Can a Patient Have a Total Laryngectomy and a Tracheostomy Tube at the Same Time?
No, a patient with a total laryngectomy does not have a tracheostomy tube in the traditional sense—they have a permanent stoma (laryngectomy stoma) that connects directly to the trachea, and while tubes may be temporarily placed in this stoma, patients with laryngectomies usually do not have a tracheostomy tube in situ long-term. 1
Understanding the Anatomical Distinction
The key difference lies in the anatomy created by each procedure:
Total laryngectomy removes the entire larynx, creating a permanent separation between the upper airway (nose/mouth) and the lower airway (trachea). The trachea is brought to the skin surface as a permanent stoma (laryngectomy stoma). 1
Tracheostomy creates an opening into the trachea while the larynx remains intact, maintaining continuity between the upper and lower airways. 1
After total laryngectomy, the patient does not have an upper airway in continuity with the lungs, which fundamentally distinguishes them from tracheostomy patients. 1
Perioperative and Short-Term Tube Use
While patients don't typically have permanent tracheostomy tubes after laryngectomy, temporary tubes may be used:
Immediate Perioperative Period
Laryngectomy tubes (not tracheostomy tubes) can be safely placed immediately after total laryngectomy and used in the perioperative period. 2
A case series of 72 patients demonstrated that soft silicone laryngectomy tubes combined with heat and moisture exchange (HME) devices can be employed safely, with zero stoma-related complications including stenosis. 2
Mean hospital length of stay was 8.4 days, and no patients experienced stomal stenosis when laryngectomy tubes with HME were used perioperatively. 2
Devices Typically Present
Instead of tracheostomy tubes, laryngectomy patients may have:
- Stoma buttons for maintaining stoma patency 1
- Buchannon bibs for protection 1
- Tracheo-oesophageal puncture (TEP) valves for speech restoration—these devices should not be removed during emergencies 1
Clinical Implications for Emergency Management
This distinction has critical emergency management implications:
For Laryngectomy Patients (Red Algorithm)
- Apply oxygen directly to the stoma, not the face, as the upper airway is not connected to the lungs 1
- Laryngectomy patients will not obstruct their airway when lying flat and aspiration of gastric contents is not a concern 1
- Ventilation can be achieved using pediatric facemasks or laryngeal mask airways applied to the anterior neck 1
For Tracheostomy Patients (Green Algorithm)
- Apply oxygen to both the face and the tracheostomy stoma when in doubt, as the upper airway may still be patent 1
- The upper airway remains potentially patent and may be used for ventilation 1
Important Clinical Pitfall
The most critical error is confusing a laryngectomy stoma with a tracheostomy. 1
- There are approximately ten times as many surgical tracheostomies as laryngectomies performed in England 1
- When percutaneous tracheostomies are included, the likelihood that an airway stoma is a laryngectomy is between 1 in 20 and 1 in 30 1
- The default emergency action is to apply oxygen to both the face and stoma for all neck breathers when there is any doubt, as a tracheostomy patient is more likely to come to harm by not having oxygen applied to the face 1
Long-Term Management
Patients requiring permanent tubes after laryngectomy represent a management failure or complication:
- Severe tracheostomal stenosis after total laryngectomy may require permanent tube use, which represents a significant personal and social handicap 3
- This situation is considered abnormal and typically requires surgical revision 3, 4
- Proper surgical technique during laryngectomy, including specific tracheostome construction methods, can reduce stenosis incidence from 31% to near zero 4