Total Laryngectomy

• Total Laryngectomy is the surgical removal of the entire larynx, primarily for advanced laryngeal cancer.
• The procedure results in a permanent opening in the neck (stoma) for breathing, separating the airway from the mouth and nose.
• Patients will experience changes in voice, requiring rehabilitation through methods like esophageal speech, tracheoesophageal puncture (TEP), or an electrolarynx.
• Recovery involves managing the stoma, adapting to new ways of speaking and eating, and often includes speech and swallowing therapy.
• Life after the surgery requires significant adjustments but allows many individuals to maintain a good quality of life with proper support.

What is Total Laryngectomy?

Total Laryngectomy refers to a major surgical intervention where the entire larynx, commonly known as the voice box, is removed. This critical organ, located in the neck, plays a vital role in breathing, speaking, and protecting the airway during swallowing. The primary indication for this surgery is advanced laryngeal cancer that has not responded to other treatments or is too extensive for less invasive options. According to the American Cancer Society, laryngeal cancer accounts for a significant portion of head and neck cancers, with surgery being a cornerstone of treatment for advanced stages.

During a total laryngectomy, the surgeon detaches the larynx from the pharynx (throat) and trachea (windpipe). The trachea is then brought forward and permanently attached to an opening created in the front of the neck, known as a stoma. This permanent stoma becomes the new pathway for breathing, meaning air no longer passes through the nose and mouth to reach the lungs. This separation of the airway from the digestive tract is a defining characteristic of the procedure, preventing food or liquids from entering the lungs.

The Total Laryngectomy Procedure

The Total laryngectomy procedure is a complex operation performed under general anesthesia. The surgeon makes an incision in the neck to access and carefully remove the entire larynx, including the vocal cords. Crucially, the hyoid bone, thyroid cartilage, cricoid cartilage, and epiglottis are all removed. After the larynx is excised, the remaining portion of the trachea is brought to the skin surface of the neck and sutured to create the permanent breathing stoma. This step, called a tracheostomy, ensures a clear and unobstructed airway for the patient.

In many cases, surrounding lymph nodes in the neck may also be removed if there is a concern about cancer spread, a procedure known as a neck dissection. The pharynx, which is the tube connecting the mouth and esophagus, is meticulously reconstructed to allow for swallowing. A feeding tube (nasogastric or gastrostomy tube) is often placed temporarily to provide nutrition while the reconstructed throat heals. The duration of the surgery can vary, but it typically takes several hours, followed by a hospital stay for initial recovery and monitoring.

Life After Total Laryngectomy and Recovery

Life after total laryngectomy involves significant adjustments, particularly concerning communication and breathing. Patients will no longer be able to speak using their vocal cords and must learn alternative methods of communication. These include:

• Esophageal Speech: Learning to trap air in the esophagus and release it to create vibrations that can be shaped into words.
• Tracheoesophageal Puncture (TEP) with a Voice Prosthesis: A small surgical opening is created between the trachea and esophagus, where a one-way valve (voice prosthesis) is inserted. Air from the lungs is diverted through this prosthesis into the esophagus, producing vibrations for speech.
• Electrolarynx: A battery-operated device held against the neck that produces vibrations, which the user then articulates into speech using their mouth and tongue.

The Total laryngectomy recovery time varies among individuals but generally involves several weeks to months for initial healing and adaptation. Immediately after surgery, patients will have a tracheostomy tube in their stoma, which may later be replaced with a smaller button or removed entirely, leaving just the open stoma. Stoma care is crucial to prevent infection and maintain a clear airway; this involves regular cleaning and humidification. Patients will also need to adapt to breathing through the stoma, which means air is no longer filtered, warmed, or humidified by the nose and mouth, potentially leading to increased mucus production and susceptibility to respiratory infections.

Swallowing rehabilitation is also a key part of recovery, as the anatomy of the throat has changed. Speech-language pathologists play a vital role in helping patients regain swallowing function and learn new communication methods. Psychological support is also important, as patients adjust to changes in body image and lifestyle. With comprehensive rehabilitation and support, many individuals can achieve a good quality of life, engaging in social activities, hobbies, and even returning to work.