Cắt thanh quản toàn phần

Total Laryngectomy

Source: http://headmirror.pbworks.com/Total-Laryngectomy

– Low collar incision

– Low tracheotomy

– Strap muscles divided as low as possible

– Divide isthmus

– Thyroid lobes mobilized off trachea (tumor side included with specimen)

– clamp paratracheal tissues, ligate inferior thyroid artery, divide recurrent

– Separate suprahyoid muscles from superior rim of hyoid (cut close to bone)

– Completely separate hyoid from its upper attachments

– Ligate superior laryngeal bundle (just below hyoid)

– Free inferior constrictor muscles from posterior thyroid ala

– Bevel trachea obliquely from front to back and from down to up over 2-4 rings

– Back wall of trachea is divided and separated from the cervical esophagus

– Enter pharynx away from tumor

– Deaver retractor into pharynx opening and separate larynx and hyoid bone from pharyngeal mucosa

– Feeding tube

– Pharyngostoma closed with running suture (t-shaped closure)

– Vertical limb of T begins at the esophagus and works up the midportion of the tongue base.

– Horizontal limb beings at lateral junction of tongue base and the pharynx on both sides and is carried middle

– Mature stoma

– Caudal lip of beveled tracheostoma suture to skin over sternal notch

– Cephalad portion attached to the midline of the collar flap

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