LarynxSupraglottic Laryngectomy

Your voice box (larynx) has two bands of muscle that form the vocal cords. The front of the voice box is made of cartilage and is sometimes called the Adam’s apple.

During a supraglottic laryngectomy (sooprah-GLOT-tik lair-un-JECT-uh-me), a surgeon removes the top part of your voice box (larynx), near your vocal cords.

Before surgery

Your doctor may ask you to have tests done before surgery. These tests may include blood work, x-rays, or an EKG (electrocardiogram). The tests you need depend on your age and medical history. Not all patients have the same tests. Your doctor’s staff will tell you if your tests will be done in the doctor’s office or in the hospital.

 

You should avoid taking aspirin or ibuprofen for 7 to 10 days before surgery.

A staff member will call you before your surgery. He or she will tell you what time to arrive at the hospital, where to park, and where to report.

Do not eat or drink anything after midnight the night before your surgery.

Day of surgery

You may brush your teeth in the morning, but do not swallow any liquid. You may be told to take certain medicines in the morning, but do so only with the smallest amount of water. You will put on a patient gown when you arrive at the hospital. An IV (intravenous) needle will be inserted into a vein in your arm. You will receive fluids through your IV during and after your surgery.

 

You will be moved to the recovery room after your surgery. You will spend 1 to 2 hours there, depending on how quickly you wake up from the anesthesia. When you are awake, you will be moved to your room on the Head and Neck Surgery Unit.

When you are in your room, you may be connected to a machine that monitors your heart (cardiac monitor). A pulse oximeter, a small device that looks like a clothes pin, will be placed on your finger, toe, or ear lobe to measure the amount of oxygen in your blood.

You will have a temporary tube in your throat called a trach (TRAKE) tube, which you will breathe through. Trach is short for tracheostomy (TRAKE-e-os-toe-me) which means a hole in your windpipe. Since you have had general anesthesia, it will be important for you to do coughing and deep breathing exercises. Your nurse and a respiratory technician will show you how to do these exercises. Coughing and deep breathing will help keep your lungs clear after surgery.

Mucus production is normal, and you can expect to cough up mucus through your trach. It is normal for the mucus to have blood in it. Your nurse and respiratory tech will also be removing mucus from your trach. You will have a hand-held suction device to remove saliva from your mouth and mucus from around your trach. A misting oxygen mask over your trach will make it easier to breathe by producing moisture, which helps thin your mucus.

An IV will provide fluids until you are ready to start tube feedings. You may have a tube in your nose called an NG tube (nasogastric tube). At first the NG tube will empty your stomach to prevent vomiting. It will be used later to provide your nutrition. You may have a catheter in your bladder to remove urine. There also may be drains in your neck. These will remove fluid from your incision and allow you to heal.

You will not get out of bed the day of surgery. The head of your bed will be raised to help decrease swelling and help you breathe. Sleeves called SCDs will be worn on your legs to help your blood circulate and prevent blood clots from forming. The sleeves fill with air, giving your legs a little squeeze, and then deflate. You may not have anything to eat or drink, but you will be given sponges to wipe your mouth.

You will have some pain and discomfort. Your nurse can give you medicine prescribed by your doctor if the pain is severe. Pain medicine is not automatically given, so be sure to tell your nurse if you are beginning to feel any pain. Since you cannot talk, pen and paper will be given to you so you can communicate. A picture board will be provided if you cannot write in English.

The staff can answer any questions that you or your family may have. A social worker is available if you or your family have questions about insurance or the need for post-hospital care, such as rehab or a skilled nursing facility. The primary care nurse also is available to help with discharge planning and to help set up home health care.

First day after surgery

Your nurse will help you bathe today. If you have a heart (cardiac) monitor, it may be taken off. You will still have an IV. The NG tube will no longer empty your stomach, but will be clamped and remain in place so that you may be fed through it tomorrow. The catheter in your bladder will be taken out. You should still try to cough and to clean out your trach tube as needed. Your nurse will help you get out of bed today and you may go for a short walk.

Second day after surgery 

If the heart monitor was not removed yesterday, it will be removed today. You will remain on the pulse oximeter. You will continue to bathe at the bedside with help. You probably will be fed through the NG tube for 5 to 7 days. A dietitian will review your chart and speak with you about your nutritional needs while healing. The IV fluid may be removed, but the IV catheter will remain in place. You will still wear your oxygen mask, but you can take it off so you can go for a walk.

Third day after surgery

Neck drains may be removed, depending on the amount of drainage in the past 24 hours. After the drains are taken out, a physical therapist will come to your room to show you exercises that will help you move your arms, shoulders, and neck. It is very important that you do these exercises the prescribed number of times during the day. You will be encouraged to walk and to sit up in a chair as much as possible.

Fourth day after surgery

It is important to increase your activity. You should be getting out of bed and walking frequently.

Fifth day after surgery until discharge

You may have blood drawn 3 times a week while you are in the hospital. NG feedings and trach care will continue. You will be encouraged to walk, do your neck exercises, and sit in a chair as much as possible.

 

When the swelling has gone down enough so you can breathe through your mouth, the doctors will start taking out the trach tube. They will deflate the balloon or cuff around the bottom of your trach to see if you can swallow your saliva without coughing. If you are able to do this, the next day the doctors will change your trach to a smaller one without a cuff. This procedure is done at the bedside and takes about a minute.

At this point you should be able to place your finger over your trach and speak. The doctors also may order a speaking valve. This will allow you to breathe air in through your trach and leave your hands free.

The next step will be to change the open inner cannula for one that is solid. This is called capping your trach. You should be able to breathe and speak comfortably. A nurse can remove the cap if you have trouble breathing. The nurse can show you how to remove the cap yourself. Once you have been able to tolerate having your trach capped for 24 hours, the doctors will remove the trach. A dressing will be placed over the opening where the trach was. This dressing will be changed several times a day. You may help the opening close faster by putting your fingers over the dressing when talking, coughing, or swallowing.

A speech therapist will work with you to help you learn the supraglottic swallowing technique. A barium swallow also may be done to study your swallowing. You will be started on a pureed diet after the trach is removed, and when the doctor and speech therapist feel you are ready. The foods you eat will have to be blended or pureed for easier swallowing. Thin liquids go down too quickly and may end up in the “wrong pipe.” When you are able to tolerate this diet, the NG tube will be removed.

You should feel better every day. You may have some days, however, when you do not feel well at all. Try to be patient with your body. It is healing and needs time. If you are interested, ask your nurse about getting a movie or books.

Your nurse will help you learn to change the dressing over your trach. He or she will teach you about your diet and how to care for your incision. Home health care will be set up before you leave the hospital. Before you go home, your nurse will give you written instructions and make a follow-up appointment with your doctor. If you or your family have any questions during your stay, be sure to speak with your nurse.

After discharge

The doctor will give you a prescription for pain medicine that is to be taken when needed. You should examine your incision daily. Call your doctor if you have any of the following:

  • An increase in redness, swelling, bleeding, or foul-smelling drainage from your incision
  • A temperature of 101 F (38.3 C) or more for longer than 24 hours
  • Pain that is not relieved by your pain medication
  • Difficulty swallowing
  • Shortness of breath or difficulty breathing

Follow-up appointments should be made with your doctor and the speech therapist. The home health nurse will come to your house to check on your progress.

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