Purpose And Implications Of Laryngectomy

In the following article, we will discuss the purpose and implications of having a laryngectomy performed. It is a surgical procedure that involves a complete removal of the larynx.

Those who have a laryngectomy have to have a tracheostomy for life. It is an opening in the trachea where a tube is inserted, which facilitates the passage of air to the lungs. This implies a need for permanent care.

The effects of a laryngectomy are incredibly diverse and involve several daily limitations. These patients need to retrain their voice and may need to deal with difficulty swallowing food. 

Who should have a laryngectomy?

Inside the larynx there are two different pathways: one leading to the stomach (esophagus) and one leading to the lungs (larynx and trachea). The larynx shares a common area with the esophagus called the pharynx. A laryngectomy removes the larynx, thus cutting off the connection between the mouth and the lungs.

The removal of the larynx is a very serious operation which doctors only perform if there is no alternative. When does this occur? In the following cases:

• There is a severe trauma to the larynx: that is, remarkable injury due to a gunshot wound or a similar factor.

• The patient has cancer of the larynx.
• There is radiation necrosis. In other words,  severe damage in this area due to radiation therapy.

What does this procedure consist of?

Laryngectomy requires general anesthesia. The surgeon makes incisions in the throat and through these he or she removes the larynx. In some cases, the doctor may also remove parts of the pharynx and / or lymph nodes.

After removing the larynx, the doctor will make a hole in the front of the trachea. This is called a stoma and it is about 20 mm in diameter. Next, the doctor will insert a tube or cannula to connect the lungs to the outside.

Finally, the surgeon makes a suture with surgical stitches. The doctor usually places drainage tubes in the throat to remove fluid and blood from the operated area. When the doctor is done, the patient is taken to a living room where he or she can recover.

Sometimes doctors also perform transesophageal perforation (TEP) during a laryngectomy. There is a small hole in the trachea and esophagus. The doctor also places a flap so that the hole remains open. The goal is to keep food away from the trachea without blocking the air passage.

Possible risks

All surgery involves risks. Among the most common are bleeding, infection, allergic reactions to medication, breathing problems and heart problems. Particularly with a laryngectomy, there are other risks such as the following:

• Hematoma or blood clot  due to a rupture of the arteries in the thyroid gland.
• Occurrence of fistulas. That is, gastric ducts or connections between the pharynx and the skin.
• Anastomotic stenosis. It is a condition where the opening to the stoma is too small.

• Leak. Occurs between the tracheotomy prosthesis and the transesophageal perforation (TEP).
• Damage to the pharynx or esophagus.
• Problems talking.
• Problems swallowing food.

What to consider before a laryngectomy

Before a laryngectomy, doctors first need to perform a series of tests and examinations. They usually order blood tests and sometimes even imaging tests. The doctor will also perform a complete physical examination.

The patient should consult a swallowing expert and a speech therapist. This will allow the patient to prepare for the implications of a laryngectomy. You should also seek the advice of a nutritionist. If you smoke, you should stop smoking and make sure you get support and information to help you quit.

You should inform your doctor about the medicine you are taking. You should also tell your doctor if you regularly consume alcohol. If you are a woman, you must also tell if you are pregnant or if there is a possibility of this.

• One should avoid any kind of medication that prevents blood clots. This reservation takes effect one week before the operation.
• The patient should not eat or drink 12 hours before the operation.
• If the patient has a beard or mustache, this should be shaved off.
• You should also follow any other instructions from your doctor.

Consequences of a laryngectomy

Once the condition stabilizes, one will be moved to another living room where one will stay for about 10 days. During this time, one will learn to speak and eat again. You will also get help to get used to the new way of breathing. 

After the stay in the hospital, one will have to continue with the rehabilitation treatment. This involves two basic aspects, which we will describe below.

Stoma care

One of the primary implications of a laryngectomy is stoma care, as viruses and bacteria can penetrate and be a potential cause of infection. Therefore, it is essential to learn how to care for it. The edges of the stoma should be cleaned with water, mild soap and gauze.

It is important to have a humidifier at home as it prevents crusting in the stoma. Sometimes the use of a special mask that provides humidified air can also be prescribed. Its use is temporary.

Implications of a laryngectomy: Speech rehabilitation

Another of the most important implications is that it causes the voice sound to change markedly. The air no longer circulates in the same way, and this creates major changes in the way the sounds are emitted. It is important to develop new ways of communicating and to re-learn how to speak.

• Esophageal speech. This involves catching the air from the mouth in the upper part of the esophagus and throat. Although difficult to learn, this technique can create speech.

• Electrolaryngeal speech. This involves attaching a device that produces voice and language. The sound will sound robotic, but it is easy to use and solves the problem in the short and long term.
• TEP speech. This involves connecting a voice prosthesis to the TEP flap (the one from the transesophageal perforation). This is placed over the stoma and makes speech possible.

The implications of a laryngectomy

The biggest risk is blockage of the stoma as it cuts off the breathing. With proper training, this can be prevented. A person with a laryngectomy requires psychological support,  as he or she will have to face many psychosocial changes.