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 deep pharynx (hypopharyngeal carcinoma).
Depending on the site of origin, a distinction is made between laryngeal cancer
- Glottic carcinoma (tumors of the vocal cords),
- supraglottic (tumors in the upper section of the larynx) and
- subglottic carcinoma (lower section of the larynx).
A laryngectomy is not necessary for all forms of laryngeal carcinoma. In the case of glottic carcinoma, radiotherapy alone can lead to a cure. In some forms and stages, 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 removes the larynx and hyoid bone from the lowest part of the pharynx and trachea.
To prevent food from entering the windpipe when swallowing, the natural connection between the food pipe and windpipe is permanently closed. In order to breathe, the windpipe must be opened to the outside; a tracheostoma is placed below the thyroid gland. A tracheostoma is an artificial opening in the windpipe.
The surgeon usually also removes the lymph nodes of the neck (neck dissection).
If metastases are present, the laryngectomy should be followed by radiotherapy.
Due to the closure of the connection between the trachea and oesophagus, the
- cleaning,
- warming and
- humidification of the air we breathe
restricted. The lack of warming and humidification can lead to tracheal inflammation with bark formation. The patient must humidify the air using inhalers or nebulizers.
Regular suctioning of bronchial secretions is also necessary as they can no longer be coughed up. The tracheal cannula must be replaced once a day. The lower airways must be protected when washing, showering and swimming.
Artificial airway (tracheostoma)
Due to the laryngectomy, patients can no longer breathe through their nose. An artificial opening below the larynx is used for breathing.
The lack of nasal ventilation leads to odor disorders and mucosal incrustations.
After a laryngectomy, patients are fitted with a tracheostomy as 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 quietly. Interaction partners can only understand the affected person in a quiet environment and by reading from the mouth at the same time.
Nowadays, however, laryngectomees no longer have to put up with this situation. If the surgical wound allows it, the patient should start learning a substitute voice in hospital.
There are three main techniques available for voice production:
- Ruktus voice (oesophageal voice),
- electronic speech aid,
- voice prosthesis with a valve mechanism (shunt valve).
The simplest and most frequently used method is learning a ructus voice (esophageal voice). This involves swallowing air into the upper oesophagus and letting it out again quickly to produce sound in the lower oesophagus.
Another method that can also be used in addition to the ructus voice is an electronic speech aid. Electromechanical structure-borne sound generators are most commonly used here. They are placed on the throat and then transmit vibrations to the pharynx and oral cavity.
Finally, it is possible to surgically insert a voice prosthesis with a valve mechanism between the trachea and oesophagus.
These methods of voice rehabilitation have advantages and disadvantages, which patients should be informed about.
A specialist in ear, nose and throat medicine (ENT) is responsible for the complete removal of the larynx.
