Laryngectomy is a surgery that involves removal of the larynx or voice box. Removal of the larynx can be classified as a partial removal or complete removal. The extent of your surgery will be determined by the reason for your surgery, and this should be discussed between you and your surgeon. Partial laryngectomy is not discussed in this information sheet.

What is a total laryngectomy?

A complete removal of the larynx or total laryngectomy is the most commonly required surgery to ensure complete removal of the tumour or cancer affecting your larynx.

Why do I need to undergo total laryngectomy?

Your doctor may recommend you total laryngectomy for any of these reasons:

1. You have an advanced tumour and/or cancer of your larynx
2. You have a relapse of tumour and/or cancer in your larynx after initial non-surgical treatment (e.g. radiation with or without chemotherapy).
3. You have a tumour and/or cancer in a neighbouring structure that entails removal of the larynx due to its close proximity to the tumour and/or cancer.

Where is the larynx (voice box)?

Your larynx is in your neck. It sits above your trachea (windpipe) and is in front of your pharynx (foodpipe) . It is part of the airway and is essential for breathing, swallowing, and speaking.

• When you breathe, your larynx opens to let air reach your lungs.
• When you swallow, your larynx closes to prevent solid and liquid food from getting into your lungs.
• When you speak, 2 muscular folds in the larynx vibrate to generate your voice.

​The surgery is performed under general anaesthesia and will be done using a long incision placed in the front of the neck. If the surgery is being done because there is a cancer or suspected cancer, your doctor may discuss with you about removing some of the lymph nodes in your neck as well (neck dissection). <insert link to neck dissection>

After the larynx is removed, the opening to the trachea will now be connected to the skin as an end tracheostome. This will be a new permanent hole in the front of your neck and air will pass through this hole into and out of your lungs. This will be your only way to breathe. Air will no longer pass through your nose or mouth.

Photo credit: Dr Anna See

​How does the surgery affect the way I live?

Without the larynx, you will not be able to speak as before. You will need to adopt new way(s) of communication, either non-verbally or verbally. Non-verbal communication will require writing or drawing. Verbal communication may still be achieved in one or more of the following 3 methods:

Tracheoesophageal puncture

• If you are a suitable candidate for this procedure, your surgeon will discuss this with you and it may be performed during the initial surgery or as a separate surgery after you have completed the initial cancer surgery.
  
• A tracheoesophageal puncture involves making a small connection and placement of a voice prosthesis between your trachea and esophagus to allow air from the stomach to pass into the mouth so that you may speak. You will need to undergo training with the speech therapist to achieve this mode of speaking.
  

Electrolarynx

• An electrolarynx is a small electronic device that you will hold near your neck to produce vibration. The vibrating sound created by the electrolarynx is then shaped by the tongue and lips and converted into understandable speech.

Esophageal speech

• Esophageal speech is a technique that involves swallowing air and then regurgitating the air to produce speech. It may be difficult to master this technique. In Singapore, the Singapore Cancer Society New Voice Club is an organisation where patients who have undergone total laryngectomy gather and undergo practice sessions to master this technique. You are encouraged to contact this organisation to find out more about their activities and offerings.

As air no longer passes through your nose or mouth when you breathe in, some patients may also experience a reduction in their smell and taste.

As the end tracheostome is a direct opening leading into the lungs, you will need to avoid activities that involve submersion in water, such as swimming or diving. You will be taught how to shower with protective equipment to prevent water from entering the end tracheostome into the lungs.

What are the risks of surgery?

Total laryngectomy is a major surgery. Apart from the permanent loss of the natural voice, the risks of this surgery include and are not limited to the following:

Bleeding- this can happen after surgery and may require re-operation if bleeding is severe.

Chest infection – the risk of this may be reduced with regular deep breathing exercises after surgery

Deep vein thrombosis and Pulmonary embolism – blood clots may form in your legs and lung vessels due to prolonged bed rest and immobilization. This can be avoided by participating in physiotherapy exercises when deemed suitable by your surgeon.

Anastomotic salivary leak – after the larynx is removed, the pharynx (foodpipe) will be stitched (ie repaired) to restore its passage. During the time taken for it to heal (usually 1 to 2 weeks), you will not be allowed to eat or drink from your mouth. You will be placed on tube feeding through the nostril or directly into the stomach via a gastrostomy tube. Poor wound healing in this anastomosed passage may result in salivary leak into the neck. Patients who are prone to poor wound healing include those with previous radiation, those suffering from diabetes mellitus or those with a history of connective tissue disorders. When a salivary leak occurs, you will require repeated surgeries during your hospitalization to clean the wound and control the infection. In some cases, a pharyngocutaneous fistula formation may result, and will require major reconstruction surgery. If so, your hospitalization will be prolonged.

Chyle leak – Lymph node channels in the neck may leak after surgery and chyle fluid may accumulate in the neck. This leak is mostly self-limiting and will resolve in 2-3 weeks (a fat-free diet is encouraged). Occasionally, a second operation may be needed to rectify it.

Difficulty swallowing – Stricture or narrowing of the stitched foodpipe may result in difficulty swallowing and you may require dilatation procedures to achieve improvement in swallowing. In some cases, lifelong dependence on tube feeding may be required.

Thyroid hormone and calcium replacement – Your thyroid gland and parathyroid glands may be removed as part of the surgery, and you may require daily thyroid hormone pill replacement and calcium pill replacement. Blood tests after surgery will determine if you require these medications.