© 2020 Head and Neck Cancer Australia 1

CONTENTS

AN OVERVIEW TO LARYNGECTOMY 3

WHY IS A LARYNGECTOMY NEEDED 5

HOW TO PREPARE FOR THE OPERATION 5

WHAT TO EXPECT DURING THE OPERATION 7

WHAT TO EXPECT AFTER THE OPERATION 8

WILL I BE ABLE TO SPEAK? 8

WILL I BE ABLE TO EAT? 9

WILL I BE IN PAIN? 9

HOW DO I BREATHE? 10

POSSIBLE RISKS OF LARYNGECTOMY 10

SIDE-EFFECTS AND MANAGING SIDE EFFECTS 12

BEFORE GOING HOME 13

OTHER TREATMENT(S) 14

FOLLOW-UP CARE 14

QUESTIONS TO ASK YOUR DOCTOR 15

© 2020 Head and Neck Cancer Australia 2

LARYNGECTOMY
This information aims to help you understand the operation, what is involved and some
common complications that may occur. It may help answer some of your questions and help
you think of other questions that you may want to ask your cancer care team; it is not intended
to replace advice or discussion between you and your cancer care team.

AN OVERVIEW TO LARYNGECTOMY
The larynx (or voice box) is an organ in the front of the neck.

• It is made up of cartilage (a firm tissue), muscles and ligaments which move to make
different sounds and protect the lungs when swallowing (see diagram below).

• The cartilage in the front of the larynx is sometimes called the Adam’s apple.

The larynx has three parts which doctors may refer to when describing where a cancer is
located within the larynx:

• upper (supraglottis): the area from the epiglottis down to the vocal cords at the top of
the larynx. The epiglottis is responsible for protecting the lungs when swallowing
foods and liquids.

• middle (glottis): this area contains the vocal cords which open when breathing, and
close when talking and swallowing.

• lower (subglottis): the area below the vocal cords where the larynx joins the trachea
(or windpipe). The trachea links the larynx to the lungs.

A laryngectomy is the removal of all (total laryngectomy) or part of the larynx (partial
laryngectomy).

Partial laryngectomy is the term used to describe removal of part of the voice box using a cut
on the neck, but your surgeon may also consider removing the cancer with a laser or robot
through the mouth without any external cuts (transoral surgery).

● Further information on partial laryngectomy is available on the Head and Neck Cancer
Australia website.

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 ● Further information about Trans-oral robotic surgery or Trans-oral laser surgery is available on
the Head and Neck Cancer Australia website.

Total laryngectomy is used for larger cancers that cannot be treated with a smaller operation.
This involves removing the whole voice box and will have a major effect on your life. It will
change the way that you talk, breath and look. Despite this, most patients adjust to these
changes with the support of their friends, family and cancer care team.

After the voice box is removed during a total laryngectomy, the top of the windpipe is sewn
to the skin of the neck to make a hole that you will breathe through after surgery. This is
called a tracheostoma, or ‘stoma’ for short.

Sometimes cancers of the voice box can extend outside of the larynx and part of the throat
(hypopharynx) needs to be removed as well. This is called a laryngopharyngectomy. Further
information of laryngopharyngectomy is available on the Head and Neck Cancer Australia
website.

Sometimes the lymph nodes in the neck may need to be removed and this is called a neck
dissection. Further information on neck dissection is available on the Head and Neck Cancer
Australia website.

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Part or all of the thyroid gland may also be removed during total laryngectomy. Further
information on thyroidectomy is available on the Head and Neck Cancer Australia website.

After the cancer is removed, some reconstructive surgery may also be done in the same
operation. Further information on different reconstructive surgeries (soft issue flaps and
regional flaps) is available on the Head and Neck Cancer Australia website.

WHY IS A LARYNGECTOMY NEEDED

A laryngectomy is recommended for patients with certain laryngeal and hypopharyngeal
cancers, when the cancer is in or close to the voice box. There are three situations where it is
commonly used:

• when radiation therapy is unlikely to cure the cancer;

• when the voice box or swallowing passage has been severely damaged by the cancer;

• when radiation therapy has already been used.

The cancer together with an area of normal-appearing tissue is removed to reduce the chance
of any cancer cells being left behind.

Tissue removed from the laryngectomy will be examined in detail by a specialist pathologist,
under a microscope to look for cancer cells. Through this examination, the cancer can be
accurately staged. Further information about staging of cancer is available on the Head and
Neck Cancer Australia website.

Possible questions that

you may want to ask your
HOW TO PREPARE FOR THE cancer care team

OPERATION How long will it

take before I can
BEFORE THE OPERATION:
eat again?
• You will need to fast (have nothing to eat or What kinds of
drink) for 6 hours before your operation food should I eat
after the
(unless advised differently by your surgeon or
operation?
anaesthetist) because thyroidectomy is
How will I talk
after the voice box
is removed?
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How will I breath
after the surgery?
What will I look
 performed under a general anaesthetic (you will be asleep and will not remember what
happens during the operation).

• Your surgeon will explain the details of your operation. Be sure to bring up any
questions or concerns, and share your needs and wishes with your cancer care team
(see box).

• You should speak to your doctor about how to manage aspects of your lifestyle, such
as smoking, drinking alcohol and chronic conditions (e.g. diabetes and obesity) that
may increase the risk of complications.

o If you take blood thinning medication for a heart condition or blood clots (such
as Warfarin, Plavix, Aspirin or Pradaxa), make sure your surgeon is aware. Some
of these medications need to be stopped more than a week before the
operation. Sometimes a short-acting blood thinner (such as Clexane) is used
before and after the surgery.
• Talk to your surgeon and cancer care team about any likely side effects to expect
following the operation. You will not be able to speak in the normal way after removal
of your voice box, so you should discuss with your cancer care team how you will
speak and swallow, and adjust.

• A laryngectomy will permanently and significantly alter your speech and breathing. It is
important to talk to a speech pathologist about what to expect after operation and
how you might be helped to speak and swallow afterwards.

• A dietitian may also be useful to discuss issues about eating.

• Your speech pathologist may arrange for you to meet another patient who had this
operation (either online or in person). It can help to hear how they have coped and
adjusted; it may also be encouraging to hear how others have managed to recover well
and lead healthy productive lives. Your cancer care team can assist with making these
contacts.

• If you are having a total laryngectomy you will be offered to meet a representative
from the Laryngectomee Association of NSW who has undergone this surgery.

• Spend some time planning how to communicate with people including the nursing
staff straight after the operation as you may not be able to talk (see section below:
Will I be able to speak).

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 • Be sure to stay well nourished; if you are having trouble swallowing it may be helpful
to take some high-calorie supplements. This is best done with the advice of the speech
pathologist and dietitian.

WHAT TO EXPECT DURING THE OPERATION

DURING A TOTAL LARYNGECTOMY:

• A cut is made in the centre of the neck, extending far across each side of the neck.

• After the larynx is removed the surgeon may send the tissue from the edges of what
was removed to the pathologist to confirm that the cancer cells have been removed.
This is called a ‘frozen section’ because the tissue is snap frozen so that it can be
quickly made into slides that can be reviewed under a microscope while you are
asleep.

• Part of the thyroid gland is also often removed.

• After the voice box is removed, your surgeon will sew the top of the windpipe to the
skin at the front of the neck. This will become the hole that helps breathing, called a
tracheostoma or laryngostoma. A tracheostoma is a little different to a tracheostomy
because it is permanent as the voice box is gone. Further information about
tracheostomy is available on the Head and Neck Cancer Australia website.

• A hole may be made in the back of the tracheostoma through to the oesophagus. This
is called a tracheo-oesophageal fistula or puncture (TEP). This hole is used for talking
by directing air from the lungs back through the mouth. The hole needs to be kept
open with a special speaking valve. Sometimes this is done during the laryngectomy
but may be done at a later stage when everything has healed.

• Lymph nodes in your neck may also be removed to remove any glands affected by the
cancer. This is called a neck dissection. Further information on neck dissection is
available on the Head and Neck Cancer Australia website.

• If reconstructive surgery using a flap is required, then this follows the removal of the
voice box. Further information about reconstructive surgery is available on the Head
and Neck Cancer Australia website.

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 • There will be a feeding tube inserted through the nose, or through the TEP hole in the
back of the stoma to help transport nutrition into the body for the first week or two
after surgery, or sometimes longer. Further information about feeding tubes is
available on the Head and Neck Cancer Australia website.

WHAT TO EXPECT AFTER THE OPERATION

• After the operation, you will be closely monitored in the hospital ward or the intensive
care unit during your recovery.

• You may have a drip in your arm to give you fluid until you are able to drink and a
feeding tube to keep your body healthy and promote healing until you are able to eat
and drink by mouth.

• You may have some surgical drains coming from the area of the operation to allow
blood or fluid to escape and prevent swelling. These will be removed before you go
home.

• The operation takes several hours, so a catheter is usually placed in the bladder to
monitor how your kidneys are working.

• After your larynx is removed, you will breathe through the breathing hole in your neck
(stoma) and will no longer be able to speak normally. A tracheostomy tube is usually
placed in the hole to start with. This tube will need to be suctioned and cleaned by the
nurse looking after you

• Most patients stay in hospital for around 2 weeks to recover but will vary depending
on the extent of your surgery and how you recover.

WILL I BE ABLE TO SPEAK?

• You will not be able to speak in the normal way after removal of your voice box. The
air from your lungs will come out from the hole in the throat (the stoma), instead of
the mouth.

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 • In hospital after surgery, you may need to write things down that you want to say to
people. It is useful to have a pen and paper, mini white board or iPad/tablet in hospital
to write down anything you want to say.

• After a total laryngectomy, there are different ways you can speak again. Your surgeon
and speech pathologist will discuss this with you and advise on the best option for
you.

• A speech pathologist will help you with voice rehabilitation that may involve speaking
by:

o swallowing air and expelling it (oesophageal speech)

o using an artificial larynx with an electronic device (electrolarynx)
o using a speaking valve in the hole at the back of your stoma so that air from the
lungs can reach the food pipe (tracheo-oesophageal speech).

WILL I BE ABLE TO EAT?

• You will still be able to eat after total laryngectomy because the swallowing passage is
not removed.

• However, you will probably have to wait about one week for your throat to heal and
to reduce risk of a salivary leak from where the throat (pharynx) has been sealed.

• Once the feeding tube is removed, you may have some difficulty swallowing and a
speech pathologist can assist with this.

• You will lose your sense of smell, since the air doesn’t pass through your nose when
you breathe in. Food will taste very different without your sense of smell.

WILL I BE IN PAIN?

• Laryngectomy is not usually a very painful operation, but you will be uncomfortable.
Let the nurse know if you are experiencing pain.

• Your anaesthetist and surgical team will give you medicine to help control any pain
and nausea after the operation.

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HOW DO I BREATHE?

• After total laryngectomy, you will breathe through the hole in your neck
(laryngostoma, or stoma). This will be permanent and you will breathe through this
hole from now on. Further information about laryngostomas is available on the Head
and Neck Cancer Australia website.

POSSIBLE RISKS OF LARYNGECTOMY

All operations carry some risks such as blood clots, wound infections, bleeding, chest
infection, adverse reactions to anaesthetic, and other complications. These risks will be
explained by your cancer specialist and anaesthetist.

Your doctor will explain details of the operation, general risks and side effects of the
operation, they may recommend:

• stopping blood thinners (e.g. aspirin) before surgery to reduce the risk of bleeding

• a blood thinner (called heparin) may be injected before and after surgery to reduce the
risk of blood clots

• antibiotics to reduce to risk of wound infection

• early mobilisation to reduce the risk of blood clots and chest infection

• special stockings to reduce the risk of blood clots.

Risks specific to laryngeal surgery vary depending on the type of surgery and general health.
In addition to the general risks of surgery mentioned above, these are possible risks:

• Bleeding: some people may experience excessive bleeding, which may be life-
threatening. If this happens, another operation may be needed to stop bleeding or
your surgeon may suggest blood transfusion.

• Abnormal opening or fistula: if the seal separating the throat and neck breaks down,
saliva may leak causing an infection. This can be a very serious complication and might
require opening a wound to allow it to drain or another operation to fix the seal.

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 • Infection: bacteria may cause an infection in the neck wound after the surgery. The
surgeon will prescribe antibiotics to prevent this occurring, but if an infection still
occurs, it might require opening part of the wound to allow any pus to drain out.

• Airway obstruction: Blocking of the airway can happen from crusting of the stoma.
You will be given careful instructions in hospital on how to look after your stoma
before you go home.

• Leakage of lymphatic fluid (chyle leak): Lymphatic fluid leaks from lymph channels
(near where lymph nodes were removed) and may cause swelling under the skin. This
can be treated using a special diet.

• Low blood calcium: The parathyroid glands (responsible for controlling the body’s
calcium levels) are located near the larynx and may be damaged or removed during the
laryngectomy. This may cause blood calcium levels to fall below normal, leading to
muscles spasms and can be treated with calcium tablets.

• Nerve damage: a number of nerves run close to the lymph nodes. Occasionally, some
of these nerves are injured or need to be removed during the operation. If the nerves
have been injured or bruised during the operation, the side effects usually go away
after a few months, but, if a nerve is removed during the operation, the weakness may
be permanent. Depending on the nerve involved, this may lead to:

o shoulder weakness, stiffness and discomfort in your shoulder, including difficulty

raising your arm above the head
o uneven smile due to weakness of the lower lip
o difficulty with speech and swallowing
o arm and breathing muscle weakness.
• Flap failure: if a flap reconstruction is needed, then microsurgery is done to join blood
vessels together to keep the flap alive. If the blood supply blocks, another operation
will be needed to fix the problem. Sometimes the problem cannot be fixed and a new
flap is needed.

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SIDE-EFFECTS AND MANAGING SIDE EFFECTS
As with all operations, there is a chance that neck dissection may lead to a number of side
effects. You may not experience all of the side effects. Speak with your doctor if you have any
questions or concerns about treatment side effects. Side effects common for total
laryngectomy may include:

• Nausea: General anaesthetic may cause nausea. This will settle down soon after the
operation and can be treated with medications.

• Swollen throat: Your mouth and throat may be swollen from the operation.

• Pain management: Pain is a common side effect of the operation. Your anaesthetist
will give you pain medicine during the operation to keep you comfortable when you
wake up, and you may continue on pain medicines to ensure pain is under control.

• Changes in eating and speaking: Total laryngectomy will affect eating, breathing and
speaking. It may be useful to have a tablet/portable device or pen and paper to write
down what you want to say; and breathing and feeding tubes may be used to help you
breathe and receive nutrition especially soon after surgery.

o You will breathe through a hole in your throat (stoma); give yourself time to
learn to breathe through a stoma and speak in a different way, and to adjust to
these big changes. A speech pathologist and your cancer care team are able to
help.
o Swallowing will likely be difficult for a few weeks and a dietitian will also provide
assistance to help with your nutrition and eating during recovery.
o You will lose your sense of smell, since the air will no longer pass through your
nose when you breathe in. Food will taste very different without your sense of
smell.
• It may help to make contact with other patients who have had this surgery or a
support group. Hearing how others have coped with this operation and the
adjustments needed can help you have a positive attitude and realistic expectations.
Seeing how others lead healthy productive lives after laryngectomy is encouraging.
Your health care team can help with making these contacts, in person or online.
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Hypothyroidism: If all or some of the thyroid gland is removed during the laryngectomy and
not enough thyroid hormone is made, some people may feel tired and sluggish. This is very
common if you have already had radiotherapy. Blood tests are used to measure the levels of
thyroid hormones about two months after surgery. You may need to remind your surgeon or
doctor to check this.

BEFORE GOING HOME

• Care of your stoma: You will be given information and careful instructions in hospital
and you will not be discharged until you and your carers are completely comfortable
with looking after your stoma.

o It is very important to keep the stoma clean. It can be very dangerous if the
airway becomes blocked. Using a small mirror may aid you with caring for the
tube.
o Ask as many questions as you need to while you are still in hospital. To get more
confident yourself, practice looking after the stoma as much as you can. It can
feel daunting but is quite simple. Don’t worry and be sure to ask any questions
you have.
o It helps if someone else you live with or see regularly, also learns what you have
to do.
o Your recovery at home may vary and you should allow time for your body to
recover and heal. With major surgery this can be slow and you may feel tired or
lack energy. Regular follow up helps to assess your progress.
• Keeping your airway moist: Normally air is kept warm and moist by the nose so dry air
does not irritate the windpipe and lungs. After total laryngectomy, the air does not go
through the nose, so it is very important that it is moistened. You will be given
instructions on keeping your airways moist. Most patients use a Heat Moisture
Exchanger (HME) device.

• Feeding tube: The gastrostomy tube is usually removed before leaving the hospital.
However, if you have to go home with the gastrostomy tube, it is very important that
you know how to look after it. You will be given information and careful instructions in
hospital. Further information on Feeding tubes (Gastrostomy) is available on the Head
and Neck Cancer Australia website.

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 • Any particular instructions for wound care or medications will be provided to you
before you go home. You may want to download further information about wound
care on the Head and Neck Cancer Australia website.

• Your doctor will advise you about any particular symptoms you should look out for
such as difficulty breathing or swallowing, fever or discharge from the wound, and
what you should do.

• You will be assessed by the team involved in your care before you go home and
follow-up will be arranged with your surgeon and GP. Follow-up may also be arranged
with any other allied health professionals to assist you with supportive care.

• Your cancer care team can help you make contact with other patients and support
groups to hear how they have coped and adjusted.

OTHER TREATMENT(S)
• Additional treatment(s) depend on the nature and extent of the cancer.

• Head and neck cancers often require treatment with more than one form of therapy
to reduce the risk of the cancer recurring. Many patients need radiation therapy after
the operation, and sometimes, may also require chemotherapy.

• Your cancer care team will be able to discuss the likelihood of needing further
treatment before your operation.

FOLLOW-UP CARE
• After your operation, you will continue to have regular follow-up visits with your
specialist doctor and cancer care team. This may include a check on the stoma.

• It may be useful to make contact with a support group, such as a Laryngectomee

association, or with other patients who have had this surgery. Your health care team
can help with making these contacts, in person or online.

• Follow-up may also be arranged with any other allied health professionals to assist you
with supportive care, such as a speech pathologist to help learn to speak again or a
dietitian to assist with swallowing or eating difficulties.

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 • Any additional reconstruction, cosmetic procedures or treatments that you may need
are planned after discharge. This enables time for you to recover from the initial
operation, get results of the pathology that examined the tissue removed at the
operation, and make the arrangements for any additional treatment or next steps.

For further information about the operation for cancer and what to expect, you can also refer
to Understanding Surgery: a guide for people with cancer, their families and friends.

QUESTIONS TO ASK YOUR DOCTOR

• What type of cancer do I have? Where is it located?

• What lifestyle changes (diet, exercise) do you recommend I make?

• What are the chances that the surgery will cure the cancer?

• What will happen if I decide not to have the surgery?

• How much will the operation cost? Will my health insurance cover it?

• What are the possible side effects of treatment? How can they be prevented or
controlled?

• When will I get the pathology results?

• What follow-up tests will I need after the operation?

• Am I suitable for any clinical trials?

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You may want to write specific questions here to ask your doctor or cancer care team

About Head and Neck Cancer Australia

Head and Neck Cancer Australia (formerly Beyond Five) is Australia’s only charity dedicated to providing
information and support to people living with head and neck cancer, caregivers, family and healthcare
professionals.

Head and Neck Cancer Australia's mission is to improve the quality of life of everyone affected by head and
neck cancer through education and access to support and to raise awareness of head and neck cancer
nationally.

Head and Neck Cancer Australia supports people through their cancer journey, from diagnosis to treatment
and life after cancer by providing comprehensive, easy to understand and easy to access information. We have
the only Directory of Head and Neck Cancer services and support groups available in Australia and New Zealand
helping people to find the right services and support when they need it most.

Phone: 1300 424 848

Email: contact@headandneckcancer.org.au
Web: www.headandneckcancer.org.au

Head and Neck Cancer Australia Disclaimer: You acknowledge and accept that the information in this factsheet is for
general information purposes only. It is not intended, nor should it be relied on, as medical or legal advice, or as a substitute
for consultation with a physician or other licensed healthcare provider. You agree that if you have individual healthcare-
related questions you should contact your doctor promptly and should not disregard professional medical advice, or delay
seeking it, because of information contained here. You also agree that Head and Neck Cancer Australia is not liable for any
injury or damage to persons or property (howsoever caused, including by negligence) arising out of or related to any use of
Head and Neck Cancer Australia’s patient education materials, or for any errors or omissions.

First Published: 2016

Last updated: November 2020

© 2020 Head and Neck Cancer Australia 16