What Is Laryngectomy?

A laryngectomy is a surgical procedure which involves the removal of a part or all of your voice box (larynx) located in your throat. The larynx is an important structure as it plays a vital part in helping you swallow, breathe, and produce sound. Sound is produced by your vocal cords situated in your larynx. The mouth and nose are connected to the lungs by the larynx which helps you to breathe by preventing food from entering your lungs. 

Despite the importance of the larynx, there are some reasons which may warrant its removal. These reasons are usually serious, where keeping your larynx intact might do more harm than good. Within this article, we will explore the reasons why you may undergo laryngectomy and explain how the procedure works. 

Anatomy of the larynx 

In your neck, there are two different pathways.¹ One pathway leads from your mouth, through the oesophagus, all the way down to your stomach. The other, leads from your mouth, through your windpipe (trachea), all the way to your lungs. The larynx is a hollow, tube-like structure located in the upper part of your trachea. Sometimes, it can even be seen and felt within your neck - this is commonly referred to as the “Adam's apple”.

The larynx helps you breathe by allowing air to pass through the trachea and into the lungs. It also houses your vocal cords which help you to produce sound. In addition, the larynx stops food from entering your trachea by closing off the top when you swallow. 

The larynx forms a connected area between both of these pathways and this area is known as the pharynx (throat). When you have your larynx removed, the connection between the two pathways is no longer there; this affects your breathing and swallowing. 

There may be several reasons that can lead to a laryngectomy: 

• Cancer of the larynx (laryngeal cancer)
• Fracture of the larynx or other severe injury/damage (laryngeal fracture)
• Damage of the larynx due to radiotherapy used in cancer (chondronecrosis)² 

Laryngectomy procedure

The removal of the larynx is a surgical procedure which is performed under general anaesthesia which means you will be asleep during the surgery and you won’t feel anything. Before your surgery, your doctor will perform a physical examination and they might conduct some blood tests, a chest X-ray or an electrocardiogram (ECG). You might have to discontinue or change any medication that you are taking regularly, and you will be asked not to eat or drink the night before your surgery.

During the surgery, the surgeon will make a small surgical cut (incision) in your neck and then remove either all (total laryngectomy) or a part of your larynx (partial laryngectomy). If only part of the larynx needs to be removed, it could be performed in a less invasive, endoscopic method.³ In some cases, part of your throat and some of your lymph nodes may be removed from the surrounding areas. 

The larynx forms a connection between the two pathways in your neck (trachea and oesophagus). When this connection is removed, certain measures need to be taken to help you keep breathing and swallowing. Your surgeon will create a hole (stoma) in your neck and use a small tube called a laryngectomy tube to connect your trachea to this hole to help you breathe. 

In some cases, your surgeon might decide to create a hole between your oesophagus and your trachea, which is known as a tracheoesophageal puncture (TEP). This hole can then be used to install a voice prosthesis to help you produce sounds.⁴ 

Some risks associated with this surgery are:

• Allergic reactions
• Infections
• Bleeding or blood clots
• Damage to nearby organs (trachea or oesophagus)
• Stomal stenosis (the stoma becoming too small)
• Problems with talking, swallowing, breathing
• Abnormal connections forming between your throat and skin (fistulas)

Rehabilitation and recovery

After your surgery, you might wake up groggy and disoriented. Pain medications may be prescribed and you will be encouraged to rest. You might have to stay in the hospital for approximately a week to 10 days. 

For the first few days, you will be provided nutrition intravenously (through your vein) as well as through a feeding tube, which is inserted through your nose directly into your stomach. When you feel a bit better you will be able to resume eating normally through your mouth. 

You will need to be re-taught how to speak, swallow, and breathe properly, without a larynx. Although this might sound daunting, you will have healthcare professionals to help you every step of the way. Your doctor will discuss with you in detail the dos and don'ts of post-operative recovery. A speech-language pathologist will work with you to help you speak properly again.

You will also be taught how to properly look after your stoma since it is now a permanent part of your life. Your stoma needs to be carefully looked after, especially the first week or so following the surgery. You need to clean it regularly to prevent the build-up of any blockage or infection. 

Impact on communication

After the removal of your larynx, you will not be able to produce sound as you once did. If you underwent only a partial laryngectomy, your voice might not be impacted since some vocal cords might be preserved. However, there are several other options that you can avail to help you communicate better:

Non-verbal communication

This is a common and basic method of communication, especially following your surgery. It involves the use of facial expressions and hand gestures, or devices to type out/write the words you are trying to communicate. 

Oesophageal speech

In this method, there are no devices involved but it takes a lot of practice to properly develop. You trap air in your oesophagus and release it in a controlled manner which produces vibrations. You then use your mouth and lips to produce words.

Electrolarynx

This is a small device which produces sound and you can hold it up to your neck and move your lips and mouth to form words. Your voice might sound a little robotic but it's easy to use and a good long-term solution.⁵ 

TEP speech

This method uses the TEP to install a voice prosthesis to produce sound.⁴  This device is placed over your stoma. It has a hands-free approach but it might not be suitable for everyone. Your suitability for this type of speech will be decided before you have surgery.  

Lifestyle changes 

Having a laryngectomy can significantly alter your life. But these changes do not necessarily mean that your quality of life will be affected, you may go on to live a full and normal life. In fact, it was reported in one research study, that 80% of patients reported a good quality of life after a total laryngectomy.⁶ Apart from learning to communicate, you will have to learn to care for your stoma every day. It needs to be kept clean and the surface needs to be wiped down regularly. Your stoma also needs to be kept moist (with the help of a humidifier) and covered with a light cloth to prevent dust from entering your lungs. Special care needs to be taken whilst showering to prevent water from entering your lungs. 

Right after the surgery, you will be fed through a feeding tube then progress to soft food and eventually normal food but this process can take a few months. Once you resume a normal diet, you will be encouraged to eat healthy and nutritious meals. You might be asked to sit up straight for about 30 minutes after every meal and avoid eating right before bed. 

Strenuous activity and heavy lifting should be avoided till about 6-8 weeks after surgery. However, you will eventually be able to resume gentle exercise and slowly build up your strength. 

Support networks

It is important to have a strong support network of your close friends and family to help you adapt to your new lifestyle. You can get help with meals or daily chores to allow you to get the rest you need post-surgery.

You can also approach your GP if you are having difficulty coping or experiencing signs of depression. There is also a patient support group which helps people adapt to their lives after undergoing full laryngectomies. Web Whispers is another support group for patients who had to undergo a laryngectomy due to throat cancer. 

Summary

A laryngectomy is a surgical procedure to remove the larynx. It can be either a total or partial laryngectomy. This procedure is recommended if the larynx has undergone severe trauma, fracture or developed a malignancy. The larynx plays an important role in helping you to breathe, swallow, and produce sound via the vocal cords. It also forms an important connection between the two pathways located in the neck.

When the larynx is removed, rehabilitation is needed to relearn how to breathe, speak and swallow without vocal cords. You will work with a speech pathologist to learn how to communicate. There are various methods that can help you produce sound, and with the help of your doctor, you can decide which is right for you. After the larynx is removed, a stoma will be created in your neck through which you will breathe. It is a permanent fixture and you will be taught how to properly care for and live with a stoma. 

Though post-operative rehabilitation after laryngectomy is a long road, it can eventually lead to a good and normal life. A good support network and a team of healthcare professionals will help ease you into your new life. It is hoped that further research and clinical trials will be conducted into laryngeal care and the improvement of voice prosthesis. Different, more precise surgical techniques need to be developed to preserve as much of the larynx as possible during surgery so that some vocal cords can be preserved.