small laryngectomy

A small range of laryngectomy due to aspiration is also called a narrow field laryngectomy. Only the thyroid cartilage, the ring cartilage and the tissue inside it were removed during the operation, and the band muscle, the hyoid bone and the hypopharyngeal mucosa were retained as much as possible. The advantages are: 1 is a permanent tracheostomy, which is conducive to keeping the airway unobstructed; 2 the oral structure is separated from the airway, thus eliminating aspiration; 3 the surgical effect is affirmative and the complications are few. Treatment of diseases: laryngeal edema, tracheal esophageal fissure Indication Small-range laryngectomy is available for: 1. Aspiration that cannot be restored. 2. Not suitable for long-term nasal feeding and tracheotomy and longer life expectancy. Contraindications Those who do not expect longevity can be replaced by nasogastric feeding or tracheotomy. Surgical procedure Tracheotomy The patient was placed in a supine position, under the shoulder pillow, the head was reclined, and the neck was straight. Local anesthesia tracheotomy. The median vertical incision was made in the neck, the 4th and 5th rings of the trachea were cut, the anesthesia cannula was inserted, the cannula was fixed, the incision was sutured, and general anesthesia was started. Intratracheal intubation can also be performed through the oral cavity without tracheotomy. 2. Incision The skin of the neck is re-sterilized, and the sterile towel is placed on the upper edge of the tongue. The incision is made down to the sternal incision or the incision at the tracheotomy. The skin, subcutaneous tissue and platysma are cut open. Separate and retract to both sides. 3. Exposure of thyroid cartilage, ring cartilage and thyroid gland The soft tissue and the sternohyoid muscle were separated along the incision to the both sides, and pulled to the sides by a hook to expose the thyroid cartilage, the ring cartilage and the thyroid gland. The thyroid gland was separated, clamped with a hemostat, and sutured with a gut to remove the hemostatic forceps. 4. Cut off the muscle attached to the thyroid cartilage First, the thyroid gland muscle is separated and pulled to the sides with a hook. Then, the sternum thyroid muscle was separated, and the two hemostatic forceps were used to clamp and cut at the upper end, and the muscle end was ligated with a silk thread, and the contralateral muscle was cut by the same method. 5. Cut the inferior phlegm and thyroid cartilage The thyroid cartilage was pulled to the opposite side, the hypopharyngeal muscle was exposed, the inferior stenosis muscle was cut along the posterior edge of the thyroid cartilage, and the upper thyroid cartilage was cut. The inferior phlegm muscle was peeled off from the thyroid cartilage with a large stripper and turned over to the inside of the thyroid cartilage to separate the mucosa of the piriform fossa from the thyroid cartilage. The same method cuts the contralateral hypopharyngeal muscles and the upper thyroid cartilage. 6. Cut off the trachea After the tissues on both sides of the larynx are completely separated, the trachea is cut off at the lower edge of the annular cartilage, and the incision is backward and obliquely upward. 7. Separate the back of the throat The ring cartilage was clamped up with a rat tooth forceps and lifted upwards, and separated from the bottom of the throat by the stripper to the sacral epiglottis to separate it from the anterior wall of the upper esophagus. 8. Cut the throat Pull the larynx upwards and outwards to expose the piriform fossa and cut it. The epiglottis is exposed through the incision, and the laryngeal body is sharply removed along the epiglottis. Keep the mucosa of the lower pharynx and esophagus as much as possible. 9. Close the lower pharynx The pharyngeal mucosa was sutured with a 3-0 filament thread and the suture layer was reinforced. The sternum of both sides of the sternum is sutured at the midsection, making it the second layer to seal the hypopharyngeal mucosa. 10. Tracheostomy and suture skin The flap was cut off in a curved shape near the end of the trachea, so that the skin and the end of the trachea were aligned neatly, and the neck skin and the end of the trachea were sutured intermittently with a 4th wire. The skin incision is sutured layer by layer.