What are the complications after total laryngectomy for laryngeal cancer

The occurrence of various complications is mainly related to the patient's physical condition and individual differences. It is also related to the size of the operation, whether radiotherapy is used, the experience of the surgeon, and the quality of the facilities. The incidence rate ranges from 10% to 30%. The following are some common complications.

1. Infection: There are neck wound infections and throat infections. Patients who receive preoperative radiotherapy, anemia, and diabetes are more likely to have this disease. The treatment for infection is to perform incision and drainage, and remove necrotic tissue and foreign matter. Generally, after a period of dressing changes, the infected wound will heal on its own.

2. Wound skin necrosis: Wound skin necrosis may manifest as blackening of the skin at the intersection of the incision, which is caused by the following reasons: 1) Excessive tension on the wound edge; 2) Improper incision design, resulting in insufficient distal blood supply; 3) Rough surgical operation; 4) High-dose radiotherapy; 5) Other factors such as hematoma, infection, etc.

3. Pharyngeal fistula is the most serious complication in laryngeal surgery, because it causes the most serious physiological damage. Patients cannot eat orally and have to rely on nasogastric tube feeding for a long time. Saliva and secretions can easily flow down into the trachea, causing pneumonia. Pharyngeal fistula can also cause the large blood vessels in the neck to be exposed and not heal, resulting in rupture of the common carotid artery and the risk of death from massive bleeding.

4. Tracheostomy stenosis occurs after total or near-total laryngectomy, mainly because the tracheal mucosa and the neck skin are not tightly anastomosed during the fistula, or the tension at the anastomosis is too high, causing scar growth; postoperative annular scar contraction is related to the individual's scar constitution;

5. Laryngeal stenosis occurs in patients who have undergone partial laryngectomy. The causes are: 1) Early laryngeal stenosis is due to the formation of granulation tissue on the glottic wound surface. It will naturally subside after a few months; 2) Long-term laryngeal stenosis. Most patients have a history of radiotherapy and laryngeal infection, which causes cartilage necrosis and mucosal defects, resulting in laryngeal web formation, laryngeal scarring or lack of sufficient laryngeal cartilage support.

6. Choking while eating: After laryngeal cartilage resection, superior laryngeal nerve resection or damage, poor vocal cord closure, etc., food may accidentally enter the trachea and cause choking, and in severe cases, it may lead to aspiration pneumonia.