowing you to have a new voice. The valve is one-way so that food and fluids won’t pass through it.

To speak, you cover your stoma with your thumb or finger. When you breathe out, it causes air to pass from your lungs through the valve and your throat muscles to vibrate. You use your lips, cheeks and tongue to form words.

You may be able to use a hands-free valve so that you don’t have to cover your stoma when you speak. Ask your doctor if you’re a candidate for this type of voice prosthesis valve.

The words coming from a voice prosthesis are the most natural sounding. Your voice prosthesis will require maintenance, including cleaning.

Electrolarynx: A number of different electronic aids are available that you can use to produce sounds. You hold these electronic devices up against your neck and they turn the vibrations into speech. You may want to try one and practice before you decide.

Some people find the muscles in their pharynx can spasm, making it difficult for them to speak after surgery. You may be treated with an injection of botulinum toxin to help your muscles relax and the spasms to stop.

Acid indigestion can cause the throat area to swell and make it more difficult for you to speak using these methods. Your doctor may prescribe antacids if you have this problem.

Olfactory rehabilitation

After a laryngectomy, many patients have trouble with their sense of smell. A type of training called olfactory rehabilitation may help with this.

Adjusting to life after surgery

Adjusting to life after a laryngectomy takes some getting used to—and you may feel overwhelmed by the initial changes. Let your care team and loved ones know of any concerns so they may help you cope.

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