After laryngeal cancer surgery

After a big operation, you wake up in the intensive care unit or a high dependency recovery unit. You usually move back to the ward within a day or so.

In intensive care you have one to one nursing care. In the high dependency unit you have very close nursing care. Your surgeon and anaesthetist also keep an eye on your progress.

These units are busy and often noisy places that some people find strange and disorienting. You'll feel drowsy because of the anaesthetic and painkillers.

When you first wake up, you will have a little clip on your finger to measure your pulse and blood oxygen levels. This is called a pulse oximeter. You may also have an oxygen mask on for a while. Your nurse will measure your blood pressure regularly.

Tubes and drains 

When you wake up you might have:

• a drip (intravenous infusion) into your arm to give you fluids until you are eating and drinking again
• a breathing tube in your neck 
• a fine tube into your stomach (gastrostomy tube) or into your stomach via your nose (nasogastric tube) for liquid feeds 
• wound drains in your neck 
• a tube into your bladder (catheter) to collect and measure urine 

Speaking 

You will not be able to talk after surgery to your voicebox (larynx). Your doctors and nurses will be very aware of this, and you will have a bell to call for help whenever you need it. Your nurse will also give you a pen and paper for you to write down anything you want to say. 

Breathing tubes

During surgery to remove part or all of your larynx, your surgeon might make a hole in your neck. This is called a stoma.

It might be temporary if you have only part of your larynx removed.  If you have your whole larynx removed you will breathe through your stoma from now on. 

If you have a stoma you might find it difficult to cough, sniff, laugh or kiss. 

Feeding tubes

You might have a tube straight into your stomach for liquid feeds until you are eating and drinking again. This is called a gastrostomy tube. 

A tube into your stomach via your nose is called a nasogastric tube. It helps to stop you from feeling sick. Later it will be used as a feeding tube. 

The nasogastric tube might go up your nose, down your throat and into your stomach. Or it may go into your breathing stoma, through a small hole at the back of your windpipe (trachea) and into your food pipe (oesophagus). The tube helps to keep the hole in your neck open so that you can have a speaking valve fitted later on. 

Wound drains

Wound drains stop blood and fluid collecting around the operation site. This helps wound healing and helps to prevent infection. 

When there is no more fluid draining the drains can be removed. This is usually after a few days. 

Painkillers

It’s normal to have pain for the first week or so. Your doctor and nurses give you painkillers.  

Tell your doctor or nurse as soon as you feel any pain. They need your help to find the right type and dose of painkiller for you. Painkillers work best when you take them regularly.

Immediately after surgery, you might have painkillers through a drip into the bloodstream that you control. This is called patient controlled analgesia (PCA). 

You get painkillers to take home. Follow the instructions your nurse gives you about how often and when to take them. Contact your doctor if you still have pain or if it gets worse.

After a few days

Moving around 

Your physiotherapist will help you to get up after your surgery. They will encourage you to sit in a chair the day after your operation. They will help you with your drips and tubes. During the first few days after surgery your tubes will be removed. This will make moving much easier. 

Your wound 

Your wound might be covered with a dressing for a few days. Some surgeons use a clear protective spray instead of dressings. 

Your stitches or clips might need to stay in for up to 10 days. 

Eating and drinking 

You might not be able to eat or drink for about 7 to 10 days. This gives your throat time to heal and prevents infection. 

Speech and language therapists play an important role during your treatment. They will help you eat and drink safely after surgery to your voice box.

A dietitian will decide about the amount of liquid feed you need until you are eating and drinking normally. 

About 7 to 10 days after surgery you have tests to check that your stoma has healed. You might have a type of x-ray called a barium swallow. Or you might drink a coloured liquid. Your doctor checks that none of this liquid leaks into your windpipe (trachea). If there are no leaks, you can start to drink normally. 

Gradually you can start to eat a soft diet, such as soup or jelly. Your dietitian will monitor this and gradually cut down your liquid feeds. 

After a laryngectomy, you will not be able to strain to open your bowels. It is very important to avoid becoming constipated. Drink lots of fluid and eat plenty of fibre. 

Speaking, smelling and tasting

Removing your voicebox (larynx) might affect your:

• sense of smell 
• sense of taste 
• speech 

Your speech and language therapist 

Speech and language therapists play an important role in helping you with communication, speech and using your voice. They will start supporting you before treatment. This continues during and after treatment. They will help you to use your voice and how to speak after surgery to remove your voice box. They can also help in making decisions about a voice prosthesis and how to use it.

If you have all of your voicebox removed (total laryngectomy), air will not pass through your nose when you breathe in. This means you will not smell anything, and it affects your taste. Your speech and language therapist can teach you how to take air in through your nose. This improves your sense of taste. 

Follow up appointments

You’ll have follow up appointments to check your recovery and sort out any problems. They‘re also your opportunity to raise any concerns you have about your progress.

Coping

If you have your whole larynx removed, it can be difficult to come to terms with learning to speak in a different way and breathing through a stoma. You need to give yourself time to adjust to these major changes.

It might be helpful to talk to someone close to you about how you feel.