[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Medical–surgical nursing](https://durgical.com/en/nursing/areas/med-surg/) › Caring for the patient with a laryngectomy: the stoma, humidification, communication and teaching

# Caring for the patient with a laryngectomy: the stoma, humidification, communication and teaching

- Safe practice

After a total laryngectomy the patient breathes only through the neck stoma; the nurse keeps it clear and humid, offers ways to talk and teaches self-care.

Updated Nov 13, 2026

## Key points

- After a total laryngectomy the patient cannot receive oxygen through the nose or mouth: give it over the stoma.
- Staff must identify the airway type: confusing a laryngectomy with a tracheostomy can lead to fatal airway mismanagement.
- A heat and moisture exchanger over the stoma filters and humidifies air and reduces crusting, mucus and cough.
- Water must not enter the stoma: teach safe showering with a stoma cover.
- Offer a means of communication from the first hours: the patient wakes unable to speak.
- Watch for fistula, wound infection, haematoma, leakage around a voice prosthesis and narrowing of the stoma.

## What it is

A total laryngectomy removes the voice box. Afterwards the person is a «neck breather»: the upper airway is separated from the trachea, so air, oxygen and any rescue breathing go through the stoma, never through the nose or mouth. Staff must know whether a patient has a laryngectomy or a tracheostomy, because confusing them can be fatal. Nursing care covers the stoma and secretions (with suctioning when needed, see its page), humidification of inspired air, nutrition by tube until swallowing is checked, early communication support, wound and drain care, watching for complications such as a fistula, and teaching before discharge. Speech can be relearned with a speech therapist, for example through a voice prosthesis.

## What it requires

- Stoma assessment: patency, secretions, crusting, skin, bleeding and swelling.
- Humidification of inspired air, usually with a heat and moisture exchanger, as the team prescribes.
- Suction equipment and a stoma-sized oxygen mask at the bedside.
- Communication aids (augmentative and alternative communication) from the start and speech therapy referral.
- Nutrition by tube until a swallow assessment allows eating by mouth.

## Components

- Airway: the stoma as the only route for breathing.
- Humidification and secretion clearance.
- Wound, drains and nutrition.
- Communication and body image.
- Self-care teaching and emergency planning.

## How it is applied (and why)

- Confirm and clearly record that the patient has a laryngectomy, as the protocol states: every responder must know to use the stoma.
- Assess the stoma and breathing every round: a blocked stoma means no airway at all.
- Keep inspired air humid with the prescribed device and clean crusts: dry air thickens mucus and blocks the stoma.
- Suction through the stoma only when needed and with hand hygiene (see airway suctioning): stoma care is an aerosol-generating task.
- Give oxygen, when ordered, with a mask over the stoma, never on the face alone: the nose and mouth no longer lead to the lungs.
- Give the patient a communication aid and a call bell within reach: the patient wakes from surgery unable to speak.
- Give tube feeds as ordered until the swallow test, and check the wound and drain: a leak may signal a fistula.
- Teach stoma cleaning, humidification, covering the stoma and keeping water out when showering, step by step with return demonstration.
- Talk about the change in appearance and voice and involve the family and the speech therapist (see body image).

## In nursing practice

- In an airway emergency mouth ventilation is useless: oxygen and ventilation go to the stoma and the rapid response team is called.
- Leakage around a voice prosthesis can lead to aspiration and breathing problems; coughing when drinking is reported.
- Neck swelling after surgery or infection can narrow the stoma.
- Heavy lifting and strenuous activity are avoided for about 6 weeks.

## Common mistakes

- Putting an oxygen mask over the face of a patient with a laryngectomy.
- Calling the stoma a tracheostomy at handover, so the next team does not know the anatomy.
- Letting the inspired air stay dry until the stoma crusts over.
- Leaving the patient without any way to call or communicate.

## Test yourself

Think of the answer, then tap the question to see it.

## Where is oxygen given to a patient with a total laryngectomy?

Over the stoma; after a total laryngectomy the nose and mouth are no longer connected to the trachea, so oxygen on the face does not reach the lungs.

## Why does a patient with a laryngectomy need humidification?

Air no longer passes through the nose; a heat and moisture exchanger filters and humidifies it, reducing crusting, mucus and cough.

## Why is water dangerous for a laryngectomy stoma?

The stoma leads straight to the trachea and lungs; water entering it can be aspirated, so the stoma is covered when showering.

## Which complications are watched for after a laryngectomy?

A fistula between the pharynx and skin, wound infection, haematoma, narrowing of the stoma and leakage around a voice prosthesis.

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## Connections

## Related 4

- [Tracheostomy care](https://durgical.com/en/nursing/tracheostomy-care/)
- [Airway suctioning: oral, nasal and artificial airways](https://durgical.com/en/nursing/airway-suctioning-oral-nasal-and-artificial-airways/)
- [Self-concept and body image after illness or surgery](https://durgical.com/en/nursing/self-concept-and-body-image-after-illness-or-surgery/)
- [Oxygen therapy: devices, flows and safety](https://durgical.com/en/nursing/oxygen-therapy-devices-flows-and-safety/)

## Related conditions 2

- [Laryngeal cancer](https://durgical.com/en/conditions/laryngeal-cancer/)
- [Head and neck squamous cell carcinoma (oral cavity and oropharynx, HPV)](https://durgical.com/en/conditions/head-and-neck-squamous-cell-carcinoma/)

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Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: [Laryngectomy](https://medlineplus.gov/ency/article/007398.htm) (MedlinePlus, U.S. National Library of Medicine, 2026); [Self-care and clinical management of persons with laryngectomy during COVID-19 pandemic: a narrative review](https://pmc.ncbi.nlm.nih.gov/articles/PMC8236747/) (Supportive Care in Cancer (open access, PMC), 2021); [Preventing and managing tracheostomy-related emergencies in the radiology suite: best practices for safety and preparedness](https://pmc.ncbi.nlm.nih.gov/articles/PMC12139224/) (Journal of Radiology Nursing (open access, PMC), 2025).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/nursing/caring-for-the-patient-with-a-laryngectomy-the-stoma-humidification-communicatio/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/caring-for-the-patient-with-a-laryngectomy-the-stoma-humidification-communicatio/