hemilaryngotomy

The purpose of the half-throatectomy is to remove the laryngeal cancer and retain the vocal function. However, the appropriate range is narrow, and should be strictly controlled. It is important not to preserve the physiological function of the larynx, but to leave cancer and cause irreparable recurrence. From embryonic, anatomical and clinical pathology studies, some suitable cases can be selected for half-throatectomy. The supraglottic area originated from the original pharynx, the ventricular band, the epiglottis, and the epiglottic wrinkles from the fourth zygomatic arch. The vocal cords and the subglottic area were from the upper end of the trachea. And the voice, can be used for half-throatectomy, does not violate the radical cure principle of cancer, and achieve the desired results. The anterior epiglottis is located between the hyoid bone and the anterior commissure of the vocal cords. It is shaped like a cone with its bottom up. The two sides are the hyoid bone, the hyoid bone, the thyroid epiglottis and the ligament, and the tip of the vocal cord is anterior. The cancer in the upper area and the supraglottic area often develops in this area. Sometimes the clinical examination is limited to the cancer of the root of the epiglottis. On the microscopic examination, the cancer has spread to the ventricular zone, and the epiglottic cancer is prone to cervical lymph node metastasis. Therefore, half-throatectomy should include all pre-neoplastic anterior gaps and, if necessary, radical neck dissection. If the pharyngeal incision is made from the sublingual bone, only the epiglottis is removed, and the cancer is easily recurred. There are many methods for semi-laryngeal resection, such as transverse upper hemi-throatectomy, anterior lateral hemi-throatectomy, and oblique half-throatectomy. Among them, transverse upper and lower laryngectomy is more practical, so this article The focus is on the operation. Treatment of diseases: laryngeal tumor laryngeal cancer Indication 1. Epiglottic cancer is confined to the epiglottis or its margin, but does not invade the root of the epiglottis, and has a safe edge with the anterior commissure of the vocal cords. 2. Epiglottic cancer invades the tongue, the scope is limited, and there is no cancer at the base of the tongue. 3. The epiglottic cancer invades and wrinkles, but the scorpion cartilage is not eroded, and there is no edema. In addition, the vocal cords should be free of cancer, good activity, and the room and tongue membranes are not invaded. Preoperative preparation Tracheotomy should be performed before surgery to avoid breathing difficulties during or after surgery. Surgical procedure Take the supine position, the shoulders are slightly raised, and the sides of the head are fixed with sandbags. The surgical procedure can be carried out as follows: 1. The incision is made transversely along the upper edge of the thyroid cartilage. Cut the skin and subcutaneous tissue. If a radical lymph node resection of the neck is performed at the same time, the incision is made to remove the lymph nodes and then enter the larynx. 2. Cut off the muscles around the hyoid bone. Cut the sternohyoid muscle, thyroid gland muscle and sternal thyroid muscle under the hyoid bone. Separate the supraspinal muscle from the hyoid bone and cut the hyoid bone in the midline. 3. Cutting the thyroid cartilage: the thyroid cartilage is cut into the upper 1/3 between the lower edge and cut horizontally. 4. Excision of the tumor separates the tongue root from the epiglottis, and removes the epiphyseal folds, close to the sacral cartilage (be careful not to expose the sacral cartilage), so that the ventricular zone is separated from the anterior commissure of the vocal cords until the transverse section of the thyroid cartilage . The cancer is included in the epiglottic anterior space, epiglottis, ventricular band, and epiphyseal wrinkles. 5. Fixed one side vocal cord In order to avoid postoperative diet into the lower respiratory tract, one side of the ankle joint can be dislocated, so that the vocal cords are fixed at the midline position, so that the glottic fissure is reduced, and no aspiration pneumonia is caused during diet. When the sound is fixed in the center line, it will not cause too much impact. 6. Suture the pharyngeal rupture: pull the adjacent residual neck muscles, repair the pharyngeal wall rupture, and suture layer by layer.