Laryngectomy and Neck Dissection

Laryngectomy

Laryngectomy is a surgery in which the larynx or voice box is removed. A laryngecotmy is performed most often for laryngeal cancer, but may be performed for individuals who suffer from chronic aspiration. A cut is made on the skin and larynx is removed, the throat is opened and recreated, and the trachea is attached to the skin to create a permanent stoma.

After total laryngectomy a patient permanently breathes through the neck stoma and not through the mouth or nose.

Total laryngectomy removes the voice box, meaning an individual must rely on artificial means of speech. Despite removal of the voice box, patients are able to phonate or make sound and have very understandable speech.

During a total laryngectomy the surgeon removes the voice box, opening the neck to create a new throat. Patients are fed through a feeding tube temporarily while the new throat heals.

Voice rehabilitation after total laryngectomy.

1. Esophageal speech – Air is forced from the belly through the esophagus or eating tube. This causes the throat tissues to vibrate similar to vocal fold vibrating. This sound is transmitted to the mouth and the tongue and lips forms this into words and sentences.
2. Electrolarynx A hand held external device is placed against the skin. This vibrates, similar to the vocal folds vibrating. This sound is transmitted through the skin, and formed by the mouth/tongue and formed into words and sentences.
3. Tracheoesophageal puncture – A valve is placed to allow air pushed from the lungs into the throat for sound production.

Neck Dissection

A neck dissection is a surgery performed to remove neck lymph nodes in the treatment of head and neck cancer.

Head and neck cancer typically originates in a site within the aerodigestive tract, or regions of the throat including tongue, tonsil, pharynx, and larynx including the vocal folds.

Head and neck cancer spreads from its origin through the lymph nodes of the neck.

In a neck dissection the lymph nodes and other non-vital structures of the neck are moved to treat disease.

A neck dissection is performed under general anesthesia. A broad incision is made on the neck skin.

In a radical neck dissection, the sternocleidomastoid muscle, internal jugular vein and spinal accessory nerve is removed along with the lymph nodes of the neck. This procedure was first reported in the early 1900s.

In a modified radical neck dissection the sternocleidomastoid muscle, internal jugular vein and spinal accessory nerve are kept intact and preserved. This modification improves a patient’s function and form compared to a radical neck dissection.

Patients are admitted to the hospital after surgery with a drain in place. Patients typically do well after surgery and recover within a week after surgery.