Different types of laryngectomy and what the difference with each othe

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Laryngectomy: main types and how they differ

A laryngectomy removes part or all of the larynx, also called the voice box. It is most often performed for laryngeal cancer, but can occasionally be needed for severe non-cancer damage or a non-functioning larynx.

The key distinction is:

Partial laryngectomy: some larynx remains, so natural breathing through the upper airway and some voice can usually be preserved.
Total laryngectomy: the entire larynx is removed, permanently separating the airway from the mouth and nose. Breathing is through a permanent neck opening called a stoma.

Normal anatomy and the change after total laryngectomy

Before total laryngectomy: airway passes from nose and mouth through larynx into trachea

After total laryngectomy: trachea ends in a permanent neck stoma

These illustrations are from the American Cancer Society surgery guide.

Type	What is removed	Typical use	Breathing after surgery	Voice after surgery	Main functional issue
Endoscopic cordectomy / transoral laser resection	A small lesion and part or all of one vocal cord, through the mouth	Small, early glottic tumors	Normal route, no permanent stoma	Often preserved but hoarse, depending on amount of cord removed	Voice quality
Vertical partial laryngectomy / hemilaryngectomy	One vertical side of the larynx, often including one vocal cord and adjacent thyroid cartilage	Selected early glottic cancers	Usually normal after healing. A temporary tracheostomy may be used	Usually retained, but breathy or rough	Voice impairment; temporary swallowing issues
Supraglottic laryngectomy	Structures above the true vocal cords, such as the epiglottis, false cords, and upper thyroid cartilage	Selected supraglottic cancers	Usually normal after recovery. Temporary tracheostomy may be needed	True vocal cords remain, so speech is generally retained	Aspiration risk, especially early after surgery
Supracricoid partial laryngectomy (SCPL) with CHEP or CHP reconstruction	Most of the larynx, including thyroid cartilage and vocal cords, while retaining the cricoid and at least one functioning arytenoid	Selected intermediate glottic, transglottic, or supraglottic cancers, including some recurrences after radiation	Usually no permanent stoma if rehabilitation succeeds	A new, low-pitched and rough but usable voice may develop	Major swallowing and rehabilitation demands; aspiration risk
Near-total laryngectomy	Almost all larynx, with a small segment retained to create a voice shunt	Rarely used, selected cases	Usually an airway stoma, depending on technique	Can permit pulmonary-powered speech in selected patients	Less commonly performed today
Total laryngectomy (TL)	The entire larynx, including vocal cords	Advanced tumor, extensive cartilage involvement, nonfunctional larynx, or salvage after chemoradiotherapy failure	Permanent tracheal stoma. Air no longer travels through mouth or nose to the lungs	Natural laryngeal voice is lost	Permanent airway change and voice rehabilitation
Total laryngopharyngectomy	Total laryngectomy plus part or all of the pharynx	Cancer extending into the hypopharynx or pharyngoesophageal region	Permanent stoma	Requires voice rehabilitation	Swallowing tract often needs flap or jejunal reconstruction

The partial laryngectomy subtypes

1. Cordectomy

The smallest form of laryngeal resection. The surgeon removes cancer from one vocal cord, commonly using a laser through the mouth. It is often grouped with partial laryngeal surgery but may not require an open neck incision.

Best suited to selected early vocal-cord cancers.
Breathing remains normal.
The dominant long-term effect is hoarseness, ranging from mild to severe.

2. Vertical partial laryngectomy or hemilaryngectomy

This removes tissue in a vertical plane, commonly one vocal cord, part of the opposite cord if necessary, and a section of thyroid cartilage.

Vertical partial laryngectomy planning illustration

Used mainly for selected glottic tumors.
It preserves a functioning portion of the larynx.
The remaining structures are reconstructed to provide an airway and a vibrating sound source.
Speech remains possible, but the voice is usually hoarse or weak.
A temporary tracheostomy and feeding tube may be needed during early healing.

3. Supraglottic laryngectomy

This removes the larynx above the true vocal cords. It may include the epiglottis, false vocal folds, and pre-epiglottic tissues while leaving the true vocal cords in place.

Used for selected cancers of the supraglottis.
Because the vocal cords are retained, speaking is usually possible.
The greatest concern is swallowing safety: the epiglottis and supraglottic structures normally protect the airway during swallowing, so aspiration and aspiration pneumonia can occur during recovery.
Good tongue-base movement, sensation, pulmonary reserve, and rehabilitation are important for candidacy. Cummings notes that impaired cord movement or tumor extension below the false cord argues against this operation. Cummings Otolaryngology Head and Neck Surgery, p. 2086.

4. Supracricoid partial laryngectomy

This is a more extensive organ-preserving operation. Much of the larynx is removed but the cricoid cartilage and one or both arytenoids are retained. The remaining larynx is reconstructed by joining it to the hyoid bone, with or without the epiglottis:

CHEP: cricohyoidoepiglottopexy, retaining the epiglottis.
CHP: cricohyoidopexy, without retaining the epiglottis.

It can treat selected tumors that are too extensive for a simpler supraglottic or vertical partial procedure, while avoiding total laryngectomy. It requires intensive swallowing and voice rehabilitation. Cummings Otolaryngology Head and Neck Surgery, p. 2089.

Total laryngectomy: the major differences

In a total laryngectomy, the voice box is completely removed and the trachea is brought forward to the skin of the lower neck.

What permanently changes

Breathing: through the neck stoma, not the nose or mouth.
Voice: vocal cords are gone, so normal voice is not possible.
Airflow and swallowing are separated: unlike a tracheostomy, food and drink cannot enter the lungs through the larynx because the larynx is no longer connected to the airway.
Smell and taste: may be reduced because air no longer passes normally through the nose.
Air conditioning: inhaled air is less naturally warmed, humidified, and filtered. A heat-moisture exchanger is often used.

Voice rehabilitation after total laryngectomy

Speech can still be regained using:

Tracheoesophageal puncture (TEP) with a voice prosthesis: commonly provides the most natural-sounding option.
Electrolarynx: handheld vibrating device.
Esophageal speech: air is learned to be injected into and released from the esophagus to create sound.

The American Cancer Society explanation notes that swallowing can often remain possible after uncomplicated total laryngectomy because the pharynx-esophagus connection is usually retained. This differs from laryngopharyngectomy, where reconstruction may be required.

Important terminology: laryngectomy versus tracheostomy

These are not the same procedure.

Tracheostomy: an opening into the trachea, often temporary. The larynx remains in place.
Total laryngectomy: removes the larynx and creates a permanent stoma. The airway and food passage become permanently separate.

In one line

Cordectomy: remove part of a cord.
Hemilaryngectomy / vertical partial: remove one side of the voice box.
Supraglottic laryngectomy: remove the upper voice box, leave true cords.
Supracricoid partial: remove most of the voice box but reconstruct from preserved cricoid/arytenoid structures.
Total laryngectomy: remove the entire voice box, permanent neck breathing, alternative speech method required.
Laryngopharyngectomy: total laryngectomy plus removal of part or all of the throat.

For selected early or intermediate tumors, partial procedures aim to preserve speech, swallowing, and normal upper-airway breathing. They are only appropriate when the tumor’s location and extent, arytenoid mobility, cartilage involvement, lung function, and swallowing reserve make safe preservation realistic. Recent systematic reviews on salvage procedures and outcomes do not change these definitions, but reinforce that the choice is highly individualized, particularly after prior radiation or chemoradiotherapy (PMID 40968204).

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