What Is a Laryngectomy? What You Should Know

A laryngectomy is the surgical removal of part or all of the larynx, also known as the voice box. It is most commonly performed in patients with laryngeal (voice box) cancer .

A surgeon can remove part of the larynx in a partial laryngectomy or the entire larynx in a total laryngectomy.

Laryngectomy may also be needed to treat chronic aspiration, a rare condition in which food or drink repeatedly enters the lungs.

This article reviews what a laryngectomy is, its types and what patients can expect before and after surgery.

What Types of Laryngectomy Are There?

There are several types of laryngectomy. Each involves an incision over the Adam’s apple to access the larynx.

Partial Laryngectomy: This is a treatment option for smaller tumors. An ear, nose and throat (ENT) surgeon removes part of the larynx, aiming to remove the cancer while preserving as much of the larynx as possible.

Supraglottic Laryngectomy: This is a type of partial laryngectomy that removes the upper larynx above the glottis (vocal cord area). Surgeons use it for supraglottic cancers. It does not usually cause loss of speech.

Hemilaryngectomy: Another type of partial laryngectomy, this operation removes one of the two vocal cords to remove small cancers. Depending on how much of the larynx is removed, the patient may or may not be able to speak afterward.

Total Laryngectomy: This removes the entire larynx. The surgeon also creates a permanent stoma (opening) in the neck to help breathing. Patients can eat and drink as usual afterward, but lose their speaking ability and need to learn new ways to communicate.

Partial laryngectomies now play a decreasing role in early-stage laryngeal cancer treatment. Surgeons increasingly prefer endoscopic resection (removal from inside using a camera), another minimally invasive operation for early-stage laryngeal cancer.

Why Is Laryngectomy Performed?

Laryngectomy is used to treat throat cancers, such as laryngeal and hypopharyngeal (lower throat) cancers.

Total laryngectomy is performed for:

• Severe laryngeal trauma
• Advanced head and neck cancer
• Cancer that does not respond to chemotherapy or radiotherapy
• A large tumor in this area
• Chronic aspiration or lack of voice resulting from paralysis of cranial nerves (nerves arising from the brain and supplying the head and neck)
• A patient with recurrent laryngeal papillomatosis .

How Does Laryngectomy Affect Neck Anatomy?

The neck contains many structures. Those most closely associated with laryngectomy are the larynx (voice box), trachea (windpipe) and esophagus (food pipe).

The anatomy of the head and neck is illustrated simply below:

The larynx and trachea connect to the lungs, while the esophagus connects to the stomach and the rest of the gastrointestinal tract.

The larynx shares an area in the neck known as the pharynx with the esophagus. This is where both passages connect to the mouth.

Total laryngectomy removes the connection between the mouth and trachea, so the person can no longer breathe through their mouth or nose. Afterward, the trachea and esophagus no longer share the same area.

Instead, the person breathes through a stoma, or opening, in the neck. They can no longer speak as before but can continue eating and drinking.

Patients should receive comprehensive information about life after surgery, and oncological rehabilitation should begin before the operation.

Partial laryngectomies preserve more of the laryngeal structure.

The illustration below shows the changes in neck anatomy before and after laryngectomy in a simplified form:

How Do Laryngectomy and Tracheostomy Differ?

A tracheostomy creates a stoma (opening) in the upper windpipe. It does not remove any or all of the larynx; an opening is created solely to enable breathing. This gives direct access to the trachea and lungs so the patient can breathe through a tube.

Tracheostomy is most commonly performed by ENT specialists and anesthesiologists.

If a surgeon removes the entire larynx (voice box), the patient needs a permanent opening, called a laryngectomy stoma. A laryngectomy stoma is not the same as a tracheostomy.

After a total laryngectomy, the surgeon brings the trachea to the neck skin. There is no longer a connection between the windpipe and mouth.

What Are the Possible Risks and Side Effects of Laryngectomy? 

Every surgical procedure carries risks, which may include:

• Pneumonia
• Thrombosis (blood clots)
• Infections
• Anesthesia-related complications

Surgery involving the throat may cause:

• Difficulty swallowing, which can affect eating
• Fistula formation (an opening between two tissues, such as the windpipe and esophagus)
• Rupture of major blood vessels or arteries, although very rare
• People who undergo total laryngectomy lose the ability to speak as they did before.
• People with a partial laryngectomy generally retain the ability to use their vocal cords but may need therapy to adjust to changes after surgery.

Preparing for Laryngectomy Surgery

Before the procedure, the doctor will probably order several tests to help assess risk factors for complications.

People with factors that impair wound healing, such as smoking or previous radiotherapy, may develop more complications.

A detailed ENT or oncological assessment can provide patients with preparation instructions covering:

• Which medications to stop and when
• When to stop eating or drinking
• What to do after admission to hospital
• Other instructions important for safety

During Laryngectomy Surgery

The surgical team works with an anesthesiologist to keep the person asleep throughout the procedure.

Once the patient is asleep, the following are placed:

• A tube down the throat to help breathing
• A nasogastric tube through the nose to manage stomach contents during surgery
• A urinary catheter to drain urine during surgery
• An incision is then made over the Adam’s apple, and part or all of the larynx is removed.

After the necessary tissue is removed, a stoma is created in the trachea. This opening allows the person to breathe directly through it.

The stoma is temporary after a partial laryngectomy and permanent after a total laryngectomy.

However, some partial laryngectomies may require a permanent stoma. The doctor can explain whether a temporary or permanent stoma is needed.

After Laryngectomy Surgery

After surgery, the patient is taken to the recovery room.

A patient may need several days in intensive care after total laryngectomy. Hospitals experienced in head and neck surgery may shorten this stay and provide specialized ward care earlier.

The person cannot eat until the throat heals, which may take 1-2 weeks. During this period, feeding is provided through a tube via the nose into the stomach.

During the hospital stay, nurses and other healthcare staff assist with aspects of care including:

• Pain management
• Nutrition (eating and swallowing) support
• Helping the person move
• Supporting communication using a writing board or similar tools
• Teaching stoma care

The person needs to get up and walk around the room to help prevent surgical complications and blood clots. They may then begin physical therapy and speech and language therapy.

Additional treatments, such as chemotherapy or radiotherapy, may be needed depending on tumor size.

Stoma Care

During the first few months after surgery, the stoma may produce excessive mucus, making breathing more difficult.

A tube fitted into the stoma can help the person breathe more easily and prevent the opening from shrinking. The tube can be removed to clear mucus.

Once excessive mucus production stops, the doctor removes the tube.

Patients need to clean the stoma once daily to prevent crusting and infection. A nurse teaches them how to do this.

The doctor may provide special filters to help keep germs out of the stoma and prevent drying.

The stoma should be covered with a tissue when coughing or sneezing, because mucus and saliva come through it rather than the mouth or nose.

Speech Rehabilitation

Speech rehabilitation includes several therapies to help patients learn to communicate.

Options include:

Nonverbal communication: This can include facial expressions, sign language, writing boards and other assistive devices.

Esophageal speech: This can be difficult to learn. It involves trapping air and creating vibrations, then using air, the tongue and lips to form words.

Electrolarynx: A device placed against the neck that produces a robotic voice.

TEP speech: This uses a tracheoesophageal puncture to insert a voice prosthesis that allows the person to speak.

Voice prosthesis: An artificial valve placed in the neck by a surgeon. When the person wants to speak, they cover the stoma and breathe through the valve. This produces a sound that can be shaped into words using the lips and mouth. The voice may be lower-pitched than before.

Other Information About Laryngectomy

Most patients continue to live in good general health after laryngectomy.

Some studies report that 1 in 3 patients develop complications after laryngectomy.

A 2018 study examined survival after total laryngectomy for recurrent laryngeal cancer. It found an overall 5-year survival rate of 49% and an overall 5-year disease-free survival rate of 58%.

Survival after laryngectomy can vary widely. Age, overall health, cancer stage and other factors affect life expectancy after this operation.

Summary

Laryngectomy is surgery to treat certain throat cancers. Its two main types are total and partial laryngectomy.

A person who undergoes total laryngectomy loses their previous speaking ability. They also need a stoma, or opening, in the neck to help them breathe.

The overall success rate varies with the person’s general health, age and cancer stage.