Vertical (lateral or anterior) partial laryngectomy

Vertical (lateral or anterior) laryngectomy is one of the main treatments for supraglottic laryngeal cancer and epiglottic cancer. Treatment of diseases: laryngeal cancer Indication 1. T1, T2 stage of supraglottic cancer is limited to epiglottis, laryngeal vestibule or paralysis, involving one side of the throat and vocal cords. 2. Epiglottic cancer invades some of the front side walls of the pear-shaped fossa. Preoperative preparation 1. Preoperative laryngoscopy, fiberoptic laryngoscopy, CT, etc. to determine the location and extent of the tumor. 2. Comprehensive examination to exclude abnormalities in heart, liver, lung function and blood. 3. Properly treat inflammatory lesions of the oral teeth, sinuses and tonsils to prevent postoperative infection. 4. Introduce the patient's family to the surgical method, postoperative functional changes and complications, and sign the surgical agreement. 5. Prepare the skin before the neck. 6. Fasting 6 hours before surgery, intramuscular injection of atropine, sodium phenobarbital, and nasogastric tube half an hour before surgery. Surgical procedure 1. Make a transverse arc-shaped incision along the lower edge of the striated flat cartilage, cut through the platysma, and flank the anterior border of the sternocleidomastoid muscle, and separate it from the deep surface of the platysma to the plane of the hyoid bone, picking up the flap and Fixed to the surgical towel. The sublingual muscles were cut under the hyoid bone, and the thyroid periosteum was cut at the upper edge of the thyroid cartilage and peeled downward, and turned together with the band muscles for use. In the affected side of the thyroid cartilage wing, at the level of the lower third of the junction horizontally. The tissue on the hyoid bone is separated, the mucosa is cut into the epiglottic valley, the incision is pulled out and the epiglottis is removed, and the extent of the tumor is observed. Cut the hyoid bone at the small corner of the healthy side of the hyoid bone, cut the periosteum of the thyroid gland and the tissue of the anterior epiglottis and the tangential line of the upper edge of the thyroid cartilage. The affected side is cut downward at the upper corner of the hyoid bone and the upper corner of the thyroid cartilage. The thyroid cartilage is transverse. Will pull the front and the outside, pull the room belt on the healthy side, from the middle of the scissors with the inner leaf along the throat, the lateral leaf along the thyroid cartilage cut to the front to the root of the epiglottis, pull to the affected side can completely expose the tumor, in The anterior union cuts off the affected side vocal cords downwards. When the inner leaves of the scissors have sufficient safety margins from the tumor under the affected side, the outer blade is cut back at the transverse direction of the medial cartilage, and behind the sacral cartilage, the sound is heard. On the door, the tumor, 2/3 of the thyroid cartilage on the affected side, and the glottic area were removed. Cut off the pharyngeal muscles, the inferior pharyngeal muscles, completely stop bleeding, and wash the wound. 2. Open the laryngeal defect, check the size of the glottic defect, and reset the skin flap above the incision. Make a rectangular transverse flap according to the size of the laryngeal defect, and the pedicle is located on the affected side. The rupture of the laryngeal cavity was sutured with the margin of the posterior larynx mucosa, the margin of the piriform fossa and the subglottic mucosal margin. The laryngeal cavity is built into the dilator, and the upper end is taken out from the nasal cavity and fixed to the anterior nares, and the lower end line is taken out through the tracheotomy opening and fixed to the tracheal tube. The 1cm wide half-thickness flap was inwardly cut at the base of the flap corresponding to the front joint 1cm, and the inwardly inverted and the contralateral acoustic and ventricular septal margin were sutured. Close the laryngeal cavity, preset the suture, close the pharyngeal cavity, reset and suture the band muscle, suture the subcutaneous tissue, skin, place drainage, replace the tracheal cannula, and bandage the knife edge.