Total Laryngectomy
What is a Total Laryngectomy?
A laryngectomy is when the larynx or voice box is removed. An opening or stoma is made in the trachea (windpipe) in the front of the neck. Air enters and leaves the trachea and lungs through this opening. A tracheostomy tube, also called a trach (trake) tube, may be placed to help keep the new airway open until the stoma is healed.
What can I Expect After Surgery?
After a brief stay in the recovery room, you will be brought back to your room. You may or may not have a trach tube in place through your stoma. Either way, you will be breathing through the stoma. Your voice box will have been removed and you will not be able to talk.
Air enters the trachea directly through the stoma so it can't be moistened by passing through your nose. Instead you will need to wear a device that fits over your stoma. This device gives moisture and sometimes oxygen. Humidity is needed to keep secretions from forming mucus plugs and to clear mucus from your airway. After a laryngectomy, your lungs and windpipe produce a great deal of mucus. At first the nurse may need to remove it with gentle suction by placing a small plastic tube into your stoma.
The nurse will also irrigate your stoma by placing a small amount of saline into your stoma. This will produce a cough reflex that loosens and brings up the secretions. After a few days, the nurse should not need to suction your stoma. Irrigating your stoma every 8 hours should be enough because it also provides humidity. For a short time, your nurse may also need to suction secretions from your mouth since swelling in the throat makes it hard to swallow.
Your trach tube may stay in place until the skin around the stoma heals. If the tube is removed, it is sometimes replaced by a stoma “button” which is a small plastic piece that fits just inside the stoma to help protect it. After a while, some people get along without either a tube or a button. If either is used, they will need to be cleaned at least 3 times a day to start with. The skin around your stoma will also have to be cleaned. Your nurse will do this for you until you are ready to learn to do it on your own. You will be given a separate Health Facts for You for this.
You will not be able to eat or drink after surgery until the swelling is gone and your throat heals. An IV will supply fluid until your stomach and bowel are working again. Fluids and nutrition supplements will be given through a tube put in place during surgery. This tube is called a “nasogastric tube” (NG), or a smaller tube called a “dobhoff”. The tube passes through your nose and throat to your stomach. You will be fed through this tube until you are ready to swallow foods again.
Will I Have a Lotof Pain?
The amount of pain one has varies. After a laryngectomy, parts of the neck and throat may be numb because nerves have been cut. For this reason, most people have moderate to little or no pain. Also, if you have had extra surgery to remove the lymph nodes in the neck, your shoulders and neck may be weak and stiff. Easing your pain is an important part of your care. Your nurse will talk with you about using a pain rating and what level of pain you can expect. Your doctor will prescribe pain medicine that can be taken when you need it.
What Do I Need to Learn before Going Home?
When you are ready to start learning how to care for yourself at home, your nurse will give you a handout and teach you how to perform the needed steps. You will be taught these cares.
- trach or stoma care which includes skin care and cleaning the trach tube
- other aspects of your care
You will begin self-care while in the hospital so that you are able to care for yourself before you go home. If other health problems prevent you from doing your own care, we will plan for this. This may include teaching a family member and or calling a home care agency to help you.
How Will I Communicate?
Because your voice box has been removed, you will need to learn to communicate in other ways. While in the hospital, it can be done by writing, gestures, or pointing to pictures, words or letters. Some people like to use a magic slate to write notes or use pen and paper. Your nurse will work with you to help you find what works best. We will supply paper and pens or pencils. A speech pathologist will meet with you to explain methods that can be used to communicate which may include esophageal speech, tracheoesophageal puncture, electrolarynx or pneumatic larynx.
Follow-up Care
Your first follow-up visit will be scheduled for you before you go home. You should receive a home-care tracheostomy Health Facts for You. Refer to this for details. Call your doctor or nurse for:
- change in color, amount, or texture of secretions.
- redness or skin breakdown around tracheostomy or stoma.
- fever of 100.5°F.
- pain not controlled by your medicine.
- any questions or other concerns.
Phone Numbers
Monday-Friday 8:00 a.m. - 5:00 p.m. call: ENT clinic (608) 263-6190
After 5:00 pm or weekends, the clinic number is answered by the paging operator. Ask for the ENT doctor on-call. Leave your name, area code and phone number. The doctor will call you back.
If you live out of the area, please call 1-800-323-8942.
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 10/21/2011
Copyright © 10/21/2011 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5082
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