A laryngectomy is the removal of all or part of the larynx and is typically performed as treatment for laryngeal cancer. A laryngectomy is occasionally performed as a last resort for the individual with chronic aspiration, unable to protect the airway either from a prior cancer treatment or complications from other conditions.
In a total laryngectomy the entire larynx is removed (including the vocal folds, hyoid bone, epiglottis, thyroid and cricoid cartilage and a few tracheal cartilage rings). The airway is separated from the nose, mouth and esophagus. The trachea is brought forward below the level of the larynx and is sutured to the base of the neck just above the sternal notch, creating a permanent opening in the neck called a stoma. Therefore, the individual does not breathe through the upper airway. Instead, breathing occurs through the stoma. A total laryngectomy is typically performed when the disease cannot be managed with more conservative measures.
Since the mouth and nose are bypassed, special care must be taken to humidify the airway. In the hospital this humidification will be provided with a cool or warm aerosol and a trach mask. Later on, the patient may prefer to use a heat moisture exchange (HME) device.
Since the stoma is the only passageway for breathing, it is important to maintain the airway and suction the trachea through the stoma as needed, using a sterile technique. It is also important to clean the stoma, as crusting of secretions may develop that can block or occlude the stoma. It is important to teach the patient, family and/or caregivers how to care for the stoma properly, and what to do in case of an emergency.
Please see the National Tracheostomy Safety Project Algorithm for Emergency Laryngectomy Management.