New Throat Reconstruction

The new laryngeal reconstruction is mainly used in patients with laryngeal cancer who need to undergo total laryngectomy. On the basis of eradicating the disease, the three functions of throat pronunciation, breathing and swallowing are reconstructed. Reconstruction of the larynx is the first method of direct anastomosis between the trachea and the pharynx by Arslan Serafini (1971). The upper end of the tracheal section replaces the larynx, which makes great progress in the reconstruction of pronunciation and respiratory function. Treatment of diseases: laryngeal cancer Indication Stage II~III laryngeal cancer, should not be treated with radiotherapy alone, and does not require full laryngectomy. Preoperative preparation Before the operation, a laryngoscopy should be performed to determine whether the cancer is invading one side or the double vocal cord, and the location of the cancer and the extent of the infiltration can be determined by X-ray filming of the laryngeal side, laryngeal body flaps, and CT scan if necessary. And whether the thyroid cartilage is involved. Surgical procedure 1. Take the supine position, raise the shoulders, tilt the head back, and fix the sandbags by the side. 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. 3. Separate the muscles of the larynx: first separate the thymus thyroid muscle, then separate the thyroid gland muscle, cut it and ligature it. Expose the thyroid cartilage flap. 4. Separation of the perichondrium: Check for thyroid cartilage for cancer invasion. If the cartilage is intact, the outer perichondrium is cut in the median and separated into two pages. 5. Cut or separate the thyroid isthmus: Close to the anterior wall of the trachea, separate the thyroid isthmus, clamp with the vascular clamp, cut at the midline, and suture through the suture. 6. Tracheotomy: The trachea was incision in the third to fourth rings of the cervical trachea, and the tracheal intubation was introduced therefrom. 7. Open the window: open a small window at the ring of the ring membrane, peep under the glottis, clear the scope of the tumor, to determine the total laryngectomy for total laryngectomy. 8. Lateral approach: If the invasion under the glottic door is not obvious, the thyroid cartilage plate from the healthy side or the less diseased side is 1/3 of the outer posterior margin, and the lateral approach is used to saw the thyroid cartilage plate with a circular saw. On the other hand, from the side of the lesion to the side of the main lesion, the patient enters the larynx for subtotal laryngectomy. On the principle of eradication of lesions on the lesion side of the thyroid cartilage plate, if the cartilage plate is intact and not invaded by the tumor, it can be sawed off at the 1/4 of the outer trailing edge and retained as the posterior support of the new laryngeal. Subtotal laryngectomy with lateral approach can avoid the conventional midline larynx rupture and easy to contact with cancer, and it is difficult to control the safety margin. This route has left the cancerous area far away, can clearly open the throat in clear vision, easy to control the cutting edge of safety, and reduce the advantages of recurrence. 9. Reconstruction of the glottis: the sphincter sarcoma of both sides of the sternum is freed, transplanted into the laryngeal cavity, as the lining of the laryngeal cavity, and folded into a glottal shape. Recreate the new glottis and fix it with a laryngeal expansion balloon. 10. Transfer of the hyoid bone: Separate the muscle plexus attached to the upper and lower margins of the hyoid bone, and cut one side at the outer edge 1/5, and the other side with the pedicle 180° in the forward and lower directions, and suture in order, before rebuilding the new throat. support. If the lesion has a wide range and requires a laryngectomy, the recurrent laryngeal nerve cannot be preserved, and the normal piriform fossa structure cannot be maintained, then the bilateral recurrent laryngeal nerves are released, and the nerves are ligated together with the part of the circumflex muscle fibers. Muscle flaps are grafted to the lateral posterior wall of the new larynx to restore the sphincter reflex of the new vocal tract. The method for reconstructing the piriform fossa structure is: corresponding to the throat and pharyngeal mucosa area behind the upper part of the neck trachea, and the left and right two bag-like structures are designed, which are sutured through the casing line and fixed on the outer lower part of the sternocleidomastoid muscle. A new pear-shaped fossa is formed to improve swallowing function.