Laryngectomy is a surgery in which the entire larynx is removed.. This type of surgery causes great changes in those who undergo it. Most notable are the loss of pharyngeal voice, changes in smell, changes in breathing, and changes in personal appearance.
Those who undergo a laryngectomy must have a lifelong tracheostomy. This is an opening in the trachea, 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 involving various daily restrictions. These types of patients need to retrain their voice and may be dealing with difficulty swallowing food and making efforts.
Who should have a laryngectomy?
There are two different pathways within the larynx: 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. Laryngectomy removes the larynx and then cuts the connection between the mouth and lungs.
The removal of the larynx is a very severe surgery that is performed only if there are no other alternatives. When it happens? In the following cases:
- There’s severe trauma to the larynx; that is, considerable damage caused by a gunshot wound or other similar factor.
- The patient have cancer of the larynx.
- There’s radiation necrosis. This is: severe damage to that area from radiation therapy.
What is the procedure?
General anesthesia is required to perform laryngectomy. The surgeon makes incisions in the neck and, through them, draws out the larynx. In some cases it can also remove part of the pharynx and/or lymph nodes.
After the larynx has been removed, your doctor will make a hole in the front of your windpipe. This is called a “stoma” and is about the same diameter as a nickel. Then, a tube or cannula is inserted to connect the lungs to the outside.
At the end, a suture with surgical stitches is performed. Usually, drainage tubes are inserted into the neck to remove fluid and blood from the operated area. Upon completion, the patient should go to a recovery room.
On some occasions, a tracheoesophageal puncture (TEP) during laryngectomy. This is a small hole in the windpipe and esophagus. A valve is then placed so that the hole remains open. The goal is to keep food out of the windpipe without blocking the airways.
Possible risks
All surgeries carry risks. Among the most common are bleeding, infection, allergic reaction to medications, breathing problems, and heart problems. With laryngectomy in particular there are other risks, such as the following:
- Hematoma or stagnation of blood due to rupture of the thyroid arteries.
- Emergence of fistulas. That is, abnormal tubes or connections between the pharynx and the skin.
- Anastomotic stricture. This is the condition where the stoma opening becomes too small.
- Filtration. It occurs between the tracheostomy implant and the tracheoesophageal perforation (TEP).
- Damage to the trachea or esophagus.
- Difficulty speaking.
- Difficulty swallowing food.
What should be considered before a laryngectomy?
Before laryngectomy, a number of tests and examinations should be performed.. Typically, blood tests and sometimes imaging studies are done. Your doctor will also perform a complete physical exam.
The patient should consult a swallowing therapist and a speech therapist.. This will allow you to prepare for the changes that will come after the surgery. You should also get the advice of a nutritionist. If you are a smoker, you should quit smoking and get support and information to do so.
The person should tell the doctor about the medications they are using. You must also indicate whether you regularly consume alcohol and, in the case of women, whether you are pregnant or likely to be pregnant.
To all of the above are added the following indications:
- Any medications that make blood clotting difficult should be avoided. This measurement will be taken one week before surgery.
- The patient should not consume food or drink for 12 hours before surgery.
- If the person has a beard or mustache, they should shave.
- Follow any other indications indicated by the doctor.
What aspects should be taken into consideration after laryngectomy?
After performing the laryngectomy, the patient will most likely spend several days in the intensive care unit (ICU). You will need to be fed through a tube that goes from your nose to your stomach. You will receive oxygen through your stoma and painkillers.
When the condition stabilizes, you will be transferred to a hospital room. You will have to stay there for about 10 days. During that time, you will be trained to learn to speak and eat again.. It will also help you get used to the new way of breathing.
After going through the hospital, you need to continue with the rehabilitation process. This includes the two fundamental aspects described below.
stoma care
There is an opening in the stoma through which viruses and bacteria can enter with the potential to cause an infection. Therefore, it is essential to learn how to take care of it. Its edges must be cleaned with water, neutral soap and gauze..
Crusts and mucus form inside the stoma. These need to be removed for air to circulate properly in the lungs. Sometimes a vigorous cough is enough to remove these buildups; if this is not possible, they will have to be removed manually. The person who intervened must receive training for this.
It’s important to have a humidifier in your homeas this prevents crusting of the stoma. Sometimes the use of a special mask that provides humidified air is also indicated; its use is temporary.
speech rehabilitation
Laryngectomy significantly changes the sound of the voice. The air no longer circulates in the same way and this causes great changes in the way of emitting sounds. It is important to develop new ways of communicating, as well as re-learning to speak.
In principle, non-verbal communication can be usedthrough gestures or sign language. Some of the alternatives for recovering speech are as follows:
- esophageal speech. It involves trapping air from the mouth into the upper part of the esophagus and throat. While difficult to learn, this technique can produce words.
- electrolarynx. It consists of adapting a device to produce voice and speech. It will look robotic, but it’s easy to use and solves the problem in the short or long term.
- TEP speech. It consists of connecting a voice prosthesis to the TEP valve (the one for tracheoesophageal puncture). This sits over the stoma and allows you to speak.
Living after a laryngectomy
Every laryngectomy means big life changes. However, with the appropriate indications and a lot of constancy almost normal daily life can be achieved. It is possible to return to breathing, speaking and eating in a way that does not cause further discomfort.
The greatest risk is blockage of the stoma, as this cuts off breathing. With proper training, it can be prevented from happening. A person with a laryngectomy needs psychological support, as they will face many psychosocial changes.
Post laryngectomy: why is it performed and what implications does it have? first appeared on research-school