What are the other Names for the Procedure?
- Supracricoid Partial Laryngectomy
- Supraglottic Partial Laryngectomy
- Vertical Partial Laryngectomy
What is the Larynx Removal surgical procedure?
A Larynx Removal (Laryngectomy) is a surgical procedure that involves the removal of the larynx (voice box) within the throat.
What part of the Body does the Procedure involve?
A Larynx Removal procedure involves the larynx, and surrounding structures within the windpipe that control the vocal cords.
Why is the Larynx Removal surgical procedure Performed?
A Larynx Removal procedure is performed for the following reason:
- Cancer of the larynx
- Very rarely, a Laryngectomy may be performed, if the voice box is severely injured
What are some Alternative Choices for the Procedure?
Other forms of cancer therapy, such as radiation therapy (using high-energy beams) and/or chemotherapy (using chemicals), may be used based on the stage of the cancer and medical health condition of the patient.
What are the Recent Advances in the Procedure?
Larynx Removal is a gold standard procedure; no advances are currently available.
What is the Cost of performing the Larynx Removal surgical procedure?
The cost of Larynx Removal surgical procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.
In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.
When do you need a Second Opinion, prior to the Procedure?
- It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Larynx Removal surgical procedure and what needs to be done
- If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
- Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently
What are some Helpful Resources?
http://www.surgery.com/procedure/laryngectomy (accessed on 08/02/2014)
http://www.nlm.nih.gov/medlineplus/ency/article/007398.htm (accessed on 08/02/2014)
Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5th Edition, New York, 2006
Prior to Larynx Removal surgical procedure:
How is the Larynx Removal surgical procedure Performed?
- The Larynx Removal procedure is performed under general anesthesia
- The surgeon makes an incision on the neck to expose the larynx. Depending on the stage of the tumor, the larynx is removed either fully or partially
- Some small tumors can be managed with partial Laryngectomies. Larger tumors however, necessitate a complete Larynx Removal, along with surrounding tissue and lymph nodes
- The windpipe originates from the lower end of the larynx; hence, after a Laryngectomy, the surgeon will attach the upper portion of the windpipe to a hole in front of the neck (this is called tracheostomy). This is performed so that the patient has a patent passage for air to reach the lungs
- The muscles in front of the neck and the skin are again sutured. A tube may be left in place, to drain fluid collections in the surgery site
Where is the Procedure Performed?
A Larynx Removal surgical procedure is performed at a hospital.
Who Performs the Procedure?
An otolaryngologist surgeon performs the Larynx Removal procedure.
How long will the Procedure take?
The Larynx Removal procedure may take anywhere between 3-6 hours.
What do you need to tell your Physician before the Procedure?
It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Larynx Removal surgical procedure and helps avoid unnecessary complications.
- Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
- If you are allergic to any specific medication or food items
- If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
- If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
- If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
- If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
- If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
- A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.
What Preparations are needed, prior to the Procedure?
- The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
- Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
- Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
- Normally local anesthesia is not used; however do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
- Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
- It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
- Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
- The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
- For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines
- The patient may also be counseled by a speech pathologist
What is the Consent Process before the Procedure?
A physician will request your consent for Larynx Removal procedure using an Informed Consent Form.
Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.
You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.
What Tests are needed, before the Larynx Removal surgical procedure?
Before a Larynx Removal procedure, the patient has to undergo certain tests, such as:
- Routine blood and urine analysis
- Chest x-ray
- Electrocardiography (ECG)
- Ultrasound imaging
- Magnetic resonance imaging (MRI) scan
- Computerized tomography (CT) scan
What are some Questions for your Physician?
Some of the basic questions that you might ask your physician are as follows:
- What is a Larynx Removal procedure?
- Why is this procedure necessary? How will it help?
- How soon should I get it done? Is it an emergency?
- Who are the medical personnel involved in this procedure?
- Where is the procedure performed?
- What are the risks while performing the procedure?
- What are the complications that might take place, during recovery?
- How long will it take to recover? When can I resume normal work?
- How many such procedures have you (the physician) performed?
- Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
- What are the costs involved?
During the Larynx Removal surgical procedure:
What kind of Anesthesia is given, during the Procedure?
General anesthesia by injection and inhalation is administered, prior to a Larynx Removal procedure.
How much Blood will you lose, during the Procedure?
There is no much blood loss in an uncomplicated Larynx Removal procedure.
What are the possible Risks and Complications during the Larynx Removal surgical procedure?
There are general factors that increase the risk of getting complications during surgery and they include:
- Obesity: Generally greater the degree of obesity, greater is the surgical risk
- Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
- Advancing age
- Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
- Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
- Poorly functioning liver, as evidenced by increased blood liver function tests
- Hypertension (increased blood pressure), especially if it is poorly controlled
- Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
- Poor lung function, as evidenced by abnormal lung function tests
- History of bleeding disorders
- Longstanding illness, such as autoimmune disorders, chronic infections
- Poor immune system due to a variety of causes
- The possible risks or complications that may arise during the Larynx Removal surgery are:
- Excessive bleeding
- Infection of the surgical wound
- Anesthetic complications
- Accidental injury to the esophagus or trachea
What Post-Operative Care is needed at the Healthcare Facility after the Larynx Removal surgical procedure?
- After the surgical procedure, patients are sent to an area of the hospital, called the postoperative recovery area (or PACU)
- The patient’s blood pressure, heart rate, and respiration cycle, shall be closely monitored, until they recover from the anesthesia. Any additional pain associated with the procedure is also treated
- Following a Laryngectomy, a stay in the intensive care unit may be warranted, where respiration, pulse, and blood pressure, shall be carefully monitored
- It may take up to a week for the wound to sufficiently heal, so as to permit swallowing of food. Until such time, nutrition is given through a tube inserted into the stomach, via the nose
- Stoma (the hole made in the neck to help breathing) care is provided; the patient and their caregivers at home, are also instructed on how to care for the stoma
- Speech pathologist consults may also be required
- Patients are usually discharged from the hospital, more than a week after the Laryngectomy surgery.
After the Larynx Removal surgical procedure:
What are the possible Risks and Complications after the Larynx Removal surgical procedure?
The possible risks and complications that may arise after a Larynx Removal procedure are:
- Excessive bleeding
- Hematoma formation (pooling of blood outside the blood vessel in the tissue)
- Passages connecting the skin with the pharynx ( a tube within the neck that continues as the food pipe), called fistula, may form
- Infection in the surgical wound, or in the voice prosthesis, if placed
- Individuals may have temporary swallowing difficulties, after the procedure
- Risk of foreign body entry into the neck stoma
What is the Prognosis after the Surgery?
A complete recovery from a Larynx Removal procedure is normally achieved. The prognosis is usually excellent, without any serious complications being noted.
When do you need to call your Physician?
Do contact your physician, if you notice any of the following symptoms:
- Pain that worsens and swelling of the surgical wound
- Bleeding or fluid drainage from the surgical wound
- Signs of an infection
- Muscle aches, headache
- Fever, feeling sick
- Complications associated with prescription medications used in treatment
What Post-Operative Care is needed at Home after the Larynx Removal surgical procedure?
At home, the following post-operative care is recommended, after a Larynx Removal procedure:
- Slowly resume regular/daily activities as soon as possible, which aids in faster recovery
- Individuals may have to resort to alternative communication means, such as writing or practice of other suitable techniques, to produce sound. The guidance of a speech pathologist may be necessary
- Keep the head in an elevated position
- Apply nonprescription antibiotic ointment, petroleum jelly, and gauze, to treat discharge around the surgical wound
- Use a heat pad or warm compress, to relieve pain due to the incision
- Take baths instead of showers immediately after surgery, until advised by the physician
- A protective cover may be necessary, while showering, to prevent water from entering the surgical wound
- Add humidity to your home by using a humidifier, especially in the bedroom
- Keep the neck stoma clean and take care to prevent entry of any foreign material
- Complete the course of prescribed medication, as advised by your physician
- Take stool softeners to prevent constipation
- Take antibiotic medication to help combat or prevent infection, per advise of the physician
- Avoid taking nonprescription medications, such as aspirin. However, individuals may take acetaminophen to relieve pain (per advise of the physician)
- Avoid all activities that are physically strenuous for about 6 weeks after the procedure
- Avoid swimming, due to the possibility of water entering the stoma, resulting in accidental drowning
- Resume driving only 2 weeks after being discharged from the healthcare facility, or as determined by your physician
- Special intravenous or tubal feeding methods are usually required for the first 2 days, following the procedure. Thereafter, slowly return to a normal daily diet
How long does it normally take to fully recover, from the Procedure?
A complete recovery from the Larynx Removal procedure may take up to a month’s time.
What happens to tissue (if any), taken out during the Procedure?
The tissue is taken for further examination and later disposed as per the standard medical procedure.
When should you expect results from the pathologist regarding tissue taken out, during the Procedure?
- The tissue removed is processed in the laboratory under a pathologist's supervision
- Slide(s) are prepared once the tissue is processed and is examined by a pathologist and a pathology report issued
- Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time
Who will you receive a Bill from, after the Larynx Removal surgical procedure?
It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.
Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:
- The outpatient facility or a hospital
- An anesthesiologist (if anesthesia was administered)
- A pathologist (if the tissue was sent for analysis)
- A Otolaryngologist
The patient is advised to inquire and confirm the type of billing, before the Larynx Removal procedure is performed.
Thanks and Gratitude:
We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.
Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA