Total laryngectomy with neck dissection

What is it?

Total Laryngectomy is a surgery done as a part of management of cancer of the voice box. This surgery involves the complete removal of the voice box and reconstruction of the food pipe. After surgery, patient would not be able to talk. 

What is the aim of the procedure?

The aim of the procedure is to remove the tumour tissue with adequate margins. This includes the voice box and the neck nodes which might be involved.

What is done during the procedure?

During this procedure the voice box in its entirety is removed with adequate margins after separating it from the food pipe and wind pipe. The remaining food pipe is sutured and closed. The remaining wind pipe is brought out through the neck as a permanent end tracheostomy. A neck dissection for the removal of the neck nodes may be additionally performed based on the nodal status.

What are the risks associated with the procedure?

• Bleeding from the operative site can occur. This may lead to a hematoma formation. Both of these require re-exploration for management.

• Tissue fluid can get accumulated under the skin flaps.

• Infection of the surgical site.

• Weaking of the closure site leading to an abnormal communication and leakage of saliva in the neck. This requires intensive management for promoting closure.

• Stenosis of the stoma site.

• Pharyngo-oesophageal stenosis.

• Hypothyroidism which may require thyroid supplements.

Post-operative care and follow-up:

In the immediate post-operative period ICU monitoring is required. Once hemodynamically stable the patient will be shifted to the ward. Daily dressing will be performed. Removal of the drains placed in the neck will be done once the drain volume is adequately low. Daily tracheostomy stoma care will be performed. Suture removal will be performed on the 10th postoperative day.

Oral feed will be gradually started on the 7th to 14th day after surgery, if there are no complications. A feeding gastrostomy or a jejunostomy will be needed if oral feeds are to be avoided. Rehabilitation for speech and swallowing will be required post-operatively.