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Why is laryngectomy required?
Laryngectomy is suitable in case of lungs and head cancer, larynx cancer, larynx damage due to previous radiation therapy and severe injury in the neck or a chronic wound. The type of injury and severity decides the procedure of laryngectomy. It is most commonly used for treating laryngeal cancer.Laryngeal cancer
It is a cancer of the larynx, also called the voice box. This cancer damages various cartilages enveloped by the larynx along with voice and spreads rapidly. The seriousness of cancer is defined by various stages. According to a study, almost 90% of the population diagnosed with stage 1 cancer has survival chances of more than five years.Laryngeal treatment
Overall procedure takes 4 to 12 hours. Before laryngectomy, basic tests are done such as blood test, x-ray, CT scan and MRI. It is performed under anaesthesia. A cut is made near the larynx in the front neck. Sometimes a portion of pharynx and lymph nodes are also removed depending on the health condition. The pharynx is a juncture where mouth, nasal passage, oesophagus and larynx meet. If cancer reaches pharynx, partial removal is done which is called pharyngectomy. Whereas lymph nodes constitute the immune system and it fights infections. After removal, a stoma is created in the neck. A stoma is a small permanent hole in front of the trachea which is directly linked to the lungs. In some cases, the tracheoesophageal puncture is also done with a laryngectomy. This is a secondary surgery where a small hole is made in oesophagus and trachea. After this, the skin in the neck and muscles of the throat are stitched in place. A tube is placed for the drainage of fluids and blood inside the neck for days after surgery.Laryngectomy recovery
After the procedure, the patient is under the observation of a doctor, mostly, in an intensive care unit. Pulse, heart rate, blood pressure and breathing rate is monitored while oxygen is delivered through a stoma. The throat is highly sensitive that eating through the mouth is not possible. To facilitate the flow of nutrition a flexible tube is inserted in the nose to directly reach the stomach. Normal hospital stay is around 7-10 days. During recovery, the most important part is the care of a stoma. After surgery, the Body is sensitive that any infection can occur easily and an open stoma can cause the introduction of virus and bacteria inside the body. Cleaning of a stoma is necessary for avoiding such reactions. With the help of water and mild soap, a stoma is cleaned normally with gauze. Clotting and mucus are removed using warm salt water which blocks the flow of air. The patient can use a humidifier to avoid clotting or crusting. After a few days, the patient will not need any of this when they get habitual to dry air.Laryngectomy complications
Some common complications involve nasogastric tube feeding, morbidity increase, discomfort, a delayed period of rehabilitation and a longer stay in hospital due to allergic reactions. A frequently occurring problem is pharyngocutaneous fistula. In this condition, fluids or saliva leaks out of the throat due to space between the trachea and larynx. Different factors responsible for such complications are consumption of smoking and alcohol, renal dysfunction, anemia, malnutrition, senility, tracheotomy, chronic obstructive pulmonary disease, hepatic dysfunction, stage of cancer and hypoalbuminemia. A free flap is inserted to reduce the risks of PCF.Laryngectomy rehabilitation
Voice rehabilitation: during laryngectomy, the larynx is removed which results in voice loss thus verbal communication. To restore voice different techniques depending on abilities and needs are used. Physical ability, physiology, cognitive ability, and other medical conditions must be kept in mind while choosing a method for rehabilitation. Sessions with speech-language pathologists are frequently conducted in case of complete laryngectomy. These sessions help in vocalizing and use of the newly installed device. A device is installed in a tracheo-oesophageal puncture for speech. This voice prosthesis provides one-way passage for air to reach oesophagus through the lungs. When this air travels through the oesophagus, it vibrates tissues that create a hoarse voice. Electrolarynx is also used for speaking. A device placed externally against the neck which when vibrates produces a mechanical voice. Another method requires pushing oxygen in the oesophagus and out for producing sound. But this method is difficult and time taking as compared to others thus making it a less preferred option. There is a rarely used option of transplant of the larynx from a donor. Taste and smell rehabilitation: complete laryngectomy results in detachment of the lower respiratory tract that is lower trachea and lungs and upper respiratory tract that is mouth, pharynx and nose. Since the flow of air through nasal passage is ceased it causes loss of sense of smell and eventually a sense of taste. For treating this, nasal airflow inducing manoeuvre was introduced in 2000. This method involves yawning with closed lips while lowering the tongue, base of mouth and jaw. This leads to pressure on the nasal passage thus airflow.Symptoms
• A persistent sore throat or cough.
• Pain or problems swallowing.
• Ear pain.
• A lump in the neck or throat.
• A hoarse voice or other voice changes.
• Blood tinged sputum when coughing.
Causes
• Have cancer of the larynx.
• Have sustained severe injury to the neck, such as a gunshot wound.
• Develop radiation necrosis (damage to the larynx stemming from radiation treatment.
FAQ
What is the cost of laryngectomy?
The cost of laryngectomy ranges around $12,000 and $90,000. Laryngectomy is covered by medical insurance companies.
What are the side effects of laryngectomy?
The side effects are bleeding, stomal stenosis, dehiscence, infection in a wound, pharyngeal stenosis, necrosis and dysphagia. Among these, PCF is most common. Approximately 29% of the patients are diagnosed with this complication.
How to prepare for laryngectomy?
All necessary tests should be done, inform the doctor about the previous health condition, previous medications should be stopped at least one week prior to surgery and bring daily personal necessities for a few days stay in hospital.
Is laryngectomy painful?
No, it is not painful as it is performed under general anaesthesia. However, during recovery mild pain can occur.
How much time is needed for the procedure to be completed?
It is a time taking process that lasts around 4-12 hours. The patient is kept for at least 10 days in the hospital to monitor health status.