Laryngectomy (Voice Box Surgery)

Introduction

Surgeons surgically resect a laryngeal tissue (segmental or total) in an evolving surgical maneuver of the extremities known as laryngectomy (speech apparatus surgery). Conventionally, it has been a treatment modality for evolutionarily late-stage malignant head and neck cancers, a serious injury, or laryngeal box disorder. However, interferences resulting from speech and breath have led advancements in medical technology to a degree of modernization that is not limited to patients’ recovery and compensation/rehabilitation.

What is Laryngectomy?

Laryngectomy is the surgical extirpation of a portion or the whole of the larynx (tissue of the voice box). The laryngeal structure comprises the vocal folds and their function is sound production, airway closure during deglutition and respiration.

Laryngectomy patients inhale through a neck incision, a stoma and an aperture surgically made. Surgery can range from partial (preserving some voice function) or total (complete larynx area removal) procedures according to the degree of morbidity.

Why is Laryngectomy Needed?

Voice Box is primarily performed for the following reasons:

1. Throat Cancer: Refractory or unresectable/non-resplendent laryngeal cancer/radiation and chemotherapy-resistant laryngeal cancer.
2. Severe Trauma: Neck injuries causing irrevocably destruction of the larynx.
3. Chronic Conditions: Conditions, including recurrent laryngeal stenosis or airway obstruction, severity.
4.  Radiation Damage: When prior cancer treatments severely damage the larynx.

Types of Laryngectomy

1. Partial Laryngectomy:

• Removes part of the larynx.
• Preserves voice function.

2. Total Laryngectomy:

• The entire larynx is removed.
• Breathing is through a stoma.

3. Supraglottic Laryngectomy:

• Removes the upper part of the larynx.
• Therapists may require the patient for swallowing therapy, but they preserve the voice.

Procedure Steps

1. Preoperative Preparation:

• Physical examination, imaging, and airway evaluation.
• Counseling on the impact on speech and breathing.

2. Anesthesia:

• General anesthesia is administered.

3. Surgical Procedure:

• The incision in the neck.
• Partial or complete removal of the larynx.
• Creation of a stoma for breathing.

4. Postoperative Care:

• Wound closure and drainage tube placement.
• Intensive monitoring in recovery.

Benefits of Laryngectomy

1. Life-saving treatment for advanced cancer.
2. Relief from chronic airway obstruction.
3. Higher quality of life for patients with severe laryngeal injury.

Laryngectomy Cost

The cost of Voice Box varies globally.

• India: The median price is estimated as $4,000-$6,500.
• USA: Costs range from $20,000 to $30,000.
• UK: Costs average around £15,000-$20,000.

Cost Comparison in Different Countries

Best Hospitals in India for Laryngectomy

• Max Super Specialty Hospital, Saket, offers advanced surgical facilities.
• Medanta The Medicity, Gurgaon—specialization in cancer ENT, nose and throat (ENT).
• Fortis Escorts, Delhi, is equipped with modern laryngeal surgery tools.

Risks and Complications

1. Risk of infection or wound complications.
2. Difficulty adapting to stoma breathing.
3. Impaired swallowing or speech.
4. Rare complications like fistula formation.

Recovery 

• Hospital Stay: Typically 7–10 days.
• Speech Therapy: For patients adapting to new voice options.
• Stoma Care: Learning proper cleaning and maintenance.
• Lifestyle Changes: Adapting to breathing through a stoma.