total laryngectomy

1. The vocal cord cancer has invaded the anterior commissure or the 1/3 of the ipsilateral vocal cord, making the vocal cord movement restricted or involving the contralateral vocal cord. 2. Outside the vocal cords such as false vocal cords, epiglottis, phlegm, wrinkles and ring cancer. 3. The subglottic area is swollen. 4. Other malignant tumors of the larynx, such as sarcoma. The whole body should be examined in detail before surgery, such as whether there is anemia, high blood pressure, heart and lung diseases, and whether the liver and kidney function are normal, so as to take necessary measures. Treatment of diseases: pharyngeal mixed tumor and laryngeal cancer Indication 1. The vocal cord cancer has invaded the anterior commissure or the 1/3 of the ipsilateral vocal cord, making the vocal cord movement restricted or involving the contralateral vocal cord. 2. Outside the vocal cords such as false vocal cords, epiglottis, phlegm, wrinkles and ring cancer. 3. The subglottic area is swollen. 4. Other malignant tumors of the larynx, such as sarcoma. Preoperative preparation 1. The systemic condition should be examined in detail before surgery, such as whether there is anemia, hypertension, heart and lung diseases, and whether the liver and kidney function are normal, so as to take necessary measures. 2. Patients with laryngeal cancer often worry about the complete loss of speech ability after surgery. They should do detailed ideological work before surgery, properly explain and strengthen their confidence in postoperative pronunciation. It turns out that as long as you have the determination, you can get some speech skills through training. 3. Precautions should be paid to oral hygiene before surgery. If there is infection in the upper respiratory tract or oral cavity, the operation time should be postponed appropriately. Surgical procedure 1. Take the supine position, raise the shoulders, tilt the head backwards, and place a sandbag to prevent the neck from shifting. 2. Incision: A vertical incision is made from the upper edge of the hyoid bone to the sternal fossa. Cut the skin, subcutaneous tissue and platysma. A "T" shaped incision can also be used depending on the condition of the lesion. 3. Cut the hyoid bone: Use the thyroid gland to pull the sternohyoid muscle to the outside, touch the hyoid bone above the throat, separate the lingual surface muscles with a vascular clamp, expose the hyoid bone, and cut with the bone in the middle of the hyoid bone. Push the broken end away from the sides. The purpose of cutting the hyoid bone is to facilitate loosening the larynx and enlarge the upper surgical field. 4. Cut off the muscles of the larynx: first separate the thymus thyroid muscle, clamp the upper edge, cut, ligation, and then separate the thyroid gland muscle, clamp the lower edge, cut, ligation. Expose the thyroid cartilage flap. The pharyngeal muscles attached to the upper corner of the thyroid cartilage were separated by a tonsil stripper, cut, ligated, and the upper thyroid cartilage was released and cut. 5. Ligation of the superior laryngeal artery: along the upper edge of the thyroid cartilage, the superior laryngeal artery is separated from the lateral side of the lingual membrane, which is cut and ligated. 6. Cut off the thyroid isthmus: Close the anterior wall of the trachea, separate the thyroid isthmus, and clamp it tightly with a vascular clamp and cut at the midline. The suture was ligated with a silk thread. 7. Cut the trachea: at the lower edge of the annular cartilage, separate the trachea and esophageal space. When separating, it is necessary to prevent the esophagus from being damaged after the separation, and it is not suitable for the front to penetrate the trachea. It can be attached to the posterior wall of the trachea, along its curvature, gradually separated from the anterior wall of the esophagus in the gap, and a sliver is introduced, and the ends of the sliver are pulled to make the trachea protrude forward, which is convenient for cutting. And prevent accidental injury to the esophageal wall. The part of the trachea that is cut off is generally between the lower edge of the annular cartilage and the uppermost edge of the trachea, and the cut surface is slightly inclined to the front lower and then higher. For example, under the glottic tumor, it can be cut at the upper edge of the second ring or the third ring. In order to cut off the specific part of the trachea, according to the laryngoscopy and X-ray of the lateral side of the neck should be estimated before surgery, a small round knife can be used to cut a small hole in the lower edge of the annular cartilage, and then the situation under the glottis is determined. Before cutting the trachea, a 2cm round skin should be cut at the upper sternum of the neck to serve as a stoma for suturing the end of the trachea. The subcutaneous tissue of the margin is slightly separated. Patients who have undergone tracheotomy before surgery should remove granulation, scars, and necrotic tissue around the incision. The end of the trachea is directly sewn to the neck stoma with a nylon thread through the tracheal wall. 8. Free laryngeal body: Free the remaining muscles, ligaments, soft tissues, etc. on both sides of the laryngeal body, and from bottom to top, the back of the laryngeal body is separated from the anterior wall of the esophagus until the level of the cartilage. Then cut the laryngeal mucosa. There are two ways to enter the throat and throat from the bottom up or from the top down. The bottom-up approach is to cut from the posterior edge of the sacral cartilage, into the throat and pharynx, and cut along the mucosa of the ankle and the epiglottis of the epiglottis until the larynx is completely free. The top-down approach is to separate the soft tissue at the anterior interstitial space layer by layer. After exposure to the epiglottis, the rat is clamped with a rat tooth forceps, cut along the edge of the epiglottis, into the throat and pharynx cavity, and the ankle is awkwardly awkward. The laryngeal body cuts the throat and pharyngeal mucosa until the laryngeal body is completely free. 9. suture the laryngeal mucosa: carefully examine and ligature the bleeding point, the laryngeal and pharyngeal mucosa from the outer upper and lower margins of the mucosa and submucosal sutures. The residual muscles in front of the neck were reinforced and sutured, and placed in a nasogastric tube. If it is operated under acupuncture or local anesthesia, it can be swallowed. If there is leakage of saliva, suture should be added at the leak. 10. Place rubber drain strips on both sides of the operating chamber, or use a negative pressure drain tube. The incision was sutured, the full-throat tracheal cannula was inserted, and the wound was wrapped with a dressing or bandage.

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