LESSON 1: Eye, Ear, Nose, and Throat (EENT) Surgery

Section IV: THROAT, TONGUE, AND NECK SURGERY

1-41

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1-41. LARYNGOFISSURE

a. General. This operation involves the opening of the larynx for exploratory, excisional, or reconstructive procedures. It is performed whenever access to the intrinsic larynx is necessary. The thyroid cartilages are split in the midline, and the true vocal cords and false vocal cords are incised at the midline anteriorly.

b. Patient Preparation. The patient is placed on the table in a dorsal recumbent position. The operative site is prepared and the patient draped with sterile sheets, as for thyroidectomy.

c. Operative Procedure.

(1) A tracheostomy is performed, and an endotracheal tube is inserted. A general anesthetic is administered, or the surgeon may elect to do the procedure with local anesthesia.

 

(2) A transverse incision is made through the skin and first layer of the cervical fascia and platysma muscles, approximately 2 cm above the sternoclavicular junction or in the normal skin crease by means of a knife handle #3 with a blade #10. The upper skin flap is undermined to the level of the cricoid cartilage; then the lower flap is undermined to the sternoclavicular joint.

 

(3) Bleeding vessels are clamped with mosquito hemostats and ligated. The strap muscles are elevated and incised in the midline.

 

(4) The thyroid cartilages are cut with a Stryker saw, and the true vocal cords are visualized through an incision into the cricothyroid membrane. The true vocal cords are divided in the midline (anterior commissure), and the interior of the larynx is exposed.

 

(5) The tracheostomy tube must be left in place postoperatively to ensure an airway.

 

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