Special Surgical Procedures II
LESSON 1: Eye, Ear, Nose, and Throat (EENT) Surgery
Section IV: THROAT, TONGUE, AND NECK SURGERY
1-42
1-42. PARTIAL LARYNGECTOMY
a. General. This operation involves the removal of a portion of the larynx. It is done to remove superficial neoplasms that are confined to one vocal cord or to remove a tumor extending up into the ventricle on the anterior commissure or a short distance below the cord. Cancers confined to the intrinsic larynx are generally of a low grade of malignancy and tend to remain localized for long periods.
b. Preparation of the Patient. 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 described for thyroidectomy.
c. Operative Procedure.
(1) A tracheostomy is performed as previously described and an endotracheal tube is inserted.
(2) A vertical incision or a thyroid incision with elevation of a flap may be employed.
(3) The sternothyroid muscles are separated in the midline and retracted by means of loop retractors.
(4) The fascial covering over the thyroid cartilage is incised with a knife, and the perichondrium is elevated from the cartilage on the side of the tumor with a Freer periosteal elevator.
(5) The thyroid cartilage is divided longitudinally in midline by means of a Stryker power saw.
(6) The cartilages are retracted with loop retractors. The cricothyroid membrane is incised with a knife. A blunt-nosed laryngeal scissors is introduced between the vocal cords to divide the mucosa of the anterior wall of the glottis.
(7) The divided cartilages are retracted with Kocher retractors to expose the interior of the larynx. A small pack of moist gauze may be placed in the trachea to prevent aspiration of blood or mucous. A 10 percent solution of cocaine may be applied to the larynx to prevent laryngeal muscular spasm. The extent of the intrinsic laryngeal tumor is determined.
(8) With a small periosteal elevator, the mucosa on the involved side of the larynx is freed; the false cord and mucosal layer of the region are lifted by means of a periosteal elevator and hooks. The involved cord is excised, using straight scissors.
(9) In some cases, the thyroid cartilage may be removed with a knife and straight scissors. Bleeding is controlled with hemostats and fine chromic gut ligatures and sutures.
(10) The gauze pack is removed from the trachea. The perichondrium is approximated with chromic gut #2-0 sutures. The strap muscles are approximated in the midline with chromic gut #2-0 sutures; then the platysma and the skin edges are approximated separately with fine silk sutures.
(11) A tracheal-laryngeal tube is left in place. It is removed at a later date when the airway is adequate. Dressings are applied to the wound and around the tube.
