Laryngectomy in Singapore

Laryngectomy refers to the surgical procedure by which the larynx, commonly called as the voice box, is removed, either partially or completely. It is a major surgery performed under the influence of general anesthesia. It is performed as a part of laryngeal cancer treatment or throat cancer treatment.

Th larynx is a small organ located in the throat. It provides a pathway for air and also possesses voice cords that help produce sound. Removal of the voice box, thus, affects breathing, swallowing and speech and the patient has to perform all these three activities through different mechanism after the surgery. 

Who requires laryngectomy?

Laryngectomy is a serious, complex, and major surgery that requires careful monitoring and must be performed under the guidance of an experienced surgeon. This radical procedure is warranted in cases of patients suffering from:

• Cancer of the larynx or throat
• Damage to larynx from past radiation treatment
• Severe injury to the voice box

During the laryngectomy procedure, the doctor may decide to remove entire larynx or just a part of it, depending on the extent of damage and the condition of the patient. The doctor may even decide to remove a part of the pharynx during the same procedure. A pharynx is a passage between the oesophagus and nasal cavity. The surgeon first makes a slit in the throat of the patient to expose the larynx and the surrounding tissues, which are then removed along with it. In some cancer cases, the surrounding lymph nodes are also removed.

This step is followed up with a creation of a hole in the neck, which is connected to the trachea. The hole is called stoma, which is placed there permanently. This procedure is also known as a tracheostomy. The cuts made are closed with the help of stitches and the wound is left to heal.

Tracheoesophageal Puncture (TEP)

Tracheoesophageal puncture (TEP) is a special procedure, typically conducted along with laryngectomy. During this procedure, a hole is created in the oesophagus and the trachea. After the hole has healed, a prosthetic voice box is attached there so that the patient is able to speak again.

Laryngectomy is a radical procedure and it requires the patient to stay in the hospital at least for a few days after the procedure. The patient spends the initial two days after the surgery in an ICU, wherein all the vital parameters such as heart rate, breathing rate, and blood pressure are carefully monitored. The patient is unable to eat anything until the wound in the throat completely heals. The patient gets all the nutrition through a feeding tube. The neck may remain painful for many days and medications are given to manage pain and swelling.

The patients are advised to move around a bit to prevent blood clots from building up. In addition, special care is needed to prevent stoma from infection as potentially harmful viruses and bacteria can enter the body through this newly created opening in the throat. It takes a long time for the patient to adjust to the changes in their throat and neck after the removal of their voice box. In the absence of a TEP, the patients are advised to consult a counsellor who can help with non-verbal communication and oesophagal speech.

Just like any other surgery, a patient who undergoes laryngectomy is at an increased risk of suffering from bleeding, infection, breathing problems or an allergic reaction to anaesthesia. Some other risks specific to laryngectomy may include infection in the wound, hematoma, stomal stenosis, problem eating and swallowing food, and damage to parts of the oesophagus or trachea.