Understanding the Larynx and Its Surgical Removal
The larynx, or voice box, is an organ in the neck with important functions. It plays a role in breathing, acting as a passageway for air to the lungs. It also prevents food and liquids from entering the airway during swallowing. The vocal cords within the larynx vibrate to produce sound, enabling speech.
A laryngectomy is a surgical procedure involving the removal of part or all of the larynx. This operation is most frequently performed for advanced laryngeal cancer. Other reasons may include severe trauma or extensive damage from radiation therapy. The decision to perform a laryngectomy is made when other treatments, such as radiation or chemotherapy, are not sufficient.
Types of Laryngectomy Procedures
The extent of larynx removed during a laryngectomy depends on the location and spread of the condition. A partial laryngectomy involves removing only a portion of the larynx. This approach is considered when cancer is small and confined to a specific area.
In contrast, a total laryngectomy involves removal of the entire larynx. This procedure is necessary when cancer is more extensive or has spread throughout the voice box. Both types of procedures alter how an individual breathes and speaks, with total laryngectomy leading to more significant changes.
Immediate Physical Adjustments
Following a laryngectomy, individuals experience changes in their physical anatomy, particularly concerning breathing and swallowing. A notable alteration is the creation of a permanent stoma, an opening in the front of the neck. This stoma connects directly to the trachea (windpipe), allowing air to bypass the nasal and oral cavities and enter the lungs.
Breathing through a stoma means air is no longer filtered, warmed, or humidified by the nose and mouth, which can lead to changes in respiratory health. The pathways for eating and drinking are re-routed. The esophagus, which carries food to the stomach, is separated from the trachea, ensuring food and liquids do not enter the airway through the stoma. This re-routing prevents aspiration, where food or liquid enters the lungs, which could lead to complications such as pneumonia.
Methods for Communication
After a laryngectomy, the ability to speak using vocal cords is lost, requiring alternative communication methods. One method is esophageal speech, which involves learning to trap air in the esophagus and releasing it to produce vibrations. These vibrations are then articulated into speech sounds using the tongue, lips, and teeth. Esophageal speech can be challenging to learn, and the resulting voice has a lower pitch and is less fluent than natural speech.
Another common option is a tracheoesophageal puncture (TEP) with a voice prosthesis. This procedure creates a surgical opening between the trachea and esophagus, where a one-way valve (the voice prosthesis) is inserted. To speak, the individual blocks their stoma, directing air from the lungs through the prosthesis into the esophagus, which vibrates to produce sound. The TEP voice is more natural-sounding and easier to learn than esophageal speech, offering a more fluent communication option.
An artificial larynx, also known as an electrolarynx, provides a mechanical way to produce speech. This small, battery-operated device is held against the neck or cheek. When activated, it produces vibrations transferred to the mouth and throat. The user shapes these vibrations into words using their tongue, lips, and teeth. The electrolarynx provides an immediate means of communication, and while the voice can sound somewhat robotic, it is a reliable tool for many.
Daily Life After Surgery
Adjusting to daily life after a laryngectomy involves new routines, particularly stoma care. Regular cleaning of the stoma is important to prevent mucus buildup and infection. This involves using a soft brush or cotton swabs to remove secretions from around and within the stoma opening.
Humidification of the air is important because air entering the lungs no longer passes through the nose and mouth’s natural filtering and humidifying processes. Using a stoma cover or a heat and moisture exchanger (HME) helps warm and humidify inhaled air, protecting the lungs and reducing mucus production.
When showering or swimming, it is important to use a stoma guard or cover to prevent water from entering the airway, as water in the lungs can lead to respiratory issues. Dietary adjustments may also be necessary, especially for those who initially experience difficulty swallowing, often requiring softer foods or specialized techniques.