Reconstruction for Laryngeal Cancer

Reconstruction is frequently unnecessary in people with early laryngeal cancer, but it can be an important part of care in people with advanced tumors.

Reconstructive surgery can be performed in people who have had only a part of the larynx removed during minimally invasive or open surgery. Doctors also perform this surgery to repair the structure of the larynx when it is not necessary to replace the voice box.

Voice restoration techniques help people who have had a laryngectomy, meaning the entire larynx has been removed.

Reconstruction may be performed during surgery to remove tumors, after laryngeal cancer treatments including radiation therapy or chemotherapy, and during recovery. General anesthesia is required.

During flap reconstruction, small areas of soft tissue that have been removed from the larynx are replaced with healthy tissue. The replacement tissue, called a flap, is attached to its own blood supply, which helps it heal. Flap tissue may come from areas near the larynx, such as the neck or chest, or from a more distant part of the body, such as the arm.

For example, a muscle from the forearm may be surgically removed, along with its blood vessel supply, to replace a missing portion of the larynx. The flap’s blood vessels are then carefully attached to vessels at the site of repair to restore blood flow.

Moving nearby tissue to repair the larynx can be done using an endoscopic approach, meaning surgeons use an endoscope—a thin, lighted tube with a video camera at the tip or an operating microscope—to highlight the anatomy of the area.

Occasionally, laryngeal cancer surgery may cause vocal cord paralysis, in which one or both vocal cords cannot open or close properly because of nerve damage or removal of tissue. Often, speech and swallowing rehabilitation can help to compensate for impaired voice or swallowing function caused by vocal cord paralysis.

If therapy is not effective, doctors can reposition the vocal cords to improve a person’s speaking, breathing, and swallowing. The approach to treatment depends on whether the paralysis is unilateral, meaning it affects just one of the vocal cords, or bilateral, meaning it affects both.

To treat unilateral vocal cord paralysis, doctors may inject a substance into the paralyzed vocal cord that gives it bulk and reduces the space between it and the healthy vocal cord. Reducing this space can improve vocal cord function. Injections can be performed with local anesthesia or general anesthesia.

Surgeons may also consider giving the paralyzed vocal cord a new nerve supply. They can remove a nearby nerve from the neck, where its function isn’t noticeable, and use it to restore the motion necessary for proper speech and swallowing. This procedure requires general anesthesia.

Bilateral vocal cord paralysis may cause difficulty breathing because both vocal cords cannot open all the way. This type of paralysis may require a temporary tracheostomy, the surgical creation of a hole in the trachea, or windpipe, to help a person breathe.

Doctors then use laser surgery to separate the paralyzed vocal cords and open the airway, while preserving as much of the voice as possible. Once the airway is restored, the hole created with a tracheostomy can be repaired.

Vocal cord separation and a tracheostomy require general anesthesia.

Recovery from reconstructive surgery for laryngeal cancer varies.

Flap surgery generally requires only two or three days of recuperation in the hospital.

Injection for vocal cord paralysis is an outpatient procedure, meaning you can go home the same day.

Surgery for vocal cord paralysis may require an overnight hospital stay. During this time, doctors monitor your health and ensure you are healing properly.

After surgery, you may meet with NYU Langone speech and swallowing therapists.