A total laryngectomy is the removal of the voice box to treat cancer. The surgery results in the creation of a permanent stoma at the base of the neck. There are many changes relative to breathing, swallowing, and communication. However, it is important to know that most patients return to doing the things they enjoy—working, golfing, riding motorcycles, traveling, caring for their children or grandchildren, and many other activities. The only thing you cannot do after a laryngectomy is go swimming.
It can be scary to receive a cancer diagnosis, and even more difficult to understand post-operative changes of total laryngectomy. The head and neck speech pathology team is here to support you at every stage. Prior to undergoing a total laryngectomy, you will be seen for a pre-operative educational appointment to help you understand post-operative changes and the rehabilitation process, and answer you and your family’s questions.
During Laryngectomy Surgery
- The surgeon will make a cut in your neck to open up the area. Care is taken to preserve major blood vessels and other important structures.
- The larynx and tissue around it will be removed. The lymph nodes may also be removed.
- The surgeon will then make an opening in your trachea and a hole in front of your neck. Your trachea will be attached to this hole. The hole is called a stoma. After surgery you will breathe through your stoma. It will never be removed or closed.
- Your esophagus, muscles, and skin will be closed with stitches or clips. You may have tubes coming from your wound for a while after surgery.
After Laryngectomy Surgery
While in the hospital, a speech-language pathologist (SLP) will follow up with you to help you learn how to communicate and care for your stoma.After you discharge, a member of the outpatient SLP team will see you back whenever you see your surgeon for post op visits. The goals at this stage include getting you back to communicating and swallowing. Our SLPs can help you find the right communication method for you. We will work closely with laryngologists and head and neck surgeons to support your rehabilitation.
Communicating After Laryngectomy
Since your vocal cords are removed during surgery, you must learn new methods for communicating and swallowing. You may also experience a change in respiration, as the airway is no longer connected to the mouth and nose, so breathing now occurs through a hole in the throat called a stoma.
Our experienced speech-language pathologists will help you every step of the way.
There are 3 common options for communication following a total laryngectomy:
Electrolarynx
Electrolarynx, also known as artificial larynx, is typically the most common form of communication immediately following surgery. It is an electronic device that acts as a separate sound source. Voicing is made either by placement against your neck or with a straw in your mouth. Your speech-language pathologist will train you in placement and use of the device.
Esophageal Speech
This is a method of speech in which you learn to swallow air into your esophagus (food tube) and release it back into the throat like a belch. The expelled air causes the muscles of the throat to vibrate to form a sound source. This method does not require any instrumentation.
Tracheoesophageal Puncture Speech
Tracheoesophageal Puncture (TEP) speech requires the creation of a tract between the breathing tube (trachea) and the food tube (esophagus) by the physician. A small prosthesis is placed in this tract to allow air to travel from the trachea to the esophagus, causing the muscles of the throat to vibrate as a sound source. A speech-language pathologist and physician will help determine if this is an appropriate method of communication.
Pulmonary Health After Laryngectomy
Your lung health is very important after surgery given the changes in your breathing. You will breathe through a permanent stoma at the base of your neck, and our team will work with you to establish optimal respiratory health and hygiene. After surgery, you will learn how to take care of your stoma and use a heat moisture exchanger (HME) system to keep your lungs healthy.
A laryngectomy is a life-changing procedure, but our team is here to support you at every stage before and after surgery. No matter your goals, we will work with you to achieve them.