Laryngectomy

A laryngectomy is a surgical procedure to remove all or part of the larynx. The larynx, also known as the voice box, is a crucial organ located in the throat at the top of the trachea (windpipe). It contains two muscular structures called vocal cords. When air passes through these cords, they vibrate and produce sound, allowing us to speak and sing.

The larynx also regulates the flow of air into and out of the lungs. It plays a vital role in protecting our airway by preventing food and liquids from entering the trachea and lungs when you swallow. Laryngectomy is most frequently performed to treat cancerous growths in the larynx.

The most common reason your doctor might recommend a laryngectomy is to treat laryngeal cancer when other treatments like radiation or chemotherapy are not effective. Other reasons you might need a laryngectomy include:

• Severe laryngeal trauma: In cases of severe trauma to the larynx, including damage from an accident or injury
• Radiation necrosis: When the larynx becomes damaged due to radiation treatment
• Advanced laryngeal stenosis: In situations where a patient’s airway becomes severely narrowed or obstructed due to stenosis or scarring
• Intractable infections: In rare cases, when severe and persistent infections affect the larynx and surrounding tissues, making it necessary to remove the affected area

Some rare genetic conditions may also require removal of the voice box if it has significant problems that cannot be addressed through other treatments.

A laryngectomy surgery is performed under general anesthesia, so you will not be awake, and you should not feel pain during the procedure. After you’ve been anesthetized, your surgeon will begin by making an incision in your neck. In a partial laryngectomy, only a portion of your larynx is removed, while total laryngectomy involves the complete removal of the larynx. In addition, depending on your individual circumstances, your surgeon may remove part of the pharynx, which is the throat passage that connects the nasal cavity and the esophagus.

After removing the larynx, your surgeon will create a permanent stoma, a small hole in the front of the trachea that will serve as your new breathing passageway. The stoma will then be attached to the trachea, enabling you to breathe through it.

Your surgeon may opt to perform a tracheoesophageal puncture (TEP), an additional procedure through which a small hole is created, connecting the trachea to the esophagus, to enable the use of a voice prosthesis for speech.

Your surgeon will close any incisions with stitches or clips and may place drainage tubes in your neck temporarily to manage post-operative fluids. The procedure typically takes five to nine hours to complete.

At Penn Medicine, we understand that a laryngectomy may be a difficult experience. We assure you that our dedicated team will be here to support you every step of the way. Our experienced surgeons perform these procedures with utmost care and precision, and our specialists will guide you through the process of adapting to changes post-surgery, to help you get back to living and feeling well.

Recovery from a laryngectomy will vary from patient to patient, depending on the extent of the surgery. In general, you can expect your hospital stay to last anywhere from 10 to 14 days. Full recovery may take several weeks to a month or longer. During that time, here’s what you may experience:

• Immediately following the surgery, you’ll typically spend three or more days in the intensive care unit (ICU) where your care team can closely monitor your vital signs and ensure you have a smooth transition into recovery.
• As your condition stabilizes, you’ll move to a standard hospital room, where you’ll continue to heal and start relearning essential skills.
• To prevent complications such as blood clots and pneumonia, you’ll be encouraged to move around and engage in light physical activity.
• Your healthcare team will teach you how to clean your stoma and suction mucus.
• You may receive nutrition through a feeding tube until you gradually progress to swallowing liquids, then solids.
• You’ll be paired with a speech therapist who will begin teaching you techniques for swallowing and speaking.

The removal of the larynx will not prevent you from eating. However, you’ll likely have a period of recovery and adjustment before you can return to your normal diet. Here are a few things to consider:

• Post laryngectomy, you may experience some temporary changes in your ability to swallow and taste.
• Your doctor may advise you to move gradually from clear liquids to soft foods before returning to your regular diet.
• Some patients require a temporary feeding tube during the early stages of recovery, but this is usually not a permanent requirement.
• Your doctor may recommend that you work with a speech and language therapist to learn new techniques for swallowing.

Laryngectomy is generally a safe and effective procedure. Like any surgical procedure, undergoing a laryngectomy carries certain risks. General risks include:

• Blood clots
• Breathing difficulties
• Infection

Potential complications that are specific to larynx removal include:

• Challenges with eating, swallowing, and speaking
• Damage to the trachea or esophagus
• Hematomas (accumulation of blood outside the blood vessels)
• Leakage around the tracheoesophageal puncture
• Restricted neck and shoulder movement
• Stomal stenosis (narrowing of the stoma)

Your Penn Medicine care team will be there to discuss these risks with you and answer any questions you might have.

Voice box surgery is a complex procedure that requires precision and the expertise of a skilled surgeon who is experienced in both traditional and minimally invasive methods. Here at Penn, two of our pioneering surgeons Bert W. O’Malley, Jr., MD, and Gregory S. Weinstein, MD, developed the groundbreaking TransOral Robotic Surgery (TORS), a surgical technique that revolutionized the removal of mouth and throat tumors.

The TORS technique offers several advantages to patients undergoing a laryngectomy, including shorter hospital stays, minimized scarring, and decreased risk of infection, among other benefits. Our multidisciplinary specialists in the Abramson Cancer Center combine their world-class expertise to ensure you receive the compassionate care you need for the best possible outcome.