I am a laryngectomee (no vocal cords). I am a total neck breather. I speak via a voice prosthesis. In the event that I stop breathing, expose my entire neck. Keep my neck opening clear and protected from liquids. Resuscitate with air or oxygen to neck opening, or use mouth-to-neck breathing.
Laryngectomy Timeline
Pre-Operation
1st Visit with:
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An Ear, Nose, Throat (ENT) physician
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Cancer Care Coordinator (this person will set-up diagnostic tests)
2nd Visit with:
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ENT Physician’s Assistant (PA)
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Anesthesia
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Speech Therapy
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Cancer Care Coordinator
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Other physicians
Operation
Pre-Operation preparations:
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The anesthesiologist will talk with you about anesthesia
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Your vital signs (blood pressure, pulse, respirations, temperature, oxygen saturation) will be taken
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An intravenous (IV) catheter will be inserted in your vein (usually the hand or arm) for fluid and medication administration before, during, and after surgery
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Blood may be drawn before surgery
Length of Operation:
Recovery Room:
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You will be in the recovery room for approximately 4 hours.
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During your recovery room stay, your vital signs and pain level will be monitored.
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When you are determined stable, you may be transferred to the Intensive Care Unit (ICU).
Post-Operation
Intensive Care Unit (ICU):
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You will be carefully monitored in the ICU for at least one day (longer for complicated cases) after surgery to make sure your body tolerated surgery
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When your are determined to be stable, you will be transferred to a medical/surgical nursing floor
Medical/Surgical Nursing Floor:
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Upon arrival to the medical surgical floor, your nurse will teach you how to:
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Care for your laryngectomy and incisions
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Suction your laryngectomy stoma
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Feed and give medications through your feeding tube (if applicable)
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Reinsert the laryngectomy tube if it becomes dislodged
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You and your family will be expected to demonstrate the above skills by discharge
Discharge:
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Approximately 7-9 days after surgery
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Nurse will have you sign discharge paperwork
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You will be sent home with (including but not limited to):
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Suction equipment from an outside agency
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Obturator for your laryngectomy tube (if applicable)
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An extra laryngectomy tube (if applicable)
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Alkalol spray
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Humidity
Follow-up
1st Visit:
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Approximately 1 week after discharge
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Meet with an ENT physician for suture, staple, and nasal gastric (NG) tube removal. May have swallow test.
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Esophagram to evaluate for possible leak
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Make arrangements for meeting with radiation oncologist, if indicated. Radiation treatment should begin within 6 weeks of surgery.
2nd Visit:
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Approximately one month after surgery
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Meet with the ENT physician
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Set-up appointment or meet with the Speech Therapist
Long-term Follow-up Care
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Evaluation by your ENT staff surgeon on a regular schedule for cancer surveillance
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Years 1-2: Every 6-8 weeks
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Year 3: Every 3 months
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Year 4: Every 4 months
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Year 5: Every year
If you would like more information or have questions, please contact The University
of Kansas Department of Otolaryngology Head and Neck Surgery at (913) 588-6701.
Glossary
Anesthesia: Medication used to produce a loss of sensation or feeling.
Anesthesiologist: A medical doctor that administers anesthesia.
Cancer: Abnormal cells that multiply without control. They can spread through the bloodstream and the lymphatic system to other parts of the body.
Carcinoma: Cancer that begins in the lining or covering of an organ.
Cartilage: Firm, rubbery tissue that cushions bones at joints.
Chemotherapy: Anticancer drugs used to treat cancer.
Clinical Trials: Studies of new cancer treatments. Results from clinical trials determine future cancer treatments.
Electrolarynx: A battery operated instrument that makes a humming sound to help laryngectomees talk.
Epiglottis: The flap that covers the trachea during swallowing so that food does not enter the lungs.
Esophageal Speech: Speech produced with air trapped in the esophagus and forced out again.
Esophagus: The tube through which food passes from the throat to the stomach.
Glottis: The middle part of the larynx where the vocal cords are located.
Humidifier: A machine that puts moisture in the air.
Laryngectomee: A person who has their voice box removed.
Laryngectomy: An operation to remove all or part of the larynx.
Larynx: An organ in the throat used in breathing, swallowing, and talking. It is made of cartilage and muscle and is lined by a mucous membrane similar to the lining of the mouth. It is also called the voicebox. The larynx has three parts: the supraglottis, the glottis, and the subglottis.
Lymph Nodes: Small, bean-shaped organs located along the lymphatic system. Nodes filter bacteria or cancer cells from the lymph fluid.
Malignant: Cancer that has the ability to spread to other parts of the body.
Metastasis: Cancer cells that spread to other parts of the body. These cells have the same appearance or characteristics of original tumor or mass.
Neck Breather: A term used for a person who has had a laryngectomy. The laryngectomee breathes from the neck because the trachea is diverted from the mouth and nose to the neck.
Obturator: A device with a curved tip used in the insertion, or reinsertion, of a laryngectomy or tracheostomy tube.
Oncologist: A doctor who specializes in the treatment of cancer.
Otolaryngologist: A doctor who specializes in the treatment of diseases of the ear, nose and throat. Also known as an ENT or Head and Neck surgeon.
Pathologist: A doctor who identifies diseases by studying cells and tissues under a microscope.
Pneumatic Larynx: A device that uses air to produce sound to help a laryngectomee talk.
Prognosis: The probable outcome or course of a disease; the chance of recovery.
Radiation Therapy: Treatment of cancer cells with high energy beams from x-rays or other sources to kill these cells.
Remission: Disappearance of the sign and symptoms of cancer; can be temporary or permanent.
Risk Factors: Something that increases a person’s chance of getting a particular type of cancer.
Speech Pathologist: A specialist who evaluates and treats people with communication and swallowing problems.
Staging: Doing exams and tests to learn the extent of the cancer; whether it has spread to any other areas of the body.
Stoma: The opening into the windpipe made by the surgeon. Laryngectomees breathe through this opening.
Subglottis: The lowest part of the larynx, just below the vocal cords down to the top of the trachea.
Supraglottis: The upper part of the larynx, above the vocal cords; including the epiglottis.
Systemic Therapy: Therapy that reaches and affects cells all over the body.
Trachea: The airway that connects the larynx to the lungs; the windpipe.
Tracheoesophageal Puncture: A small
opening made by the surgeon, between the esophagus and the trachea. A valve keeps food out of the trachea but lets air into the esophagus for esophageal speech.
Tracheostomy: Surgery to create an opening in the windpipe.
Tracheostomy Button: A ½ to 1½ inch long plastic tube placed in the stoma to keep it open.
Tracheostomy Tube: A 2-3 inch long metal or plastic tube that keeps the stoma and trachea open.
Tumor: An abnormal mass of tissue.
Vocal Cords: Two small bands of muscle within the larynx that closes to prevent food from getting into the lungs and they vibrate to produce voice.
If you would like more information or have questions, please contact The University
of Kansas Department of Otolaryngology Head and Neck Surgery at (913) 588-6701.
Parts of the Mouth
Your mouth allows you to speak, breathe, and chew. Listed below are specific parts of the mouth and where they are located.
© 2005 The StayWell Company, 780 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your health care provider's instructions.
Parts of the Throat and Neck
Your throat allows you to swallow, breathe, and speak. Parts of the neck help you fight infection. Listed below are specific parts of the throat and neck and where they are located.
© 2005 The StayWell Company, 780 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your health care provider's instructions.
Laryngectomy
A laryngectomy is an operation to remove the larynx. The larynx, or voice box, is the organ that produces the sound that allows us to speak. It also prevents food from entering the air passage.
Who is a candidate for the procedure?
A person with cancer of the larynx is a candidate for this procedure.
How is the procedure performed?
A laryngectomy is done through an incision in the neck. The larynx is removed. Air can no longer pass from the lungs into the mouth, because the connection between the mouth and the windpipe no longer exists. So a new opening for air to enter the lungs must be made in the front of the neck.
The upper portion of the trachea, or windpipe, is brought out to the front of the neck to create a permanent opening. This opening is called a “stoma.” A laryngectomy tube may be placed in the stoma to keep it open until it heals.
Often, an operation called a
neck dissection is done at the same time as a laryngectomy. This is done to remove the lymph nodes in the neck, to which cancer may have spread.
What happens right after the procedure?
After the laryngectomy surgery, the person will be taken to the surgery recovery room to be watched closely for a short time. Vital signs, blood pressure, pulse, and breathing will be checked frequently. A small mask with humidified air will be placed over the stoma. This helps to keep the secretions thin and prevent blockage of the airway. The head of the bed will be elevated to promote drainage from the surgical site. Suction drains may have been placed under the skin to catch any fluid that collects at the incision. The nose, mouth, and the laryngectomy tube will be suctioned gently.
What happens later?
The person usually spends a few nights in the intensive care unit after a laryngectomy. Fluids are given through an intravenous line. A stomach tube may be inserted in the nose into the stomach to supply nutrition until the throat has healed. You will not be able to eat by mouth for 7-14 days. The total hospital stay after a laryngectomy is usually about a week.
Before discharge, the person is taught how to care for the stoma. It is very important that the person and the family understand stoma care. The stoma is the person's only airway. It must be kept free of fluids, mucus, and anything else that can block the flow of air. Any blockage of the stoma can be very serious.
The person will need to learn a new way of speaking.
Speech therapy can help to provide alternative ways of speaking. These alternative ways to speak include using artificial voice aids, esophageal speech, and voice prosthesis. It may be helpful to talk with someone who has undergone this procedure. The International Association of Laryngectomees can help provide support.
What are the potential complications after the procedure?
Surgery carries the risk of bleeding, infection, wound healing problems including a salivary fistula (an opening into the throat), and allergic reactions to anesthesia. As with any major surgery, there is a slight risk of heart attack, stroke, or death. Keeping the new airway open is essential to prevent airway complications.
If you would like more information or have questions, please contact The University
of Kansas Department of Otolaryngology Head and Neck Surgery at (913) 588-6701.
Adapted from: Hendrickson, Gail.
Laryngectomy. Retrieved from: http://health.discovery.com/encyclopedias/3208.html
Radical or Modified Radical Neck Dissection
A radical neck dissection is a procedure used to remove
cancerous tumors from one side of the neck or upper airway. Almost all the lymph nodes and some of the muscles, tissues, veins, and nerves in this area may be removed as well.
Who is a candidate for the procedure?
A person who has a cancerous tumor in the lymph nodes in the neck and upper airway is a candidate for this procedure.
How is the procedure performed?
The procedure is done under general anesthesia. This means that the person will be put to sleep with medications. An incision, or cut, is made under the chin towards the ear. Another incision is made down to the bottom of the neck. A third incision is made down the middle of the neck. Other incisions may also be made so the surgeon has a full view of the structures inside the neck. The skin is then spread open and the tissues underneath the skin are pulled away from the skin. The surgeon then removes the lymph glands from the neck and oral cavity.
In addition to the lymph nodes, there are three main structures that may be removed from the neck area if they are involved by cancer. These are: the internal jugular vein, the accessory nerve, and the sternocleidomastoid muscle.
Any other veins, nerves, or muscles that are involved with the
cancer are also removed. If the cancer has spread, it may be necessary to remove sections of the jaw, tongue, or voice box.
At times, it is also necessary to perform a
tracheostomy. A tracheostomy is a surgically created opening through the neck into the trachea, or windpipe. The incision is closed with
sutures, staples, or skin clips.
What happens right after the procedure?
Usually after a radical neck dissection, a person will be in the surgery recovery room for a few hours for close monitoring. Oxygen will be given through a facemask or nasal prongs. Pain medication will be given as needed. A person cannot eat or drink anything at first. Then later in the day, the person can start taking small sips of fluid. There may be a few tubes that are left near the incision to drain fluids and blood. These tubes will be removed once the draining stops.
For the next few days the person will be encouraged to do deep breathing. This helps to clear the lungs and prevent
pneumonia. The day after surgery the person will be encouraged to get out of bed and walk around. This helps to lower the risk of blood clots.
If a
tracheostomy was done, the person (and family members) will be given special training in caring for the tracheostomy site.
What happens later at home?
The person will be in the hospital from 4 to 14 days depending if other operations have also been performed with the neck dissection. Activity at home will be based on how the person is recovering. Usually a small amount of activity is recommended on the first day or two after getting home. The person can increase the activity level if he or she feels ready. Sutures, staples, or clips are usually taken out 7 to 10 days after surgery. A person is advised not to drive or participate in strenuous activity for several weeks.
What are the potential complications after the procedure?
After a radical neck dissection a person may have bleeding at the surgery site, infection, pain, and scarring. There is also a chance for injury to the veins and nerves in the neck. This can cause bleeding or numbness. This procedure may also cause a deformity of the neck and face.
If you would like more information or have questions, please contact The University
of Kansas Department of Otolaryngology Head and Neck Surgery at (913) 588-6701.
Adapted from: McLaughlin, Eileen.
Radical Neck Dissection. Retrieved from: http://health.discovery.com/encyclopedias/3212.html
Patient Education:
General Information for the Laryngectomee
Activities of Daily Living:
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Plan regular rest periods during the day.
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Exercise lightly as tolerated, such as walking. Increase your level of exercise on a daily basis but not to the point of exhaustion or pain.
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Maintain your diet as ordered by your physician. Food will taste dull and it will have no odor, however, you must eat and keep your weight up in order to heal and get well.
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Drink plenty of fluid; at least 8-10 glasses of water a day. Drinking the recommend amount of fluids will decrease your chance of getting constipated.
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You may drink any other fluids in addition as long as they do not contain alcohol. Alcohol will dehydrate your body.
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You may shower 24 hours after your drains have been removed.
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When showering, you will need to cover your stoma/incision with a shield or cover with your hand. Avoid getting soap lather in your stoma because it will make you cough. Pat area dry with towel.
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Shave with an electric razor or safety razor.
Communication:
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Wear a medical alert bracelet that says “Neck Breather”.
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Notify your physician of the following conditions:
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Severe pain and swelling, redness or drainage from the incision area.
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Prolonged fever of 101.5 degrees Fahrenheit for over 24 hours.
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Persistent cough
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Respiratory distress, difficulty breathing, or a feeling of being short of breath.
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Contact 911 or your local EMS when you have trouble removing dried or thick secretions from your stoma or difficulty breathing from your stoma.
Other:
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Avoid smoking or being in the room where others are smoking. The smoke fume may irritate your throat and will induce coughing.
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Avoid persons with respiratory tract infections, especially colds. You will be more susceptible to these infections for the first several months after surgery.
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Contact the doctor’s office if you have any questions at (913) 588-6700.
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To contact one of our hospital ENT nurses, please call (913) 588-9350.
Patient Education:
Incision Care
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Wash your hands with soap and water.
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Pour equal amounts of hydrogen peroxide and water in a cup.
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Dip one swab into the hydrogen peroxide mixture. Clean around stoma and incision. Do this one swab at a time and remove any dried crust or mucus.
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Rinse off any hydrogen peroxide mixture with a swab or gauze that is dipped in plain water.
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Gently dry your skin with a dry cloth.
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A
Source: http://devweb3.vip.
ohio-state.edu/patedu.htm ate.edu/patedu.htm
pply a thin layer of triple antibiotic ointment to stoma and incision with a cotton swab for the first 10 days after surgery (if ordered by your physician).
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Clean stoma and incision 2 times a day and as needed until healed.
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Look at your incision. If it is red or hurts, repeat stoma care more than 2 times a day.
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Wash your hands with soap and water.
If you would like more information or have questions, please contact The University
of Kansas Department of Otolaryngology Head and Neck Surgery at (913) 588-6701.
Adapted from: Ohio State University Medical Center. Laryngectomy Stoma Care. Retrieved from: http://devweb3.vip.ohio-state.edu/patedu.htm
Patient Education:
Stoma Care
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Spray the stoma with alkalol spray (diluted one part alkalol to two parts of water) every 1-2 hours while awake. This will help keep the secretions moist and prevent crusts from forming. It will also make it easier for you to cough the secretions out. The diluting water may be plain tap water.
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Remove dried secretions from stoma with tweezers as needed. You may need to use alkalol to loosen the crust.
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Blood specks in the sputum occur in the winter. Increased moisture helps prevent crusting and subsequent blood specks.
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I
Source: http://devweb3.vip.ohio-state.edu/patedu.htm
t is important that you cover the stoma when you cough. Your secretions are now coming from your stoma instead of your mouth.
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Keep you stoma covered at all times with either the stoma cover or other collars of your choice. This will keep dirt and debris out of your stoma. This will also help you keep from coughing in an embarrassing manner. You may want to wear clothing with high necklines or scarves so that the area is covered and looks attractive during cold weather when the air is dry, you will need to place extra covering over your stoma so that the air will condense on the cover and freeze.
If you would like more information or have questions, please contact The University
of Kansas Department of Otolaryngology Head and Neck Surgery at (913) 588-6701.
Adapted from: Ohio State University Medical Center.
Laryngectomy Stoma Care. Retrieved from: http://devweb3.vip.ohio-state.edu/patedu.htm
Patient Education:
Suctioning
Suctioning keeps your stoma clear of excess mucus
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Suction when unable to clear your secretions or you are having trouble breathing.
Suctioning Procedure:
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Collect your supplies
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Suction machine
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Catheter
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Small bowl of distilled water
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Disposable powder-free gloves
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Wash your hands with soap and warm water. Then put on clean, disposable, powder-free gloves.
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Prepare to suction
nsert the obturator into the laryngectomy tube. You will know the obturator is in place when you see the round tip protrude out of the cannula.
old the obturator in place with your thumb and grasp the outer cannula under the faceplate with the index and middle fingers, and insert the new tube following the track of the dislodged tube.
mmediately remove the obturator.
aring for the Mouth
ash your hands.
ather supplies: feeding syringe, empty cup.
ut the tip of the syringe in the water.
he tube.
ull the plunger out of the syringe.
old the syringe straight up and let the formula run through the tube by gravity.