Total laryngectomy: Stages III and IV laryngeal and hypopharyngeal cancers usually require removal of the entire voice box. With the removal of the voice box, the windpipe is then brought up to the skin of the neck as a stoma (or hole) which the patient will breath through.
Stoma care following total laryngectomy: Having a stoma instead of a larynx means that the air you breathe in and out will not pass through your nose or mouth. As air passes through the nose or mouth, it is humidified, warmed, and filtered (dust and other particles are removed). After a laryngectomy and tracheostomy, the air reaching the lungs will be dryer and cooler. This may cause irritation of the lining of the breathing tubes and accumulation of thick or crusty mucous. For this reason, patients should learn how to take care of their stoma (periodic suctioning, cleaning, and use of a humidifier). Your doctors, nurses, and other healthcare providers can help teach you how to care for and protect the stoma. Support groups formed by other patients who have also had a laryngectomy can provide essential information on stoma care and use of products for protecting and cleaning the stoma.
Restoring speech after total laryngectomy: After a total laryngectomy, you will not be able to speak using your vocal cords. However, there are several options for restoring speech after total laryngectomy. Losing one's voice box to cancer no longer means losing one's ability to talk.
Esophageal speech: After a laryngectomy, the windpipe (or trachea) has been separated from the mouth and food pipe, and therefore, the patient can no longer expel air from the lungs through the mouth to speak. With training, some patients can swallow air and create a belching type of speech. This is the most basic form of speech rehabilitation. With the advent of new devices and surgical techniques, learning esophageal speech is often not necessary.
Tracheoesophageal puncture (TEP): One of the most significant advances in restoring speech has been the development of the tracheoesophageal puncture (TEP). TEP is performed either at the time of initial surgery or at a later time. This procedure creates a communication between the windpipe and food pipe through a small puncture at the stoma site. A small one-way shunt valve placed into this puncture restores the patient's ability to force air from their lungs into the mouth. After this operation, patients can cover their stoma with a finger to force air out of their mouths, producing sustained speech. This takes practice, but patients can work closely with speech pathologists after surgery to learn this technique.
Electrolarynx: For patients who cannot have tracheoesophageal punctures because of certain medical reasons, or while patients are learning to use their TEP voice, they may use electrical devices to produce a mechanical voice. These devices are either placed in the corner of the mouth or against the skin of the neck. By moving one's mouth and tongue, the patient is able to form the sound into words.
Partial laryngectomy: Smaller cancers of the larynx can often be removed without taking out the entire voice box. There are several different types of partial laryngectomy procedures. These procedures differ in which areas of the larynx are removed. Their goals are the same -- keeping as much of the natural larynx as possible while removing the cancer.
Neck dissection: Cancers of the larynx and hypopharynx often spread to the lymph nodes in the neck. Depending on the stage and exact location of the cancer, it may be necessary to remove lymph nodes from the neck. This operation is called a neck dissection. There are several forms of neck dissections ranging from the radical neck dissection to a selective neck dissection. They differ in the amount of tissue removed from the neck. Their goals are to remove lymph nodes proven or likely to contain metastatic cancer. The amount of tissue to be removed depends on the size and extent of the metastasis.
