What to Know About a Laryngectomy

A laryngectomy is a major surgery that is done to remove your voice box, or larynx.

Your larynx is the part of your throat that contains your voice box. It’s located at the upper end of your windpipe (trachea). Your larynx is important for breathing, swallowing, and speaking.

Reasons for a Laryngectomy

There are several reasons for a laryngectomy:

  • Laryngeal cancer (cancer of the larynx)
  • ‌Chondronecrosis of the larynx — a rare complication in which there’s damage to your larynx, usually due to radiation therapy
  • Severe larynx damage or fracture

Before Your Surgery

Your healthcare team will work with you to prepare you for the surgery. You’ll meet with a speech therapist and other specialists who can help you prepare for life after your laryngectomy.

You’ll have to take some tests a few weeks before your surgery. These tests may include:

Inform your doctor about the medications that you’re currently taking and if you have any allergies to medications.

You’ll also need to temporarily stop taking certain medications such as nonsteroidal anti-inflammatory drugs (NSAIDS) and aspirin. Your healthcare provider will tell you when to stop taking them. 

Laryngectomy Surgical Procedure

Your laryngectomy may be partial or total, depending on your condition.

You’ll be asleep under general anesthesia for the surgery. 

The surgeon will make an incision (cut) on your neck. In a partial laryngectomy, only part of the larynx will be removed. In a total laryngectomy, your entire larynx is removed.

Part of your pharynx may be removed too. Your pharynx, or your throat, is the passage between your nasal cavity and esophagus. In some cases, your lymph nodes may also be removed.

Your surgeon will create a permanent hole, or stoma, in the front of your neck and an opening in your trachea (windpipe). Your trachea will be attached to the stoma. The stoma is what you’ll breathe through after your surgery.

Your incisions will be closed with stitches or clips. You may have tubes coming out from your wound. 

Your surgeon may do a tracheoesophageal puncture (TEP). This creates a small hole in your trachea and esophagus, where a voice prosthesis will be placed. This device will help you to speak.

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After the Surgery

You may be in the hospital for 10 to 14 days after your surgery. 

You may be getting oxygen through a tube or a mask at first. You’ll also have a catheter that drains urine. You’ll get pain medication as needed.

You won’t be able to eat through your mouth initially. You’ll first get your nutrition through the feeding tube. Once you can swallow liquids, the tube will be removed. This usually takes place 8 to 10 days after your surgery. 

Communicating After a Laryngectomy

You’ll have to learn new ways of breathing, swallowing, and speaking. Speech and swallowing rehabilitation programs will help you to adapt. 

You may have to begin with nonverbal communication like gestures, mouthing your words, writing messages by hand, or typing.

After you recover, your speech-language pathologist will work with you to learn one of these ways of communication:

Voice prosthesis. If you decide to get a voice prosthesis, you’ll learn tracheoesophageal speech. You’ll cover your stoma as you exhale. This redirects air into your esophagus. The air allows muscle vibrations in your esophagus to create sound.

Artificial larynx (electrolarynx). This is a battery-operated device that you hold to your neck when you want to speak. The device creates vibrations that transfer from your skin to your throat.

Esophageal speech. This doesn’t require a device, but it takes practice. You’ll have to learn how to push air down into your esophagus and back out again. This creates a hoarse sound.

Caring for Your Stoma

After your surgery, you’ll breathe through your stoma, so it’s important to learn the proper care for it. Your health care provider will give you detailed instructions. 

Hand washing. Wash your hands before and after caring for your stoma. Make sure all of your supplies are clean. 

Keep your stoma clean. Every morning and evening, check the area around your stoma and inside your trachea wall for crusts and mucus. Gently wash the skin around your stoma with mild soap and water. Wipe it dry.

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Keep your airway moist. This will reduce coughing and prevent mucus from drying out. The air you breathe doesn’t pass through your nose and mouth, so you’ll have to humidify it. 

A saline spray can help. Using a humidifier at home, especially at night, will create humid air. Keep your humidifier clean to prevent any infections. 

Removing crusts. Try to cough out any mucus in your stoma. Using a saline spray can help. Or try placing a warm damp cloth over your stoma. 

You may also need to use suction to remove any secretions that you can’t cough out. This will involve the use of a suction machine. Your healthcare team will show you how to suction, and also how to clean your machine and supplies. 

Cover your stoma. Covering it will prevent dirt and dust from entering your airway. You may want to use a special stoma cover. Scarves or turtleneck tops can also be used to cover your stoma.

Recovery After a Laryngectomy

You should be able to resume most of your regular activities. But there are some things you can’t do, like swimming and taking baths, because water will enter your stoma. 

Gradually start to exercise. This will help you recover and gain strength. Walking is a good exercise to start with. Talk to your doctor before starting any strenuous exercise. 

You may have upsetting feelings following your surgery. Get support from your family and friends. Talk to your doctor to let them know how you’re feeling. They may be able to provide you with advice and resources, such as local support groups.

WebMD Medical Reference Reviewed by Dan Brennan, MD on April 25, 2021

Sources

SOURCES:

Journal of Laryngology and Otology: "Severe laryngeal fracture treated by supracricoid laryngectomy."‌

Journal of Physiology and Pharmacology: “QUALITY OF LIFE OF PATIENTS AFTER LARYNGECTOMY.”

Medscape: “Chondronecrosis of the Larynx.”

Memorial Sloan Kettering Cancer Center: “About Your Total Laryngectomy.”

NYU Langone Health: “Voice Restoration for Laryngeal Cancer.”

UC Davis Medical Center: “CARE OF YOUR LARYNGECTOMY STOMA.”

Wake Forest Baptist Health: “Laryngectomy.”

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