Laryngeal fissure

Early vocal cord tumors, such as lesions confined to the middle of one side of the vocal cords, the front end did not invade the anterior commissure, the posterior did not affect the sound process, the vocal cords were normal, can be used for laryngeal splitting. Although the vocal hoarseness after surgery, the general conversation, breathing and diet are not hindered, the five-year survival rate is similar to the use of radiation therapy, can reach more than 90%. If the cancer has reached the anterior commissure or even exceeds the anterior commissure and contralateral vocal cords, the conventional laryngeal spasm is not suitable, and the anterior commissure larynx can be used. Treatment of diseases: congenital laryngeal fissure Indication Early vocal cord tumors. Contraindications 1, with systemic diseases, can not tolerate surgery. 2, local infection, not suitable for surgery. Preoperative preparation Before operation, the laryngoscopy should be performed in detail, and the x-ray film on the lateral side of the larynx should be taken to determine the location of the cancer, the activity of the vocal cords, and the presence or absence of cancer in the subglottic area. A biopsy should be performed. If it is not confirmed by biopsy, it is not easy to operate. Surgical procedure In the supine position, the shoulders are slightly raised, and the sides of the head are fixed with sandbags. Surgical methods are divided into two types: conventional laryngeal splitting and anterior commissure laryngeal splitting. (a) conventional laryngeal rupture 1. The incision is made from the hyoid bone down to the sternum for a neckline midline incision, incision of the skin, subcutaneous tissue, direct thyroid cartilage, ring cartilage. And separate the muscles under the hyoid bone, cut off the thyroid isthmus, and expose the upper part of the trachea (Figure 3). 2. Cut the thyroid cartilage and cut the thyroid cartilage from the midline of the upper edge of the thyroid cartilage. If the thyroid cartilage has been ossified and hard to cut, use an electric circular saw (Fig. 4). 3. Cut the mucosa, enter the larynx and cut the mucosa along the midline. After entering the larynx, carefully examine the walls of the larynx and re-examine the extent of the cancer to see if it can be opened. If the examination finds that it is inconsistent with the preoperative estimate, the surgical plan should be changed according to the intraoperative condition (Figure 5). 4. Cut the trachea and move the cannula to the tracheal incision for easy observation during surgery. At this time, the upper part of the trachea should be cut, the tracheal intubation should be pulled out from the mouth, and placed in the tracheal incision in the upper part of the trachea. The air bag of the tracheal intubation is inflated to prevent blood from flowing down. If the blockage is not tight enough, the lower part of the glottis can be filled with gauze to ensure the smoothness of the lower airway. Tracheostomy can also be performed before surgery. 5. Excision of the cancer The vocal cord on the disease side was cut from the thyroid cartilage as a blunt dissection along the cartilage (Fig. 6). Exceeding the vocal cords upwards, reaching the ring cartilage downwards, and including the vocal cords of some of the sacral cartilage, preferably reaching a safe margin of nearly 1 cm around the normal tissue around the cancer, using a curved shear to cut the cancer along the safety margin. (Figure 7). If there is more bleeding, use gauze to fill the hemostasis, and check the excised tissue, if there is enough safety margin, if necessary, freeze frozen biopsy. If suspicious spots are found, the scope of surgery can be expanded in time to improve the efficacy. 6. After a few minutes of stopping the blood pressure, take out the gauze and check for bleeding. At this time, it is often seen that there is an arterial hemorrhage (from the superior laryngeal artery) on the wound surface, and ligation should be added to stop bleeding. Before closing the laryngeal cavity, it is necessary to examine in detail whether there is any bleeding, and two layers of rubber finger can be used as a water bag, which is tied on the thin plastic tube, and the tube is taken out from the nostril through the throat, and the water bag is left in the throat. In the cavity, the water is injected to expand it, which is used to compress the throat. The lower end is pierced with a thick wire and fixed to the neck (Fig. 8). 7. Stitching the incision thyroid cartilage without suturing, as long as the perichonal membrane is sutured, the sublingual muscles and subcutaneous tissue on both sides can be sutured, and finally the skin is sutured. 8. Pull out the tracheal intubation and pull out the tracheal intubation and replace with a tracheal cannula. (2) The anterior commissure laryngeal rupture is available for the case where the cancer reaches the anterior commissure and the anterior commissure and the contralateral vocal cord front. The method is as follows: 1. The incision is the same as above. 2. It is best to use an electric circular saw when cutting thyroid cartilage to cut thyroid cartilage. The incision should be biased to the opposite side so that when the mucosa is cut into the larynx, a part of the front end of the contralateral vocal cord can be included. It is also believed that the anterior ligament ligament at the front end of the vocal cords is directly attached to the anterior part of the thyroid cartilage. For more thorough surgery, one side of the cartilage near the midline of the thyroid cartilage can be removed (Fig. 9) to reduce recurrence. 3. When the mucosa is opened and the mucosa is incision, it should enter the larynx from the contralateral side and include a part of the front end of the contralateral vocal cord. If the resection is not enough, it may recur in the future; if the resection is too much, it may cause laryngeal stenosis, so special caution should be taken during surgery. 4. The other steps are the same as the above. complication 1. Postoperative bleeding: Complete hemostasis during operation and use of water bladder compression are important measures to prevent bleeding. If bleeding occurs after surgery, the laryngeal cavity should be reopened to stop bleeding, and should be pressurized with water bladder, or filled with iodoform gauze to avoid re-bleeding. 2. Pulmonary infection: If there is too much blood flowing into the lower respiratory tract during surgery, it may cause pulmonary infection. Therefore, the upper part of the trachea should be blocked during operation to prevent blood from flowing down, and antibiotics should be used appropriately.