The Purpose and Implications of a Laryngectomy
In the following article, we want to discuss the purpose and implications of a laryngectomy, a surgical procedure that involves the complete removal of the larynx. This type of surgery causes great changes in those who undergo it. The most relevant is the loss of pharyngeal voice, alterations in the sense of smell, changes in breathing, and changes in personal appearance.
Those who undergo a laryngectomy must have a tracheostomy for life. This is an opening in the windpipe, with a tube inserted, which facilitates the passage of air into the lungs. This implies the need for permanent care.
The effects of laryngectomy are very diverse and involve several daily limitations. These patients must re-educate their voice and may have to deal with difficulties swallowing food.
Who should undergo a laryngectomy?
Inside the larynx, there are two different pathways: One leads to the stomach (esophagus) and the other to the lungs (larynx and trachea). The larynx shares a common space with the esophagus called the pharynx. A laryngectomy removes the larynx and, therefore, cuts the connection between the mouth and the lungs.
The removal of the larynx is a very severe surgery that doctors only perform if there’s no other alternative. When does this occur? In the following cases:
- There’s severe trauma to the larynx; that is, considerable damage resulting from a gunshot wound or other such factor.
- The patient has cancer of the larynx.
- There’s radiation necrosis. In other words, severe damage to that area from radiation therapy.
What does the procedure consist of?
Laryngectomies require general anesthesia. The surgeon makes incisions in the neck and, through them, removes the larynx. In some cases, the professional may also remove part of the pharynx and/or lymph nodes.
After removing the larynx, the doctor will make a hole in the front of the windpipe. This is called a “stoma” and is about the diameter of a nickel. Then, they’ll insert a tube or cannula to connect the lungs to the outside.
Finally, the surgeon makes a suture with surgical stitches. They usually place drainage tubes in the neck to remove fluids and blood from the surgical site. After completion, the patient must go to a recovery room.
Read also: Mechanical Ventilation Treatment
Sometimes, doctors also perform a tracheoesophageal puncture (TEP) during a laryngectomy. This is a small hole in the trachea and esophagus. They place a valve so that the hole remains open. The goal is to keep food out of the windpipe without blocking the passage of air.
The possible risks
All surgery involves risks. Among the most common are bleeding, infection, allergic reaction to medications, breathing problems, and heart problems. In a laryngectomy. in particular, there are other risks, such as the following:
- Hematoma or pooling of blood due to rupture of the thyroid arteries
- The emergence of fistulas. That is, abnormal ducts or connections between the pharynx and the skin
- Anastomotic stenosis. A condition in which the opening of the stoma becomes too small
- Leakage. Occurs between the tracheostomy prosthesis and the tracheoesophageal perforation (TEP)
- Damage to the trachea or esophagus
- Difficulties in speaking
- Difficulties swallowing food
What to consider before a laryngectomy
Before laryngectomy, doctors must perform a series of tests and examinations. They usually order blood tests and sometimes imaging studies as well. The physician will also do a complete physical examination.
The patient should consult with a swallowing therapist and a speech therapist. This will allow you to prepare for the implications of a laryngectomy. You should also have the advice of a nutritionist. If you’re a smoker, you should quit smoking and receive support and information to help you quit.
You should inform your doctor about the drugs you’re using. In addition, you should tell your doctor if you regularly consume alcohol and, in the case of women, if you’re pregnant or if there’s a possibility of pregnancy.
In addition to the above, the following indications should be added:
- Avoid any medication that hinders blood clotting. This measure goes into effect one week before the surgery.
- The patient shouldn’t consume any food or drink for 12 hours before surgery.
- If the person has a beard or mustache, they must shave it.
- Follow any other instructions your doctor provides.
The implications of a laryngectomy
After the laryngectomy, the patient will most likely spend several days in the Intensive Care Unit (ICU). They’ll need to receive food through a tube that runs from the nose to the stomach. They’ll also receive oxygen through the stoma and pain medication.
When the condition stabilizes, you’ll move to a hospital room, where you’ll remain there for about 10 days. During that time, you’ll learn to speak and eat again. You’ll also receive help to get used to the new way of breathing.
After the hospital stay, you’ll need to continue with the rehabilitation process. This includes the two basic aspects, which we’ll outline below.
One of the main implications of a laryngectomy is caring for the stoma, as viruses and bacteria can enter with the potential to cause infection. Therefore, it is essential to learn how to care for it. The edges of the stoma should be cleaned with water, mild soap. and gauze.
Inside the stoma, crusts, and mucus form. These must be removed so that air can flow properly into the lungs. Sometimes coughing forcefully is enough to remove these accumulations. However, if this isn’t possible, they’ll have to be removed manually. The person being operated on should be trained to do this.
It’s important to have a humidifier at home, as this prevents crusting of the stoma. Sometimes, the use of a special mask that provides humidified air is also indicated. Its use is temporary.
Implications of a laryngectomy: Speech rehabilitation
Another one of the most important implications is that it causes the sound of the voice to change markedly. The air no longer circulates in the same way and this causes great changes in the way sounds are emitted. It’s important to develop new ways of communicating and to relearn how to speak.
In principle, non-verbal communication can be used, through gestures or sign language. Some of the alternatives for speech recovery are the following:
- Esophageal speech. This involves trapping air from the mouth in the upper esophagus and throat. Although difficult to learn, this technique can produce speech.
- Electrolaryngeal speech. This involves fitting a device to produce voice and speech. It will sound robotic, but’s easy to use and solves the problem in the short or long term.
- TEP speech. This involves connecting a voice prosthesis to the TEP valve (the one from the tracheoesophageal puncture). This is placed over the stoma and allows speech.
The implications of a laryngectomy
Any laryngectomy involves major implications that are life-changing. However, by following your doctor’s instructions and with a lot of perseverance, you can achieve an almost normal daily life. It’s possible to breathe, speak, and eat again in a way that doesn’t cause major discomfort.
The greatest risk is the blockage of the stoma, as this cuts off breathing. With proper training, this can be prevented. A person with a laryngectomy requires psychological support, as they’ll have to face many psychosocial changes.It might interest you...