Laryngectomy is a surgical procedure involving the removal of part or all of the laryngeal structures, primarily used to treat laryngeal cancer, severe laryngeal trauma, or certain congenital diseases. This operation results in a permanent tracheostomy in the neck, allowing patients to communicate via an artificial voice or sign language. The goal of the surgery is to eradicate the cancerous lesion while maintaining respiratory function, making it a key approach in head and neck tumor treatment.
Based on the extent of resection, it can be classified into total laryngectomy and supraglottic laryngectomy. Total laryngectomy involves removing the entire larynx and vocal cords, necessitating permanent tracheostomy for breathing. Supraglottic laryngectomy preserves some vocal cord function, allowing limited speech recovery in some patients. The surgical mechanisms include: 1) excising diseased tissue to prevent cancer spread, 2) establishing a tracheostomy for breathing, 3) repairing surrounding tissues to preserve swallowing function.
Main indications include: 1) advanced laryngeal cancer unresponsive to chemotherapy, 2) severe laryngeal trauma causing airway obstruction, 3) recurrent infections or benign tumors compressing the airway. Rare cases such as congenital laryngeal hypoplasia in infants may also be suitable. The extent of disease must be confirmed via imaging and biopsy, and the suitability assessed by an ENT specialist.
This treatment is performed under general anesthesia as an open surgery, with a duration of approximately 4-8 hours. Postoperatively, patients require speech therapy to adapt to the artificial voice. There are no medication dosage issues, but strict adherence to postoperative care instructions is necessary, including tracheostomy site cleaning frequency and respiratory muscle rehabilitation plans.
The main benefits include: 1) complete removal of malignant tumors to prolong survival, 2) prevention of cancer metastasis to lymph nodes, 3) maintaining airway patency. Long-term benefits include improved quality of life, reduced need for secondary surgeries, and improved swallowing function. Some patients can regain basic communication through electronic artificial larynx devices.
Preoperative considerations include: 1) cardiopulmonary function should be ASA class II or below, 2) hemoglobin levels should be maintained above 10 g/dL. Contraindications include: uncontrolled diabetes mellitus (blood glucose >250 mg/dL), coagulation times exceeding 1.5 times normal, and active, untreated respiratory infections.
When combined with chemotherapy, surgery should be delayed until two weeks after the last chemotherapy dose. For concurrent radiotherapy, the degree of radiation-induced fibrosis should be evaluated beforehand. Special attention should be paid to anticoagulant use; it is recommended to stop aspirin-like medications 7 days prior to surgery.
According to the 2020 Head and Neck Surgery Yearbook statistics, patients with locally advanced laryngeal cancer undergoing total laryngectomy have a 5-year local control rate of 85%, an improvement of 30% over conservative treatments. Post-voice rehabilitation, 75% of patients can resume daily conversation. However, complete recovery of swallowing function occurs in only 60%, requiring long-term training with speech therapists.
Alternative options include: 1) laryngeal-preserving surgeries (partial vocal cord removal), 2) combined chemotherapy and high-dose radiotherapy, 3) tracheostomy with conservative management. The choice depends on tumor staging, overall patient health, and speech function needs, requiring multidisciplinary team assessment.
Preoperative assessments include head and neck imaging (such as CT or MRI) to evaluate tumor extent, and speech therapy evaluations for swallowing and speech functions. Patients should also undergo simulated tracheostomy care training to learn postoperative breathing and cleaning techniques, along with psychological counseling to alleviate preoperative anxiety.
What special care is needed for daily maintenance of the tracheostomy after surgery?Daily cleaning of the skin around the stoma with normal saline, replacing the anti-reflux pads around the tracheostomy tube to prevent secretions from blocking the airway. Indoor humidity should be maintained above 50%. During cold weather, use specialized masks or humidifiers to reduce cold air stimulation. Immediate medical attention is required if breathing difficulties or redness/swelling around the stoma occur.
How can swallowing function be improved after surgery?It is recommended to choose semi-solid or puree foods with appropriate viscosity, avoiding very hot, cold, or spicy foods. Maintain an upright position at 45 degrees during meals, and perform swallowing exercises afterward to strengthen laryngeal muscles. If frequent choking occurs, short-term nasogastric feeding may be necessary, with personalized dietary plans devised by a therapist.
What methods are available for speech recovery after surgery?Patients can use electronic speech devices or esophageal speech training to restore communication. Esophageal speech involves practicing phonation after swallowing air, initially guided by a speech therapist for rhythm and volume control. Some patients may opt to preserve the vocal cords or implant voice prostheses during surgery, with professional rehabilitation to improve speech clarity.
What long-term impacts on quality of life may occur after surgery, and how can they be managed?The tracheostomy may affect olfaction and temperature regulation, so avoiding dusty or dirty environments is advised. Psychological impacts such as identity crises may occur; joining patient support groups is recommended. Regular follow-up every six months to monitor head and neck recovery, along with ongoing physiotherapy, can help maintain physical function and social participation.
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