Head and neck surgery in oncologic patients: Laryngectomy and radial neck dissection

Laryngeal cancer is the second most common form of head and neck cancer. The main objective of a laryngectomy is to achieve a cancer cure; however, maintaining good speech and swallow functions is very critical to the patient's quality of life. While laryngeal preservation is preferred, at times the best oncological and functional outcome might involve removing the entire larynx. Depending on the extent of involvement, a total or partial laryngectomy might be performed. Sometimes if there is regional metastasis to the surrounding lymph node, a radical neck dissection can be performed as well. Although there has been a steady decline in laryngeal cancers related to alcohol and tobacco abuse, the increase in human papillomavirus infection has caused a steady increase in the United States and other western countries. Radical neck dissection is indicated when there is an involvement of the sternocleidomastoid muscle, internal jugular vein, or spinal accessory nerve and cervical lymph nodes. The perioperative care of patients undergoing either a partial/total laryngectomy or a radical neck dissection requires adequate planning and knowledge of each step of the perioperative phase.