Head & Neck Cancer Surgery

Laryngectomy

Laryngectomy is performed when a cancer is found in the voice box, which contains the vocal cords. Part of or the entire voice box may be removed, and the airway is permanently brought out through the skin on the front of the neck so that the patient may breathe.

Preoperative Information

• Before surgery, the patient meets with their team of health professionals, including the surgeon, medical oncologist (in charge of chemotherapy, if necessary), radiation oncologist (in charge of radiation therapy, if necessary), and speech pathologist/therapist. Together, a comprehensive plan is made so that everyone is clear about the patient’s goals, treatment, and care.
• There are risks to any surgery. These will be explained by the doctors.

Post-operative Information

• Directly after surgery, a patient usually is monitored at least 24 hours in the Intensive Care Unit, with nurses checking up on them every hour. When ready, the patient will be transferred to a Step-Down care unit. There, a patient can rest and nurses will check on them every 2–4 hours. Laryngectomy patients usually are kept in the hospital for five to 10 days and can go home with family assistance and a nurse that checks in every few days.
• The voice box is removed during surgery, and after the patient has recovered for a few weeks, a speech therapist will work with the patient after the surgery to help patients learn a new way of communicating. This may begin either in the hospital or clinic. Here are a few of the options:
  • Transesophageal prosthesis (TEP): A one-way valve prosthesis that connects the airway to the back of the throat. Air can be pushed through the valve from the airway to the throat and out the mouth to generate speech
    
        

• Electrolarynx: A handheld vibrating machine is placed against the skin on the neck or in the mouth to create a monotone voice.
  
  
  
  
• Esophageal Speech: Air from the stomach is pushed up through the esophagus and mouth, vibrating on its way out, generating speech.
• The speech therapist also will discuss different swallowing methods after surgery, either in the hospital or clinic. Swallowing may be different and possibly difficult in the beginning.
• Nutrition after surgery will be either through a feeding tube inserted through the nose that goes into the stomach (nasogastric/NG tube) or through a tube inserted through the skin directly into the stomach (gastrostomy/G tube).
  Some patients keep a tube-feeding system when they go home because they are not ready or able to take enough nutrition through their mouth. It is important to have both good nutrition and hydration. In general, patients will be trialed on liquids five days after surgery, unless they have had radiation treatment, in which it will be done for 10 days post-surgery.

• The Laryngectomy Stoma is the place where the patient breathes. Patients will need what is called a laryngectomy tube, which is a clear plastic flexible tube, to remain in their stoma. It usually does not need to be held in place with anything.
  
  

• Humidified and warm air is important to prevent crusts, dryness, and extra mucus from building up. Patients need to use an air humidifier when at home and especially when sleeping. The Discharge Planner in the hospital will help arrange these supplies for home use.