Best Laryngectomy Surgery in Delhi, India

A laryngectomy is a surgical procedure that involves removing the larynx, commonly known as the voice box. The larynx plays an essential role in breathing, speaking, and swallowing, and its removal can be necessary when these functions are severely compromised. While the procedure requires significant adjustments to daily life, it is often the best option to improve overall health and well-being when other treatments are not effective.

Partial Laryngectomy

In this procedure, only a portion of the larynx is removed, allowing the patient to retain some natural voice and swallowing functions. Partial laryngectomy is typically performed when the condition is localised and does not require the complete removal of the voice box.

Total Laryngectomy

This involves the complete removal of the larynx and is often necessary for advanced conditions. After this procedure, the patient breathes through a stoma, a surgically created opening in the neck. Total laryngectomy is usually performed in cases of extensive disease or severe trauma to the larynx.

The type of laryngectomy is chosen based on the patient’s medical condition, the extent of the damage, and the goals of the treatment.

Throat Cancer

Laryngectomy is most commonly performed to treat cancers of the larynx or surrounding structures. It is often necessary in advanced stages of cancer when other treatments, such as radiation therapy or chemotherapy, are insufficient. The surgery helps remove cancerous tissues and prevents the disease from spreading to other parts of the body.

Severe Trauma or Injury

Major injuries to the larynx from accidents, burns, or physical trauma can cause irreparable damage to the voice box, making it impossible to speak, breathe, or swallow normally. In such cases, laryngectomy is performed to restore breathing and prevent further complications.

Chronic Infections or Inflammatory Conditions

Persistent infections, such as severe cases of laryngeal tuberculosis, or chronic inflammatory diseases like advanced laryngeal stenosis, may require laryngectomy if they significantly impair the larynx and do not respond to medication or less invasive treatments.

Airway Obstruction

Tumours, growths, or structural abnormalities within the larynx can block the airway, leading to breathing difficulties. Laryngectomy is performed in severe cases to bypass the blockage and ensure an open airway for proper respiration.

Degenerative Conditions

Rarely, degenerative disorders such as recurrent laryngeal papillomatosis or certain autoimmune conditions can damage the larynx beyond repair, making its removal the best option for improving quality of life.

Radiation-Induced Damage

In some instances, prior treatments for cancer, such as radiation therapy, can cause extensive damage to the larynx, leading to dysfunction or chronic pain. A laryngectomy may be recommended to alleviate symptoms and improve overall function.

Each condition requiring laryngectomy is evaluated on an individual basis, considering the severity of symptoms, the potential for alternative treatments, and the patient’s overall health. The goal is always to provide relief while ensuring the best possible outcome for the patient.

Medical Evaluations

Before undergoing a laryngectomy, patients undergo a series of medical evaluations to assess their overall health and confirm the need for surgery. These may include physical examinations, imaging tests such as CT or MRI scans, and biopsies to determine the extent and severity of the condition. 

Breathing and swallowing tests are also conducted to understand how the larynx is currently functioning. These evaluations help the surgical team plan the most effective approach for the procedure.

Pre-Surgery Preparation

Preparation for surgery includes detailed discussions with the medical team about the procedure, potential risks, and expected outcomes. Patients may have to consult with nutritionists if eating and swallowing is an issue to ensure they are in optimal health before the surgery. 

Those who smoke or consume alcohol are advised to stop, as these habits can interfere with healing. Specific instructions regarding medications, such as discontinuing blood thinners, are also provided.

Laryngectomy is performed under general anaesthesia to ensure the patient is unconscious and pain-free throughout the procedure. Once the anaesthesia takes effect, the surgeon begins by making an incision in the neck to access the larynx. 

For a partial laryngectomy, only the affected part of the larynx is removed, preserving as much of the voice box as possible. For a total laryngectomy, the entire larynx is removed, including the vocal cords, to eliminate the affected tissues fully.

In cases where a total laryngectomy is necessary, a stoma is created in the lower part of the neck. This opening serves as a permanent airway, allowing the patient to breathe. The surgeon carefully connects the windpipe (trachea) to the stoma and ensures proper alignment to facilitate respiration. In addition to removing the larynx, surrounding lymph nodes or tissues may also be removed if cancer has spread to nearby areas.

Once the surgical removal is complete, the incision is closed with sutures, and the area is carefully bandaged. A drainage tube may be placed temporarily to prevent fluid buildup. After surgery, the patient is moved to a recovery area where vital signs are closely monitored to ensure a stable and smooth transition from surgery to post-operative care.

Immediate Post-Surgery Care

After the procedure, patients are monitored in an intensive care unit or a specialised surgical ward. They may experience discomfort, which is managed with pain relief medications. A temporary feeding tube is often placed to provide nutrition while swallowing abilities are assessed and restored

Breathing Adjustments 

One of the most significant changes after a laryngectomy is breathing through a stoma in the neck. Patients receive detailed guidance on how to care for the stoma, including cleaning techniques and tips for preventing blockages or infections. Medical specialists offer training and support during this transition.

Rehabilitation

Speech rehabilitation begins soon after surgery, focusing on helping patients regain their ability to communicate. Options may include an electrolarynx, oesophageal speech, or a voice prosthesis, depending on the patient’s preferences and recovery progress. Speech therapists work closely with patients to ensure they adapt to these new methods effectively.

Like any major surgical procedure, laryngectomy carries potential risks and complications. While advancements in surgical techniques have improved safety, patients should be aware of possible challenges during and after the surgery.

Immediate Risks During Surgery

• Bleeding: Significant blood loss can occur during the procedure, requiring careful monitoring and, in rare cases, blood transfusions.
• Infection: The surgical site may become infected, though this is typically managed with antibiotics and proper wound care.
• Damage to Surrounding Structures: Nearby nerves, blood vessels, or tissues may be inadvertently affected during the procedure, leading to complications such as difficulty swallowing or changes in sensation around the neck.

Short-Term Post-Surgery Complications

• Breathing Difficulties: Issues may arise with the newly created stoma, such as blockages or irritation, which require immediate attention.
• Swallowing Problems: Temporary or permanent difficulties in swallowing may occur, particularly if other structures in the throat were affected during surgery.
• Wound Healing Issues: Slow or incomplete healing of the surgical site can lead to discomfort or the need for additional interventions.
• Blood Clots: The risk of clots forming in the legs or lungs increases with prolonged immobility after surgery.

Long-Term Complications

• Permanent Loss of Natural Speech: Patients undergoing a total laryngectomy lose their ability to speak naturally and require alternative communication methods such as an electrolarynx or voice prosthesis.
• Stoma-Related Issues: The stoma can develop complications, such as infections, excessive mucus production, or narrowing (stenosis), which may require medical intervention.
• Psychological Impact: Adapting to life changes, including altered breathing, speech, and physical appearance, can lead to emotional distress or depression. Support from counselling and support groups can be beneficial.
• Risk of Recurrence: In cases of cancer, there remains a possibility of recurrence, necessitating ongoing monitoring and follow-up care.

How long does it take to recover from a laryngectomy?

Recovery from a laryngectomy typically takes several weeks to a few months. Most patients stay in the hospital for 1–2 weeks after surgery. Complete healing, including adapting to breathing and communication changes, can take 6–12 weeks.

Will I be able to eat normally after a laryngectomy?

Many patients can return to eating normally over time. Initially, a feeding tube may be used to ensure proper nutrition while the throat heals. Swallowing therapy is often helpful in regaining the ability to eat solid foods.

Are there any dietary restrictions following the surgery?

In the early recovery phase, soft and easy-to-swallow foods are recommended. Spicy or acidic foods may irritate the throat and should be avoided. Over time, most people can resume a regular diet with guidance from a nutritionist.

How does a laryngectomy affect my sense of smell and taste?

A laryngectomy can reduce your ability to smell and taste because air no longer flows through the nose. However, there are techniques and therapies to help improve these senses, such as learning to "sniff" through the mouth.

What are some common challenges faced during rehabilitation?

Patients may face challenges such as adjusting to the stoma, learning to communicate using alternative methods, and dealing with emotional changes. Physical therapy, speech therapy, and counselling can address these difficulties effectively.

Is it safe to exercise or swim after a laryngectomy?

Light exercises like walking are encouraged, but swimming requires special care because water entering the stoma can cause serious complications. Special stoma covers are available for safer water activities.

What type of care does the stoma require?

The stoma needs daily cleaning to prevent blockages and infections. Humidifiers or stoma filters can help keep the airway moist, and protective covers shield it from dust and debris.

Can I travel after having a laryngectomy?

Yes, travel is possible with proper preparation. Carry stoma care supplies and ensure access to medical help if needed. If flying, inform airport security about the stoma and any medical devices you use.

Are there any assistive devices available for communication?

Yes, devices like electrolarynxes, voice prosthesis, and speech apps can help patients communicate. Speech therapists can guide patients in choosing the best option.

How do I manage mucus production after a laryngectomy?

Using a humidifier, staying hydrated, and cleaning the stoma regularly can reduce mucus buildup. Special filters or heat moisture exchangers (HMEs) are also helpful in managing this issue.

What should I do if I experience difficulty breathing through the stoma?

If breathing becomes difficult, check for mucus blockages or swelling. Clean the stoma gently, and use a suction device if needed. Seek medical attention immediately if the issue persists.

Can I return to work after a laryngectomy, and what adjustments might be needed?

Yes, many patients return to work after recovery. Adjustments such as using assistive devices for communication or modifying workspaces to accommodate the stoma may be necessary, depending on the job. Employers often support these changes.

Reviewed by Dr. Nitin Leekha, Director - Cancer Care / Oncology, Surgical Oncology, Gynecologic Oncology, Robotic Surgery, Breast Cancer, Head & Neck Oncology, Uro-Oncology, Thoracic Oncology on 21 Jan 2025.