Laryngectomy

Laryngectomy is the removal of all or part of the voice box (larynx). The voice box is in the neck and contains the vocal cords. It also helps you swallow and breathe. It is taken out to treat cancer of the larynx.

You will be asleep during the surgery. The doctor will take out all or part of the voice box through a cut in the front of your neck. This cut is called an incision. How much of the voice box the doctor takes out depends on how large the cancer is and how far it has spread. You will have stitches or staples in the incision.

Your ability to talk after surgery depends on how much of the voice box is removed. If all of it is removed, you will not be able to talk. In this case, the doctor will also make a hole in your neck to help you breathe. This is called a tracheotomy. The hole is called a stoma.

You will probably have a tube in your neck to drain fluid from the incision for 1 to 4 days after surgery. The stitches or staples will be taken out 1 to 2 weeks after surgery. The scar will fade over time. For a week or more after surgery you will need to get food through a tube. The tube goes into your nose and down your throat to your stomach. Your throat will heal in 2 to 3 weeks.

You can go home 1 to 2 weeks after surgery. You will probably be able to go back to work 6 to 8 weeks after surgery. It may take 3 to 4 months to feel normal again. Speech therapy will help you learn new ways to communicate if you can't talk normally after surgery. Most people can do their normal activities after a laryngectomy.

Losing your ability to talk can be very upsetting and hard to accept. It can affect your self-image and lead to depression. If you need help after surgery, you may want to see a counselor.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

Activity

• Rest when you feel tired. Getting enough sleep will help you recover. Sleep with your head up by using three or four pillows. You can also try to sleep with your head up in a reclining chair. Do not sleep on your stomach.
• Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation. You may climb stairs.
• Be careful while showering and shaving if you have a stoma in your neck. Do not get water in the stoma, because it could get into your lungs. If you have a stoma, follow your doctor's instructions on how to care for it.
• Do not lean your head back quickly or for a long time. This puts pressure on your neck and may slow your healing.
• Avoid strenuous activities, such as bicycle riding, jogging, weight lifting, or aerobic exercise, until your doctor says it is okay. This includes mowing the lawn or shoveling snow.
• For about 6 weeks, avoid lifting anything that would make you strain. This may include a child, heavy grocery bags and milk containers, a heavy briefcase or backpack, cat litter or dog food bags, or a vacuum cleaner.
• Ask your doctor when you can drive again.

Diet

• Your diet will go from a clear liquid diet, to a full liquid diet, and then a soft diet before you can eat normally. This generally takes 1 to 2 months. Most people are on a soft diet when they leave the hospital. Your doctor will give you specific information about what you can eat.
• If you are on a soft diet, eat foods that are easy to swallow and digest. These include pancakes and waffles; most cereals; scrambled eggs and omelets; canned or cooked fruits; finely ground beef, chicken, turkey, and pork; mild cheeses; potatoes and pasta; and cooked vegetables.
• It is important to keep your weight and energy up. Do not fill up your stomach with sweets like candy and cookies. Sweets may also make you feel lightheaded and cause a problem called dumping syndrome. Dumping syndrome can make you feel faint, bloated, shaky, and sick to your stomach. It also can cause diarrhea.
• Sit up straight when you eat and for 30 to 60 minutes after you are done eating. This can help food move through your digestive tract. Try not to eat anything in the 3 hours before you go to bed.
• You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fiber supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.

Medicines

• Your doctor will tell you if and when you can restart your medicines. The doctor will also give you instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Be safe with medicines. Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• If you think your pain medicine is making you sick to your stomach:
  • Take your medicine after meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain medicine.
• Your doctor may prescribe antibiotics. Take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

Incision care

• If you have strips of tape on the incision, leave the tape on for a week or until it falls off.
• Wash the area daily with warm, soapy water and pat it dry. Your doctor will tell you how to take care of this. Don't use hydrogen peroxide or alcohol, which can slow healing. You may cover the area with a gauze bandage if it weeps or rubs against clothing. Change the bandage every day.

Other instructions

• If you have a stoma, keep it covered with a light cloth. This keeps out dust and particles that could enter your lungs and cause problems.
• You may want to use a humidifier to add moisture to the air. This keeps the stoma from drying out and getting crusty. Follow the directions for cleaning the machine.
• It is normal to have some yellowish mucus around your feeding tube. This is not a sign of infection. Keep your feeding tube clamped unless you are using it. Keep it taped to your skin at all times. Be sure there is some slack in the tube so if you move suddenly, it does not pull out.
• If you cannot talk after surgery, a speech therapist will teach you new ways to communicate.
• Find a counselor you like and trust if you are having trouble coping after surgery.