The larynx is a structure in the throat which, in humans and other mammals, is required for the production of sound. Also known as the voice box, the larynx is largely made up of cartilage, with several associated muscles. Sometimes, usually as a result of cancer, the larynx must be partially or completely removed. When the entire larynx is removed, the procedure is called a total laryngectomy.
While many cases of laryngeal cancer can be treated with chemotherapy or radiotherapy, sometimes it is necessary to completely remove the larynx to prevent the cancer from spreading throughout the body. In a total laryngectomy procedure, the larynx is removed, and the connection between the mouth and nose and the trachea and lungs is blocked. After the surgery, the patient will no longer breathe through his or her mouth or nose; instead, he or she will breathe through an opening made in the trachea, called a stoma.
To prepare for total laryngectomy surgery, a patient will undergo tests such as X-rays, an EKG and blood tests, in order to develop a picture of his or her overall physical health. He or she might be asked to avoid taking certain medications, such as aspirin or other blood thinners, for a week or longer prior to the procedure. In addition, he or she might visit a speech therapist and nutrition counselor to talk about rehabilitation after surgery.
During a total laryngectomy, an incision is made in the neck to expose the larynx and surrounding tissue. The larynx is removed through this incision. Once the larynx has been removed, the surgeon creates a stoma in the neck. The end of the trachea is then attached to the stoma, to provide a way of transporting oxygen to the lungs. The surgeon might also make a second hole called a tracheo-esophageal puncture, into which a prosthetic speech device can be placed.
After surgery is complete, the patient will spend several days in a hospital, often in an intensive care unit. Feeding takes place intravenously to allow time for initial healing to take place. In most cases, the patient can resume normal eating within approximately one week, although this time might be extended if necessary. He or she can return home after several days, but healing of the throat often takes three or four weeks.
Part of rehabilitation after total laryngectomy involves the patient learning how to speak, either through physical therapy or the use of a prosthetic device placed in the tracheo-esophageal puncture. The device has a button that can be pushed to occlude the stoma, allowing air to be exhaled out of the mouth for speech. Alternatively, someone who has had a laryngectomy can learn esophageal speech. This method requires the individual to learn how to breathe air into and out of the esophagus and to articulate sounds on the exhalation. This method is extremely difficult to master, however, and is rarely used.