Your 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.
During a supraglottic laryngectomy (sooprah-GLOT-tik lair-un-JECT-uh-me), a surgeon removes the top part of your voice box (larynx), near your vocal cords.
You should 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.
You will be moved to the recovery room after your surgery. 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 clothes pin, 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 (TRAKE-e-os-toe-me) 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 will also 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. It will be used later 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 worn on your legs to help your blood circulate and 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, pen and paper will be given to you so you can communicate. A picture board will be provided if you cannot write in English.
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 set up home health care.
When the swelling has gone down enough so you can breathe through your mouth, the doctors will start taking out the trach tube. They 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 next day the doctors will change your trach to a smaller one without a cuff. This procedure is done at the bedside and takes about a minute.
At this point you should be able to place your finger over your trach and speak. The doctors also may order a speaking valve. This will allow you to breathe air in through your trach and leave your hands free.
The next step will be to change the open inner cannula for one that is solid. This is called capping your trach. You should be able to breathe and speak comfortably. A nurse can remove the cap if you have trouble breathing. The nurse can show you how to remove the cap yourself. Once you have been able to tolerate having your trach capped for 24 hours, the doctors will remove the trach. 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.
A speech therapist will work with you to help you learn the supraglottic swallowing technique. A barium swallow also may be done to study your swallowing. You will be started on a pureed diet after the trach is removed, and when the doctor and speech therapist feel you are ready. The foods you eat will have to be blended or pureed for easier swallowing. Thin liquids go down too quickly and may end up in the “wrong pipe.” When you are able to tolerate this diet, the NG tube will be removed.
You should feel better every day. You may have some days, however, when you do not feel well at all. Try to be patient with your body. It is healing and needs time. If you are interested, ask your nurse about getting a movie or books.
Your nurse will help you learn to change the dressing over your trach. 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 have any questions during your stay, be sure to speak with your nurse.
The doctor will give you a prescription for pain medicine that is to be taken when needed. You should examine your incision daily. Call your doctor if you have any of the following:
Follow-up appointments should be made with your doctor and the speech therapist. The home health nurse will come to your house to check on your progress.