Laryngectomy: Find a Specialist & Treatment Information

Laryngectomy is the medical term for the complete removal of the larynx (total laryngectomy). This radical procedure is one of several treatment options for

• laryngeal cancer (laryngeal carcinoma) and
• cancers of the lower throat (hypopharyngeal carcinoma).

In the case of laryngeal cancer, a distinction is made based on the site of origin between

• glottic carcinoma (tumors of the vocal cords),
• supraglottic carcinoma (tumors in the upper part of the larynx), and
• subglottic carcinoma (lower part of the larynx).

A laryngectomy is not necessary for all forms of laryngeal carcinoma. In cases of glottic carcinoma, radiation therapy alone can lead to a cure. For some forms and stages, a partial removal of the larynx may also be sufficient.

A laryngectomy is necessary for advanced glottic carcinomas and supraglottic carcinomas.

A laryngectomy is performed under general anesthesia. During the procedure, the surgeon detaches the larynx and hyoid bone from the lower part of the pharynx and the trachea.

To prevent food from entering the trachea when swallowing, the natural connection between the esophagus and the trachea is permanently closed. To allow breathing, the trachea must be opened to the outside; a tracheostomy is created below the thyroid gland. A tracheostomy is an artificial opening in the trachea.

In most cases, the surgeon also removes the lymph nodes in the neck (neck dissection).

If metastases are present, the laryngectomy should be followed by radiation therapy.

Because the connection between the trachea and the esophagus is closed,

• cleansing,
• warming, and
• humidification of the inhaled air

is also restricted. The lack of warming and humidification can lead to tracheitis with crust formation. The patient must humidify the air they breathe using inhalers or nebulizers.

In addition, regular suctioning of bronchial secretions is necessary, as they can no longer be coughed up. The tracheostomy tube must be replaced once a day. The lower respiratory tract must be protected during washing, showering, and swimming.

Artificial Breathing Opening (Tracheostomy)

Due to the laryngectomy, patients can no longer breathe through their nose. An artificial opening below the larynx is used for breathing.

Due to the lack of nasal ventilation, patients experience impaired sense of smell and crusting of the mucous membranes.

After a laryngectomy, patients receive a tracheostomy because they can no longer breathe through their nose © Valentina | AdobeStock

Loss of Voice

Loss of voice is often the most serious consequence of a laryngectomy. The voice is not completely lost, but patients speak very softly. The person they are speaking with can only understand them in a quiet environment while lip-reading.

However, people who have had their larynx removed no longer have to resign themselves to this situation. If the surgical wound allows it, the patient should begin learning to use a prosthetic voice while still in the hospital.

Essentially, there are three techniques available for voice production:

• Ructus voice (esophageal voice),
• electronic speech aid,
• voice prosthesis with a valve mechanism (shunt valve).

The simplest and most commonly used method is learning to produce a belching voice (esophageal voice). This involves swallowing air into the upper esophagus and quickly releasing it in the lower pharynx to produce sound.

Another method, which can also be used in conjunction with the burp voice, is an electronic speech aid. Electromechanical bone conduction devices are most commonly used for this purpose. They are placed on the neck and then transmit vibrations to the pharynx and oral cavity.

Finally, there is the option of surgically implanting a voice prosthesis with a valve mechanism between the trachea and the esophagus.

These methods of voice rehabilitation have advantages and disadvantages, which a patient should be informed about.

An otolaryngologist (ENT specialist) is responsible for the complete removal of the larynx.