laryngectomy

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Laryngectomy

Definition

Laryngectomy is the partial or complete surgical removal of the larynx, usually as a treatment for cancer of the larynx.

Purpose

Normally a laryngectomy is performed to remove tumors or cancerous tissue. In rare cases, it may be done when the larynx is badly damaged by gunshot, automobile injuries, or similar violent accidents. Laryngectomies can be total or partial. Total laryngectomies are done when cancer is advanced. The entire larynx is removed. Often if the cancer has spread, other surrounding structures in the neck, such as lymph nodes, are removed at the same time. Partial laryngectomies are done when cancer is limited to one spot. Only the area with the tumor is removed. Laryngectomies may also be performed when other cancer treatment options, such as radiation or chemotherapy, fail.

Precautions

Laryngectomy is done only after cancer of the larynx has been diagnosed by a series of tests that allow the otolaryngologist (a specialist often called an ear, nose, and throat doctor) to look into the throat and take tissue samples (biopsies) to confirm and stage the cancer. People need to be in good general health to undergo a laryngectomy, and will have standard preoperative blood work and tests to make sure they are able to safely withstand the operation.

Description

The larynx is located slightly below the point where the throat divides into the esophagus, which takes food to the stomach, and the trachea (windpipe), which takes air to the lungs. Because of its location, the larynx plays a critical role in normal breathing, swallowing, and speaking. Within the larynx, vocal folds (often called vocal cords) vibrate as air is exhaled past, thus creating speech. The epiglottis protects the trachea, making sure that only air gets into the lungs. When the larynx is removed, these functions are lost.Once the larynx is removed, air can no longer flow into the lungs. During this operation, the surgeon removes the larynx through an incision in the neck. The surgeon also performs a tracheotomy. He makes an artificial opening called a stoma in the front of the neck. The upper portion of the trachea is brought to the stoma and secured, making a permanent alternate way for air to get to the lungs. The connection between the throat and the esophagus is not normally affected, so after healing, the person whose larynx has been removed (called a laryngectomee) can eat normally. However, normal speech is no longer possible. Several alternate means of vocal communication can be learned with the help of a speech pathologist.

Preparation

As with any surgical procedure, the patient will be required to sign a consent form after the procedure is thoroughly explained. Many patients prefer a second opinion, and some insurers require it. Blood and urine studies, along with chest x ray and EKG may be ordered as the doctor deems necessary. The patient also has a pre-operative meeting with an anesthesiologist. If a complete laryngectomy is planned, it may be helpful to meet with a speech pathologist and/or an established laryngectomee for discussion of post-operative expectations and support.

Aftercare

A person undergoing a laryngectomy spends several days in intensive care (ICU) and receives intravenous (IV) fluids and medication. As with any major surgery, the blood pressure, pulse, and respirations are monitored regularly. The patient is encouraged to turn, cough, and deep breathe to help mobilize secretions in the lungs. One or more drains are usually inserted in the neck to remove any fluids that collect. These drains are removed after several days.It takes two to three weeks for the tissues of the throat to heal. During this time, the laryngectomee cannot swallow food and must receive nutrition through a tube inserted through the nose and down the throat into the stomach. During this time, even people with partial laryngectomies are unable to speak.When air is drawn in normally through the nose, it is warmed and moistened before it reaches the lungs. When air is drawn in through the stoma, it does not have the opportunity to be warmed and humidified. In order to keep the stoma from drying out and becoming crusty, laryngectomees are encouraged to breathe artificially humidified air. The stoma is usually covered with a light cloth to keep it clean and to keep unwanted particles from accidentally entering the lungs. Care of the stoma is extremely important, since it is the person's only way to get air to the lungs. After a laryngectomy, a healthcare professional will teach the laryngectomee and his or her caregivers how to care for the stoma.Immediately after a laryngectomy, an alternate method of communication such as writing notes, gesturing, or pointing must be used. A partial laryngectomy patient will gradually regain some speech several weeks after the operation, but the voice may be hoarse, weak, and strained. A speech pathologist will work with a complete laryngectomee to establish new ways of communicating.There are three main methods of vocalizing after a total laryngectomy. In esophageal speech the laryngectomee learns how to "swallow" air down into the esophagus and creates sounds by releasing the air. This method requires quite a bit of coordination and learning, and produces short bursts (7 or 8 syllables) of low-volume sound.Tracheoesophageal speech diverts air through a hole in the trachea made by the surgeon. The air then passes through an implanted artificial voice prosthesis (a small tube that makes a sound when air goes through it). Recent advances have been made in implanting voice prostheses that produce good voice quality.The third method of artificial sound communication involves using a hand-held electronic device that translates vibrations into sounds. There are several different styles of these devices, but all require the use of at least one hand to hold the device to the throat. The choice of which method to use depends on many things including the age and health of the laryngectomee, and whether other parts of the mouth, such as the tongue, have also been removed.Many patients resume daily activities after surgery. Special precautions must be taken during showering or shaving. Special instruction and equipment is also required for those who wish to swim or water ski, as it is dangerous for water to enter the windpipe and lungs through the stoma.Regular follow-up visits are important following treatment for cancer of the larynx because there is a higher-than-average risk of developing a new cancer in the mouth, throat, or other regions of the head or neck. Many self-help and support groups are available to help patients meet others who face similar problems.

Risks

Laryngectomy is often successful in curing early stage cancers. However it does cause lifestyle changes. Laryngectomees must learn new ways of speaking. They must be continually concerned about the care of their stoma. Serious infections can occur if water or other foreign material enters the lungs through an unprotected stoma. Also, women who undergo partial laryngectomy or who learn some types of artificial speech will have a deep voice similar to that of a man. For some women this presents psychological challenges.

Normal results

Ideally, removal of the larynx will remove all cancerous material. The person will recover from the operation, make lifestyle adjustments, and return to an active life.

Abnormal results

Sometimes cancer has spread to surrounding tissues and it is necessary to remove lymph nodes, parts of the tongue, or other cancerous tissues. As with any major operation, post- surgical infection is possible. Infection is of particular concern to laryngectomees who have chosen to have a voice prosthesis implanted, and is one of the major reasons for having to remove the device.

Key terms

Larynx — Also known as the voice box, the larynx is composed of cartilage that contains the apparatus for voice production. This includes the vocal cords and the muscles and ligaments that move the cords.Lymph nodes — Accumulations of tissue along a lymph channel, which produce cells called lymphocytes that fight infection.Tracheostomy — A surgical procedure in which an artificial opening is made in the trachea (windpipe) to allow air into the lungs.

Resources

Organizations

American Cancer Society. 1599 Clifton Road NE, Atlanta, GA 30329. (800) ACS-2345. http://www.cancer.org.Cancer Information Service. National Cancer Institute, Building 31, Room 10A19, 9000 Rockville Pike, Bethesda, MD 20892. (800) 4-CANCER. http://www.nci.nih.gov/cancerinfo/index.html.International Association of Laryngectomees(IAL). 7440 North Shadeland Ave., Suite 100, Indianapolis, IN 46250. http://www.larynxlink.com/.National Institute on Deafness and Other Communication Disorders. National Institutes of Health, 31 Center Drive, MSC 2320, Bethesda, MD 20892-2320. http://www.nidcd.nih.gov.The Voice Center at Eastern Virginia Medical School. Norfolk, VA 23507. http://www.voice-center.com.

laryngectomy

[lar″in-jek´to-me] partial or total removal of the larynx" >larynx by surgery. It is usually performed as treatment for cancer of the larynx. Depending on the type of surgical procedure, the patient's speech may change in quality or be lost entirely. therapy" >Speech therapy is thus an important component of the treatment plan. There are three methods of speaking without use of the larynx. Esophageal speech is one method the patient may learn. The patient is taught to trap air in the esophagus. As an alternative to laryngeal voice, air vibrates the upper esophagus, providing a usable sound for speech. The patient modifies this sound into words by moving lips, tongue, and jaw.
An larynx" >artificial larynx is a battery-operated device that projects sound into the oral cavity when words are formed. The puncture" >tracheoesophageal puncture is a newer technique that is now widely used. It consists of a valve being placed in the tracheal stoma to permit air to be diverted into the esophagus and out through the mouth, with placement of a voice prosthesis to allow speech.Patient Care. Because of the physical and emotional adjustments that patients and their families must make to the surgical procedure and its aftermath, it is especially important that they receive instruction and counseling prior to surgery. They will need help in coping with their fears and anxieties about the patient's ability to communicate after surgery, and they must know that the members of the health care team are available to listen to them uncritically and answer their questions honestly. Patients should be given an explanation about the type of equipment to be used in the immediate postoperative period and the purpose of each procedure. They are assured that a pencil and paper or other means of communicating by writing will be at the bedside at all times after surgery and that they will not be left without some means of summoning help. It is understandable that one of the greatest fears of these patients is that, since they will be unable to cry out or speak, they will be left alone and might suffocate.
There is some justification for a patient's fear of suffocation; this is the major hazard during the immediate postoperative period. Turning, coughing, and deep breathing are important in maintaining a patent airway. Suctioning may be required, and humidification is also important. An extra tracheostomy tube is kept at the bedside in case an emergency arises and for daily changing of the outer tube if the surgeon so chooses. After a variable period of time, the tracheostomy tube may be removed permanently. Feedings usually begin at 1 to 2 weeks.
In preparation for discharge, patients are taught self-care of their laryngectomy. They are warned against aspirating water into the lungs during bathing or showering. Although a dressing is not necessary for covering the tracheal opening in the neck, the patient may wish to conceal it with a small square of cotton material or wear a collar or scarf of porous material to hide the wound. These types of covering are useful in that they act as filters and remove dust and other irritants from the air being inhaled through the stoma.
Printed material about self-care is available from the local Cancer Society. Many communities have a laryngectomee club, which offers much moral support and information that are valuable to patients and families during the period of adjustment. Information regarding these laryngectomee clubs and other aspects of postlaryngectomy rehabilitation can be obtained by writing to the American Speech Language Hearing Association, 10801 Rockville Pike, Department AP, Rockville, MD 20852; telephone (301) 897–5700.

A, Prior to laryngectomy, air flow is through the nose and mouth. B, Surgical removal of the larynx requires that a new opening be made for air passage. The trachea and esophagus are separated. From Polaski and Tatro, 1996.

lar·yn·gec·to·my

(lar'in-jek'tŏ-mē), Excision of the larynx. [laryngo- + G. ektomē, excision]

laryngectomy

(lăr′ən-jĕk′tə-mē)n. pl. laryngecto·mies Surgical removal of part or all of the larynx.

laryngectomy

Surgical oncology The surgical removal of part or all the larynx for invasive cancer Types Hemilaryngectomy, supraglottic, total. See Hemilaryngectomy, Subtotal laryngectomy, Supraglottic laryngectomy, Total laryngectomy.

la·ryn·gec·to·my

(lar'in-jek'tŏ-mē) Excision of the larynx. [laryngo- + G. ektomē, excision]

laryngectomy

Surgical removal of the Adam's apple (LARYNX). Laryngectomy is performed for otherwise untreatable cancer of the larynx. The cut upper end of the windpipe (trachea) must be brought out through an opening in the front of the neck to allow breathing. Normal speech is impossible after laryngectomy.

la·ryn·gec·to·my

(lar'in-jek'tŏ-mē) Excision of the larynx. [laryngo- + G. ektomē, excision]

laryngectomy

lar·yn·gec·to·my

laryngectomy

lar•yn•gec•to•my

laryngectomy

laryngectomy

laryngectomy

laryngectomy

Laryngectomy

Definition

Purpose

Precautions

Description

Preparation

Aftercare

Risks

Normal results

Abnormal results

Key terms

Resources

Organizations

laryngectomy

lar·yn·gec·to·my

laryngectomy

laryngectomy

la·ryn·gec·to·my

laryngectomy

la·ryn·gec·to·my

laryngectomy

Words related to laryngectomy

noun surgical removal of part or all of the larynx (usually to treat cancer of the larynx)

Related Words