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Lesson

Laryngectomy vs Tracheostomy

10 min Airway & Breathing Skip to quiz

Objective: Tell a laryngectomy stoma from a tracheostomy, and put oxygen on the opening that actually reaches the lungs.

Why this matters

These two neck openings look similar, and they are not the same airway. A tracheostomy is a tube into the trachea. The mouth and nose may still connect to the lungs. A total laryngectomy removes that connection. The neck stoma is the only way in.

Bagging the face of a laryngectomy patient moves no air into the lungs. Covering a tracheostomy and forgetting the upper airway can do the same thing if the mouth is the path that is still open.

Key points
  • For a laryngectomy, oxygen and ventilation go on the neck. The mouth is not a rescue airway.
  • For a tracheostomy, the stoma is the usual path, and an upper airway may still exist.
  • If you are not sure, put oxygen on the neck and on the mouth until the history or a medical-alert card tells you which one you have.
Verbalize
  • I do not know yet if this is a laryngectomy. I am oxygenating the neck and the mouth.
  • This is a laryngectomy. I am not intubating the mouth.
  • I am putting a waveform on the opening that is actually moving the chest.
Tracheostomy compared with total laryngectomy A tracheostomy enters the trachea below a larynx that is still there, so the mouth may still reach the lungs. A total laryngectomy separates the mouth from the airway. The neck stoma is the only way to the lungs. Tracheostomy: larynx is still there mouth larynx stoma food path Blue: mouth can still reach the lungs. Teal: the usual path is the neck tube. The tube enters below the larynx. Laryngectomy: mouth is separated mouth no larynx only airway Tan: mouth connects to the esophagus only. Blue starts at the neck opening. Bagging the face moves no lung air. If you are not sure which operation it was, put oxygen on the neck and the mouth. A speaking valve can block the stoma. Take a blocking cap off in distress. A speech puncture is not the airway. Confirm with chest rise and a waveform.
A tracheostomy leaves the larynx in place, so the mouth may still reach the lungs. The neck tube enters below the larynx. A total laryngectomy separates the mouth from the airway. The mouth then leads only to the esophagus, and the neck stoma is the only way to the lungs. If you are not sure which operation it was, put oxygen on the neck and on the mouth. A speaking valve or a cap can block the stoma. A speech puncture is for voice, not for ventilation. Confirm with chest rise and a waveform.

Clinical sequence

  1. Look for a medical-alert bracelet, a card, or a caregiver who can say laryngectomy or tracheostomy.
  2. Open the neck. A cap or a speaking valve can block exhalation until you know the cuff status and which airway this is. If the patient is in distress or in arrest, remove a humidification mask, cap, or speaking valve that is blocking the opening.
  3. Suction the stoma the way you were trained. Do not force a tube you were not trained to place.
  4. Apply oxygen to the stoma. If the patient might still have an upper airway, oxygenate the mouth as well until you are sure.
  5. Confirm ventilation with chest rise and waveform capnography. A silent chest and a flat waveform means you are on the wrong opening, or the tube is obstructed.

Teaching points

  • National Tracheostomy Safety Project algorithms separate the two emergencies on purpose. The laryngectomy pathway does not include mouth-to-trachea ventilation.
  • Do not use an oral airway or a nasal airway as the plan for a known total laryngectomy. Those devices sit in an airway that no longer reaches the lungs.
  • Pair this with tracheostomy emergencies and home ventilator failure when a circuit is attached.

Common errors

  • Intubating the mouth of a laryngectomy patient while the stoma is left open to room air.
  • Sealing a tracheostomy stoma and then failing to ventilate the mouth when the tracheostomy tube is out and the upper airway is the remaining path.
  • Leaving a cap or speaking valve on during an arrest.

Practice

One-minute check

You find a neck opening and no one can say which operation it was. Say where the oxygen goes in the first minute, and what would make you stop trying the mouth.

Sources & Further Study

Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.

Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.

Check Your Understanding

Questions drawn only from this lesson. After you check, the key is highlighted. Education practice — not a certification exam.

1. A total laryngectomy means:
2. If you cannot tell a laryngectomy from a tracheostomy in a patient who is not breathing, you should:
3. A tracheostomy, unlike a total laryngectomy, usually:
4. A speaking valve or cap found on the neck should make you:
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