Total Laryngectomy

What is total laryngectomy?

Total laryngectomy is a surgery in which the larynx (also called voice-box) is completely removed to eradicate the disease in the larynx. Total laryngectomy ends up in complete and permanent separation of the upper part of the airway from the lower airway, hence a permanent opening (stoma) is created in the patient’s neck to help in respiration. This leads to loss of voice and smell.

What is the need for total laryngectomy?

Removing the larynx is a severe yet necessary treatment for people who have:

  • Advanced stage laryngeal cancer
  • Radiation necrosis (damage to the larynx due to radiation treatment)

The doctor will perform a partial or total laryngectomy, on the basis of your condition.

Duration of the surgery

Laryngectomy is a lengthy surgery that lasts around five to twelve hours. Most patients will stay in the hospital for 7 – 10 days.

Before surgery
  • The healthcare team will perform several diagnostic tests to assess your overall health.
  • You’ll also meet with speech therapists and swallowing specialists who’ll prepare you for life after a total laryngectomy.
  • You will undergo a physical examination, blood tests, and scans
  • Stop taking certain medications such as blood thinners for time being.
  • Avoid eating the night before surgery. Tell your doctor if you’re allergic to any medications (antibiotics, anesthesia, and pain relievers).

You will be under the effect of general anesthesia during the surgery. You’ll be asleep and won’t experience pain during the process.

Total laryngectomy

The surgeon will 

  • Make incisions in the neck to remove the larynx, lymph nodes, and some part of the pharynx depending on the cause. 
  • Create a permanent hole in the front of the trachea known as a stoma that connects directly to the lungs.
  • Close the throat muscles and the skin on the neck with surgical stitches once the surgery is over.
After procedure
  • The healthcare team will shift you to the intensive care unit.
  • You might have drainage tubes in the neck to drain the fluids and blood for a week after the surgery.
  • The doctors will monitor your blood pressure, pulse, breathing, and other vital parameters.
  • You’ll receive oxygen through the stoma after surgery.
Post-operative care
  • Do not eat through your mouth till your doctors tell you. A feeding tube will be inserted into your stomach to provide nutrition. 
  • Your neck may have swelling and pain. Take pain medications as directed by the physician.
  • Learn how to swallow and communicate without your larynx(voicebox). Communicating after a total laryngectomy can be challenging. Hence, you may require speech therapy for a post procedure rehabilitation.
  • Physiotherapy sessions will reduce the risk of blood clots and pneumonia. It will help you learn to breathe. 
  • Stoma care is a crucial part of recovery. The stoma opening can be an entry point for bacteria and viruses into the body, leading to infection. Proper care may limit the complications.
Risks and complications
When to call a doctor?

Call your doctor if you have:

  • Fever higher than 100.5 °F (38 °C)
  • Drainage from the incision
  • Shortness of breath (Dyspnea)
  • Warm skin around the incision 
  • Discomfort around the incision
  • Blockage in the stoma 
Questions to ask your doctor
  • What is the need for total laryngectomy?
  • Do you have other options to treat my condition?
  • What will be the duration of the procedure?
  • How will it affect speech, swallowing, and breathing?
  • When can I go home?
  • What are the post-procedure instructions?
  • When can I resume my work?
  • What assistance will I need at home?
  • How to manage post-operative pain and stoma care?
  • What additional treatment or therapy will I need?
  • When can I start eating solid food?
  • When should I follow up?
  • How might surgery affect my daily life?
  • When and how should I contact you?

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