Larynx Surgeries

What Is Larynx Surgery?

Larynx surgery is a surgical procedure that is done on for the management of disorders or diseases affecting the larynx or the voice box. Most larynx surgeries are done for the management of laryngeal cancer, while some other minor conditions may also benefit from larynx surgery.

Is this procedure an elective or an emergency procedure?

Larynx surgery is generally done as an elective procedure.

Types of larynx surgery

Larynx surgery may be of the following types

• Open surgeries of the larynx
  • Laryngectomy: Larynx removal or removal of the voice box
    • Total Laryngectomy: Mostly done for cancer of the larynx
    • Partial Laryngectomy: Usually for the preservation of function of speech
      • Supracricoid Partial Laryngectomy
        • Cricohyoidoepiglottopexy (CHEP)
        • Cricohyoidopexy (CHP)
      • Vertical Partial Laryngectomy
    • Laryngeal Reconstruction Surgery
  • Minimally Invasive Surgeries:
    • Laser Endoscopic Cricopharyngeal Myotomy: When there is a laryngeal cause associated with difficulty in swallowing
    • Laryngeal Framework Surgery: For the management of vocal cord paralysis or laryngeal stenosis
    • Laser Laryngeal Microsurgery: Is used for the management of both noncancerous and cancerous tumors of the vocal cords, as well as vocal cord polyps and nodules

Indications for larynx surgery

Some indications for larynx throat surgery may include the following

• Cancers of the larynx
• Noncancerous tumors of the larynx
• Vocal cord polyps, nodules, cysts, and paralysis
• Laryngeal stenosis
• Recurrent Respiratory Papillomatosis

Larynx surgery contraindications and risk factors

Some contraindications for throat surgery include the following

• Presence of distant metastasis or spread of the cancer
• The poor general health of the individual resulting in a high anesthetic risk
• Severe cardiovascular disease
• Tumors that are very close to the internal carotid artery

Investigations before larynx surgery

Some investigations that are done before a throat surgery may include the following

• Laboratory tests:
  • CBP & ESR
  • Liver and Renal Function tests
  • Coagulation profile and blood typing
  • Basic metabolic panel
• Imaging tests:
  • Chest X-Ray
  • Laryngoscopy
  • Echocardiogram
• Electrocardiography (ECG)
• Complete ENT Evaluation
• Evaluation by a speech pathologist

Preoperative advice

Before a larynx surgery, the following is advised

• Risks and benefits of the procedure are explained
• Nothing by mouth after midnight on the night before surgery
• Anticoagulant medication may be stopped 1 week before surgery
• Antibiotic prophylaxis may be started a few days before the surgery

Intraoperative details

Duration: Depending on the type of procedure, throat surgery may last between 1-4 hours or more.

Anesthesia: Larynx surgeries are usually done under general anesthesia, other than minor procedures that may be done under local anesthesia.

Description of the procedure:

Open Larynx Surgery:

With the individual lying down, IV lines and foley’s catheter in place, and after the anesthetic has taken effect, a skin incision is made in the neck, the muscles and deep tissue are separated, and care is taken to keep important blood vessels out of the way. The hyoid bone and the thyroid cartilage are identified and separated. A tracheostomy is done to allow for entry of air into the lungs after the larynx (which is the connection between the mouth and the lungs) is removed. Depending on the procedure either a part or whole of the larynx is removed. In a partial laryngectomy, at least one vocal cord is retained, while in a total laryngectomy the larynx, a part of the pharynx, and if regional lymph nodes are affected due to cancer they are removed too.

Minimally Invasive Laser or Endoscopic Larynx Surgery:

Instead of an open neck incision the procedure is carried out via the use of an endoscope. If laser larynx microsurgery is being done the removal of the tumor tissue and the larynx is done using a laser. The endoscope is introduced into the throat via the mouth.

Laryngeal Framework Surgery:

This is a type of phono surgery in which the cartilages of the voice box are modified to achieve proper vocal fold tension for optimal sound production. In a Laryngeal framework surgery, the thyroid, arytenoid, or the cricoid cartilage may be modified to improve the position and function of the vocal folds. This is usually done under conscious sedation.

Laryngeal Reconstruction Surgery:

Mostly done as a laryngotracheal reconstruction surgery in which both the larynx and the trachea are reconstructed. Laryngeal reconstruction surgery may be done as a single-stage reconstruction or a double stage reconstruction. In a single-stage laryngeal reconstruction surgery, a tracheostomy can be avoided.

Laryngeal Reinnervation Surgery:

Laryngeal reinnervation surgery is done to restore the nerve connections of the larynx which are responsible for the movement of the vocal cords. In a laryngeal reinnervation surgery, the dysfunctional recurrent laryngeal nerve (which is the main nerve controlling the larynx) is attached to another nerve called the ansa cervicalis which helps to improve the transmission of nerve signals to the vocal cords.

Laryngeal Cleft Repair Surgery:

This is a minimally invasive surgery done with an endoscope. In a laryngeal cleft repair surgery, the cleft which is an abnormal connection between the voice box and the food pipe(esophagus) is closed. Laryngeal cleft surgery is indicated in children who do not respond to conservative therapy via injections to close the cleft.

Postoperative details

After throat surgery, the following may be done

• For major surgeries under general anesthesia
  • The individual is moved to a recovery room and kept under observation until awake and stable
  • Cardiovascular function is monitored
  • Feeding is done via a nasogastric tube
  • Drains are placed in the neck to remove fluids that can accumulate at the surgical site
  • Deep breathing and coughing are encouraged to clear the lungs
  • Humidified air is breathed in through the stoma
  • Care is taken to keep the stoma(opening in the throat after a tracheostomy through which the individual breathes after larynx surgery) clean
  • The individual is shifted to a regular room after 5-7 days in the ICU
• For minor larynx surgeries
  • The individual is placed in an ICU overnight and monitored

Discharge: For minor larynx surgery procedures the discharge is usually on the 2^nd or 3^rd postoperative day. For major larynx surgery procedures, discharge is usually after 10-14 days.

Medication: Pain relievers and antibiotics are usually prescribed.

Review: Regular reviews are done over the next 6 months to 1 year with the first review being 5-7 days after discharge.

Resumption of normal activities: Usually with restrictions 6-8 weeks after the major larynx surgery procedures. The resumption of normal activities is usually earlier for minor larynx surgery procedures.

Role of diet/exercise/lifestyle changes

Some measures that are needed after throat surgery include

• Proper care of the stoma
• Consultations with a speech therapist to re-learn to speak after the surgery; based on the procedure and the condition of the individual, speech, and vocalization may be of the following types
  • Oesophageal Speech
  • Tracheoesophageal speech
  • Device modulated speech 

Complications of larynx surgery

Some complications that may be seen after larynx surgeries may include the following

• Bleeding and hematoma formation
• Infections
• Infection of the lungs
• Fistula formation
• Damage to the teeth: during endoscopic procedures
• Laser burn injuries
• Reduced quality of life
• Psychological stress, anxiety, depression 

Prognosis

The prognosis of larynx surgeries depends on the type of procedure and the condition that is being treated. Early-stage cancers and other noncancerous conditions treated with larynx cancer surgery have a good prognosis. Late-stage cancers have a poor prognosis and are associated with both high morbidity and mortality.

Indications for hospitalization if required

Hospitalization will be required for some larynx surgeries while some larynx surgeries may be done as office or daycare procedures.

Suggested clinical specialist/Department to consult for the procedure

Larynx Surgeries are done by specialists from the Department of Otorhinolaryngology (ENT).