Total Laryngectomy

Total laryngectomy is the surgical removal of the whole larynx in certain conditions, such as laryngeal cancer, hypopharynx cancer, etc. Total larynx removal is planned in advanced stages of cancer when other treatment options such as radiotherapy, chemotherapy, etc., have failed. It is sometimes also indicated in patients with extra-laryngeal tumours and tumours at the base of the tongue. The windpipe is taken through a hole (stoma) in front of the neck for respiration.

Alternate Name

Whole larynx removal

Body Location

Larynx (voice box) in the neck region

How is Total Laryngectomy Performed

Total laryngectomy is done under general anaesthesia and sedatives to block the pain and make you sleep. Your surgeon will place a breathing tube through your mouth for respiration and a nasogastric (NG) pipe through your nose for nutrition. Then, the surgeon will make the incision in the neck in the larynx area and will remove it carefully to prevent damage to adjoining tissues, nerves, and organs. A stoma is made in the front of your neck, which serves as the new opening for the trachea (windpipe). The incisions are then closed and covered with bandages.

Preparation for Total Laryngectomy

• Before undergoing surgery, you will undergo certain blood tests such as complete blood count, bleeding time, clotting time, etc. In addition, you will undergo a pre-anaesthesia checkup (PAC), including a chest X-ray and electrocardiogram (ECG), to assess your suitability for the surgery. Your doctor will order imaging tests such as CT-scan, Magnetic Resonance Imaging (MRI), etc., to identify the target location and plan the surgery.
• You should quit smoking and alcohol use as these could complicate the surgery. If you take any medications such as aspirin or blood thinners, inform your doctor. You might be asked to discontinue those drugs and given anti-anxiety medications to calm your nerves.
• You should not eat or drink anything post-midnight, the day before the surgery. Reach the hospital 4-6 hours before the scheduled time as you will be kept under observation for some time and then prepared for the surgery.

Procedure Type

Surgical procedure

Follow-up

After the surgery, visit your surgeon for all the follow-ups as per the schedule to ensure a complication-free recovery. Avoid strenuous exercise such as running, weight lifting, cycling, etc. However, you can start with walking and stair climbing and gradually increase the walking distance. Physical activity will help you recover and gain strength quickly. Take your medications, including painkillers, antibiotics, etc., as prescribed, and do not overconsume for quick pain relief. You will need to learn new ways to speak and communicate as you will not be able to speak as you were doing before the surgery. You will be breathing through the stoma, so you need to adjust to the new way of respiration as well.

Risks

Risks and side effects of the total laryngectomy include the following:

• Blood loss: Excessive blood loss could occur in complicated cases and require additional interventions.
• Infection: Infections could occur after the surgery with symptoms such as swelling, fever, etc. Antibiotic treatment might be required in such cases.
• Stomal Stenosis: Narrowing the stoma for air passage is very common in total laryngectomy and might require stomaplasty.
• Injury: During the removal of the larynx, an injury could occur to the adjoining tissue or cells, leading to nerve damage.

In addition, hematoma, seroma, or pharyngocutaneous fistula could occur.

Recovery

Recovery after total laryngectomy depends on age and is usually without any major complications. You should always look for any signs of complications such as infections, stomal stenosis, etc., and seek immediate medical attention if required. Make sure to follow up with your surgeon at the scheduled visits.

You will be required to wear a plastic tube most of the time to prevent the breathing stoma from shrinking. You might be asked to avoid showering for around one week post surgery. Ensure an active lifestyle to avoid constipation and drink plenty of fluids such as water, juices, etc., to keep yourself hydrated.