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Hemilaryngectomy

HemilaryngectomyYour voice box (larynx) has two bands of muscle that form the vocal cords. The front of the voice box is made of cartilage and is sometimes called the Adam’s apple.

A hemilaryngectomy (HEM-ee-lair-un-JECT-uh-me) is a surgery in which either the right or left half (hemi) of your voice box is removed.

Before Your Surgery

Before your surgery, your doctor may ask that you have tests done. These tests may include blood work, x-rays, or an (EKG) electrocardiogram. The tests you will need depend on your age and medical history. Not all patients have the same tests. Your doctor’s staff will tell you if this testing will be done in the doctor’s office or in the hospital.

Avoid taking aspirin or ibuprofen for 7 to 10 days before surgery. A staff member will call you before your surgery. He or she will tell you what time to arrive at the hospital, where to park, and where to report.

Do not eat or drink anything after midnight the night before your surgery.

Day of Surgery

You may brush your teeth in the morning, but do not swallow any liquid. You may be told to take certain medicines in the morning, but do so only with the smallest amount of water. When you arrive at the hospital, you will put on a patient gown. An IV (intravenous) needle will be inserted into a vein in your arm. You will receive fluids through your IV during and after your surgery.

After your surgery, you will be moved to the recovery room. Your family will be told when your surgery is over. You will spend 1 to 2 hours there, depending on how quickly you wake up from the anesthesia. When you are awake, you will be moved to your room on the Head and Neck Surgery Unit.

When you are in your room, you may be connected to a machine that monitors your heart (cardiac monitor). A pulse oximeter, a small device that looks like a clothespin, will be placed on your finger, toe, or ear lobe to measure the amount of oxygen in your blood.

You will have a temporary tube in your throat called a trach (TRAKE) tube, which you will breathe through. Trach is short for tracheostomy, which means a hole in your windpipe. Since you have had general anesthesia, it will be important for you to do coughing and deep breathing exercises. Your nurse and a respiratory technician will show you how to do these exercises. Coughing and deep breathing will help keep your lungs clear after surgery.

Mucus production is normal, and you can expect to cough up mucus through your trach. It is normal for the mucus to have blood in it. Your nurse and respiratory tech also will be removing mucus from your trach. You will have a hand-held suction device to remove saliva from your mouth and mucus from around your trach. A misting oxygen mask over your trach will make it easier to breathe by producing moisture, which helps thin your mucus.

An IV will provide fluids until you are ready to start tube feedings. You may have a tube in your nose called an NG tube (nasogastric tube). At first the NG tube will empty your stomach to prevent vomiting. Later it will be used to provide your nutrition. You may have a catheter in your bladder to remove urine. There also may be drains in your neck. These will remove fluid from your incision and allow you to heal.

You will not get out of bed the day of surgery. The head of your bed will be raised to help decrease swelling and help you breathe. Sleeves called SCDs will be placed on your legs to help your circulation and to prevent blood clots from forming. The sleeves fill with air, giving your legs a little squeeze, and then deflate. You may not have anything to eat or drink, but you will be given sponges to wipe your mouth.

You will have some pain and discomfort. Your nurse can give you medicine prescribed by your doctor if the pain is severe. Pain medicine is not automatically given, so be sure to tell your nurse if you are beginning to feel any pain. Since you cannot talk, a pen and paper will be given to you so you can communicate. If you cannot write in English, a picture board will be provided.

The staff can answer any questions that you or your family may have. A social worker is available if you or your family have questions about insurance or the need for post-hospital care, such as rehab or a skilled nursing facility. The primary care nurse also is available to help with discharge planning and to help arrange home health care.

First Day After Surgery

Your nurse will help you bathe today. If you have a heart (cardiac) monitor, it may be taken off. You will still have an IV. The NG tube will no longer empty your stomach, but will be clamped and remain in place. You may be begin tube feedings today. The catheter in your bladder will be taken out. Your nurse will help you get out of bed today and you may go for a short walk.

Second Day After Surgery

If the heart monitor was not removed yesterday, it will be removed today. You will still remain on the pulse oximeter. You will continue to bathe at the bedside with help. You probably will be fed through the NG tube for 5 to 7 days. A dietitian will review your chart and speak with you to determine your nutritional needs while healing. The IV fluid may be removed, but the IV catheter will remain in place. The neck drains and your trach tube also will remain. You may still wear your oxygen mask, but you can take it off so you can go for a walk.

Third Day After Surgery

You will be encouraged to walk and sit in a chair as much as possible. Tube feedings and trach care will continue.

Fourth Day After Surgery Until Discharge

You may have blood drawn 3 times a week. When the swelling has gone down enough that you can breathe through your mouth, the doctors will remove your trach tube. The doctors will deflate the balloon, or cuff, around the bottom of your trach to see if you can swallow your saliva without coughing. If you are able to do this, the cuff will remain deflated, and the doctors may order a speaking valve to use with your trach.

The next day, the doctors will change your trach to a smaller size without a cuff. This allows more air to enter your lungs so that you can breathe normally. This procedure is done at the bedside and takes about one minute. At this point you should be able to cover the opening of the trach with your finger and speak. Your voice may sound wispy or harsh at first, but with practice your voice should sound almost like it did before surgery.

The next step is to place a cap on your trach. This is done by removing the open inner cannula and replacing it with a solid one. This will let you breathe through your mouth. If you have a hard time breathing, the nurse will take the cap off. If the nurse is not available, someone else will show you how to take it off yourself. The cap will remain in place for 24 hours.

If you have tolerated having your trach capped, the doctors will take out the entire trach the next day. A dressing will be placed over the opening where the trach was. This dressing will be changed several times a day. You may help the opening close faster by putting your fingers over the dressing when talking, coughing, or swallowing. The speech therapist will help you return to normal speech. Once this has been done, the NG tube will be removed.

Try to be patient with your body while it is healing. If you are interested, ask your nurse about obtaining a movie or books.

Your nurse will help you learn to change the dressing over your trach site. He or she will teach
you about your diet and how to care for your incision. Home health care will be set up before you leave the hospital. Before you go home, your nurse will give you written instructions and make a follow-up appointment with your doctor.

If you or your family members have questions during your hospital stay, be sure to ask your nurse.

After Discharge

The doctor will give you a prescription for pain medicine that is to be taken as needed. You should examine your incision daily. Call your doctor if you have any of the following:

  • An increase in redness, swelling, bleeding, or foul-smelling drainage from your incision
  • A temperature of 101 F (38.3 C) or higher for longer than 24 hours
  • Pain that is not relieved by your pain medicine
  • Difficulty swallowing or trouble breathing
  • Trouble eating

Follow-up appointments should be made with your doctor and a speech therapist if needed. The home health nurse will come to your home to check on your progress.

 

Revised July 2011

 

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