Undergoing voice box removal surgery, also known as a laryngectomy can be a terrifying and confusing experience. It alters the way you eat, swallow, breathe, and speak. You might have a lot of questions regarding the procedure and recovery. We will help you understand every step of the procedure, associated risks, and things you need to consider after the surgery.
What is Laryngectomy?
The partial or total surgical removal of the larynx (voice box) known as laryngectomy. The surgery disconnects the esophagus from the trachea.
This alteration in anatomy changes the way you eat and breathe. A stoma (hole) is positioned into the trachea to facilitate breathing. After undergoing a laryngectomy, you may lose the ability to speak and require the assistance of a speech pathologist for your rehabilitation.
A laryngectomy usually performed on patients who:
- Suffer from laryngeal cancer
- Experience physical trauma to the neck
- Have radiation necrosis resulting from radiation treatment
What is Larynx?
To fully understand the procedure and recovery process, you must first understand the anatomy of your neck. In most cases, The larynx, commonly known as the voice box contains vocal cords that produce sound through vibrations.
The larynx resides in the anterior portion of the neck, located below the pharynx and above the trachea (windpipe). Do you know?. The pharynx connected to both the esophagus (food pipe) and the larynx. The food goes to the esophagus while the air goes to the larynx via the laryngopharynx.
Important functions of Larynx
Moreover, This positioning of the larynx allows it to have many important functions. It facilitates breathing, prevents food from entering the trachea, and is essential for phonation (producing sound).
After a laryngectomy, the connection between the trachea and the esophagus is terminated and you will require a modified breathing route (stoma).
Types of Laryngectomy
Depending on the nature and extent of the illness or injury in that case, your doctor will decide whether you need a partial or total laryngectomy.
Partial Laryngectomy
Without a doubt, Partial laryngectomy performed to treat small cancers or injuries of the larynx. The procedure only removes cancer-affected areas of the vocal cords, leaving behind the majority of the healthy portion intact.
After the laryngectomy, you may retain full or partial speech abilities. The procedure does not hinder swallowing abilities; however, a temporary tracheostomy is placed in the neck to facilitate breathing. This tube is later removed and you are able to breathe on your own.
Different types of partial laryngectomies performed depending on the area of the cancerous region. A supraglottic laryngectomy is performed to remove supraglottic cancers. In such a case, the vocal cords are not affected by cancer, and you will retain full speech capacity after the surgery.
The right or left part of the voice box surgically removed in hemilaryngectomy. In this condition, one vocal cord remains after surgery and you retain some of your previous speech abilities.
Without a doubt, The most commonly used minimally invasive procedures used in partial laryngectomy are transoral robotic surgery (TORS) and transoral laser microsurgery (TLM). These procedures remove the cancerous areas via the oral mouth.
The surgery can also be performed by making an incision through the neck to reach the cancerous portion of the larynx.
Total Laryngectomy
The larynx completely removed in total laryngectomy. The procedure removes the vocal cords, epiglottis, hyoid bone, thyroid, cricoid cartilage, and some of the tracheal cartilage rings.
During the surgery, the stoma placed into your neck becomes the only means of breathing for you. After the surgery, you will lose your ability to speak and will require speech rehabilitation to learn alternative speaking methods.
Preparing for Surgery
Before the surgery, nutritionists, speech pathologists, and swallowing specialists will walk you through the changes that you will experience after the surgery and recovery options best suited for you.
Your doctor might recommend a few tests before performing the surgery such as a physical exam and routine blood tests. You will be asked to fast the night before the surgery. Your doctor may also ask you to discontinue certain medications before the surgery.
Laryngectomy Surgery
Laryngectomy can take from five to twelve hours and perform under general anesthesia. The procedure begins by making an incision into your neck to remove the affected laryngeal area. If the pharynx is affected by cancer, it is also removed alongside the larynx (a process known as pharyngotomy). The doctor also removes the lymph nodes present in the area.
The surgeon then sews the anterior portion of the trachea to the neck in order to create a stoma. The nickel-sized stoma allows you to draw air directly through your neck and into your lungs.
The surgery concluded by sewing the neck back up and inserting drainage tubes into the surgical site. The tubes drain the blood and other fluids from the surgical site.
Recovery and Rehabilitation after Laryngectomy
The recovery period after the laryngectomy depends on the type of procedure performed. Usually, after the surgery, you will spend a few days in the intensive care unit (ICU) where the doctor will monitor you closely.
In a few days, when the doctor deems fit, you can move to a regular hospital room. During this recovery period, you will learn how to breathe through your stoma and swallow. Speech therapists will help you seek alternative speaking methods. You will also be taught how to clean and take care of your stoma.
Your drainage tube will remove 1-4 days after the procedure. You might experience numbness and weakness of the neck and face as a result of the surgery. This might last up to 3-4 months after the procedure. Patients are encouraged to walk and do light physical activities to avoid the creation of blood clots.
Diet
In case, You will not be able to eat through your mouth for about two weeks after the surgery. During this time, a gastrostomy tube (feeding tube) in your stomach. The gastrostomy tube will help provide you with nutrition to give you the strength for recovery.
In this case, After the removal of the gastrostomy tube, your doctor might switch you to a liquid diet or a soft diet for a couple of months. After your throat fully recovered, you may resume your normal diet.
How to Take Care of Stoma?
Learning how to take care of the stoma is crucial in avoiding infection or a blockage of the airway. During your recovery period, you should learn how to properly clean the stoma.
To conclude, The mouth of the stoma must carefully clean with soap and water with the help of gauze. You can also use salt water to remove the mucus and crust from the edges of the stoma. Keeping the modified airway clean will prevent the formation of any infection.
The formation of crust on the stoma can block your air passage. You can prevent the formation by placing a humidifier in your room, especially while you sleep.
Forcefully coughing can help clear your stoma of mucus. If you are unable to cough, your doctor will teach you how to safely use suction to remove the mucus from the stoma on your own. Your doctor will also educate you on how to deal with emergencies that you might face while breathing through a stoma.
Learning How to Talk Again
Your speech therapist will help you through the process of speech rehabilitation. Learning how to speak again after a partial or total laryngectomy can be a challenging task. In most cases, when the vocal cords no longer exist, alternative speaking methods employed.
- Esophageal Speech:
The general principle of esophageal speech is drawing air into the esophagus and releasing it in a controlled manner that causes oscillation of the esophagus. These oscillations combined with the movement of the tongue and lips produce speech.
Esophageal speech is difficult to master but it resembles actual speech to a great extent.
- Tracheoesophageal puncture (TEP) for Voice Prosthesis:
After creating an incision between the trachea and esophagus, a one-way silicone valve inserted. The valve does not allow food or water to enter the trachea.
You can cover your stoma and force air into the esophagus via the valve. The air causes the walls of the throat to vibrate through which you are able to produce speech.
It is advised to have the valve inserted 3-6 months after the laryngectomy so that your body has sufficient healing time.
- Electrolarynx:
A small battery-operated device that assists you in producing speech. You place the device on your mandible (lower jaw) or neck, the device creates vibrations that you can use to produce speech. The speech produced sounds robotic.
- Nonverbal Forms of Communication:
These include using gestures, writing, pictures, sign language, and facial expression in order to communicate.
Risks
Generally, associated risks of laryngectomy include:
- Infection
- Bleeding
- Hematoma (collection of blood within the tissues)
- Blood clots
- In addition, Pneumonia (due to leakage of any liquid into the lungs)
- Salivary fistula (leakage of saliva from throat to neck)
- Nerve injury
- Hypocalcemia and hypothyroidism (as a result of damage to the thyroid or parathyroid glands or their removal during surgery)
What to Expect after Laryngectomy
Patients who undergo laryngectomy have a good recovery rate with promising results. Learning to breathe with a stoma and talk without a larynx can be difficult and quite challenging. It is essential to take care of your stoma and clean it to avoid the formation of crust or any infection.
In short, If you experience any trouble in swallowing, shortness of breath, excessive pain, change in the color of sputum, or if your stoma becomes constricted, contact your doctor right away.