A laryngectomy is the surgical removal of the larynx, the organ in your throat that houses your vocal cords, protects your airway when you swallow, and connects your nose and mouth to your lungs. The surgery is most commonly performed to treat advanced laryngeal cancer, and it fundamentally changes how a person breathes, speaks, and eats. Depending on the extent of the disease, surgeons may remove all or part of the larynx.
Why a Laryngectomy Is Performed
The most common reason for a laryngectomy is laryngeal cancer that hasn’t responded to radiation or chemotherapy, or cancer that’s too advanced for those treatments to work. It’s the standard surgical approach for stage T4 laryngeal cancers and some stage T3 cancers where the larynx is no longer functioning properly. It may also be performed as a first-line treatment when the tumor has invaded the cartilage of the larynx or spread into surrounding soft tissue.
Less commonly, a laryngectomy is performed for severe throat trauma that can’t be reconstructed, chronic aspiration (when food or liquid repeatedly enters the lungs due to nerve damage), or rare conditions like recurrent laryngeal papillomatosis that threatens to spread into the trachea. Certain tumor types that don’t respond well to radiation, including sarcomas and melanomas of the larynx, may also require surgical removal.
Total vs. Partial Laryngectomy
A total laryngectomy removes the entire larynx. This is the more extensive procedure and results in a permanent opening in the neck called a stoma, which becomes the person’s only airway. The connection between the throat and the windpipe is permanently separated, meaning air no longer passes through the nose or mouth.
A partial laryngectomy removes only the diseased portion of the larynx while preserving as much healthy tissue as possible. There are several types. Vertical partial laryngectomy cuts through the thyroid cartilage vertically, while horizontal partial laryngectomy takes a horizontal approach and comes in three main variants based on how much tissue is removed. The least extensive type removes structures above the vocal cords while keeping them intact. More extensive types remove the vocal cords and surrounding structures but preserve key cartilage that allows the remaining anatomy to function.
Patients who undergo partial laryngectomy generally report better quality of life than those who have a total laryngectomy. They typically retain lung-powered speech and the ability to swallow without a permanent stoma. However, partial procedures are only an option when the cancer is caught early enough and is in the right location.
How the Surgery Changes Your Anatomy
During a total laryngectomy, the surgeon separates the windpipe (trachea) from the esophagus, which is the tube that carries food to your stomach. The lower end of the trachea is brought forward and stitched to the skin of the neck, creating the stoma. From that point on, you breathe entirely through this opening rather than through your nose or mouth.
This separation has several cascading effects. Because air no longer flows through your nasal passages, your sense of smell is significantly diminished or lost entirely. Scent molecules simply don’t reach the olfactory receptors high in the nose anymore. And since much of what people call “taste” actually depends on smell, food flavor perception is also reduced.
Swallowing After Surgery
Although the esophagus remains intact, swallowing changes significantly after a total laryngectomy. The reconstructed throat (called the neopharynx) is narrower than normal and generates less pressure to push food through. One study found that the throat opening in laryngectomy patients measured roughly 7 millimeters across, compared to about 11 millimeters in people who hadn’t had the surgery.
Long-term swallowing problems affect roughly 72% of patients. Common complaints include food feeling stuck in the throat, needing extra swallows to get food down, tightness, regurgitation, and meals taking much longer than they used to. Most people can eventually eat by mouth, but nearly all need to adapt their food choices. Soft, bite-sized, or minced foods are typical starting points, and many people use sips of liquid to wash food down. Swallowing exercises can meaningfully improve these outcomes over a period of weeks, and the improvements tend to hold even after the exercise program ends.
Learning to Speak Again
Losing the larynx means losing your natural voice, but there are three established ways to produce speech after surgery.
- Tracheoesophageal puncture (TEP) is considered the gold standard. A small valve is placed between the windpipe and the esophagus. When you cover your stoma and exhale, air is redirected through the valve into the throat, vibrating the tissue to create sound. TEP produces the most natural-sounding speech with the best pitch, volume, and clarity.
- Electrolarynx is a handheld device you press against your neck or cheek. It produces vibrations that you shape into words with your mouth. It doesn’t sound natural, but it’s easy to learn and allows communication quickly after surgery.
- Esophageal speech involves swallowing air and then releasing it in a controlled belch to vibrate the throat. It requires no devices and costs nothing, but it’s the hardest method to master. Only about 24 to 26% of people who attempt it achieve usable speech quality.
Living With a Stoma
After a total laryngectomy, the stoma requires daily care for the rest of your life. In the morning and evening, you’ll use a flashlight and mirror to check for mucus buildup and crusting inside the opening. The skin around the stoma gets washed with mild soap and water. If mucus collects inside, coughing it out, using saline spray, or inhaling steam from hot water can help loosen it.
Humidification becomes a constant consideration. Normally, your nose warms, filters, and moistens the air you breathe. With a stoma, dry air goes straight into your lungs. Saline spray every two to three hours keeps the airway moist and reduces crusting. A humidifier in the bedroom is especially helpful since the stoma tends to dry out overnight.
Covering the stoma when you’re outdoors protects against dust, insects, and cold or hot air. Gauze, cotton, or crocheted covers serve this purpose. You also cover it when coughing or sneezing, since mucus is expelled from the stoma rather than the nose or mouth.
Complications and Recovery
Most people stay in the hospital for 10 to 14 days after a total laryngectomy. Soreness, tightness, and muscle aches around the incision site can persist for six months or longer.
The most common surgical complication is a pharyngocutaneous fistula, an abnormal channel that forms between the inside of the throat and the skin of the neck, allowing saliva to leak through the wound. This occurs in roughly 21% of patients undergoing their first laryngectomy and about 33% of those having a salvage procedure (surgery after radiation or chemo has failed). It happens when the surgical repair of the throat lining doesn’t heal properly. Most fistulas are diagnosed when saliva appears in the wound and are confirmed with a dye swallowing test.
Survival Rates for Laryngeal Cancer
The overall five-year relative survival rate for laryngeal cancer is 62.1%, based on data from the National Cancer Institute. Survival varies considerably by how far the cancer has spread at the time of diagnosis. When the cancer is still confined to the larynx, the five-year survival rate is 79.3%. If it has spread to nearby lymph nodes, that drops to 49%. For cancer that has metastasized to distant parts of the body, the rate is 35.2%. About half of all laryngeal cancers are diagnosed while still localized, which is the most favorable scenario.