Total Laryngectomy

A laryngectomy (lair-un-JECT-uh-me) will change your body in 2 ways. First, your larynx or voice box will be removed. Because of this, you will need to learn a new way to speak.

Second, your nose and mouth will be permanently separated from your windpipe (trachea) and lungs. You will now be breathing through a new opening in your neck called a stoma (STOH-ma). You will also have a red rubber tube (catheter) in your stoma. This tube will be at the site of your before and after surgeryspeech prosthesis.

These diagrams illustrate what your body is like before and after surgery.

Before your surgery

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

What to expect after surgery

You will be moved to the recovery room after your surgery. Your family will be told when your surgery is over. 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). You also will be placed on a pulse oximeter, a small device that looks like a clothes pin, which monitors the 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.

Coughing and breathing after surgery

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 also will 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.

Aftercare

An IV will provide fluids until you are ready to start tube feedings. You may have a tube in your nose called an NG (nasogastric tube). At first, the NG tube will empty your stomach to prevent vomiting. It will be used later to provide your nutrition. You also will have a red rubber catheter under your trach. This keeps the site of your speaking prosthesis open until the speech therapist inserts your prothesis on your follow-up visit. You may have a catheter in your bladder to remove urine. You also may have drains in your neck. These will remove fluid from your incision and allow you to heal.

You will not get out of bed on 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 circulation and to 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. If you need pain medicine before your nurse asks you, please ask her for it. 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 questions that you or your family may have. A social worker is available if you or your family have questionsabout insurance or the need for care (such as rehab or a skilled nursing facility) after you leave the hospital. 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 are on 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 for you to be fed through tomorrow. The catheter in your bladder will be taken out. You should still try to cough and clean out your trach tube as needed. Your nurse will help you get out of bed today. 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 still 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 stopped, but the IV catheter will remain in place. You will still wear your oxygen mask, but can take it off so you may 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, shoulder, 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 in the halls and to sit in a chair as much as possible. Walking helps to keep you from getting pneumonia and helps your blood circulate.

Fourth day after surgery

It is important to increase your activity. You should be getting out of bed and frequently walking in the halls. A speech therapist will visit you and show you different speech devices. These can help you communicate until you receive your permanent prosthesis. The nurse will discuss home care supplies that will be needed.

Fifth day after surgery

You will have blood work done 3 times a week while you are in the hospital. You should be walking, doing your exercises, and sitting in a chair as much as possible.

Your trach tube will be changed to a laryngectomy tube today. This is a simple and painless procedure that only takes a few minutes. This tube is the one that will go home with you. You will be shown a laryngectomy video and given laryngectomy information. You will then begin to learn about laryngectomy care. A family member also should learn about your care, in case of an emergency or for any reason you cannot care for yourself.

Sixth day after surgery

You will begin to take care of your laryngectomy under the supervision of your nurse.

You should feel better every day. You may have some days, however, when you do not feel well. Try to be patient with your body, it needs time to heal. If you are interested, ask your nurse about movies and books to help pass the time.

Seventh day after surgery

The NG tube will be removed. You may be allowed to have a liquid diet by mouth. It is very important that you and a family member learn about taking care of your condition at home. You should buy a bedside humidifier to use at home. You should be doing your own laryngectomy care with little help from the nurse.

Eighth day after surgery

You may have a soft diet if your doctor feels you are ready. You should know how to put your red rubber catheter back in if it accidentally moves or falls out. It is important to put the the catheter back in as soon as possible to keep the opening from closing.

Your nurse will give you written instructions before you go home. The nurse will give you a spare laryngectomy tube and help you make follow-up appointments with your doctor and speech therapist. Home health care will be arranged. Equipment that you will need at home — such as a suction machine, suction catheters, trach care kits, normal saline bullets, and Velcro trach ties — will be available. The nurse will come to visit you when you leave the hospital. 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 to be taken when needed. You should examine your incision daily. Tell the 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 higher for more than 24 hours
  • Pain that is not relieved by your pain medication
  • Difficulty swallowing

Go to the nearest emergency room if you have:

  • Difficulty breathing even after you have done your laryngectomy care
  • Difficulty replacing your red rubber catheter

You should do your neck exercises daily.

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