What Is a Total Laryngectomy?

Total laryngectomy is the most widely used, highly effective and earliest operation for the treatment of laryngeal cancer. The biggest disadvantage of total laryngectomy is that the patient loses his larynx for life after the operation, which causes permanent loss of sound and anterior cervical tracheostomy. At present, total laryngectomy is still the main method for treating laryngeal cancer.

Basic Information

Chinese name: Total laryngectomy
Anesthesia: general anesthesia

Indication: Laryngeal cancer
complication: Infection, pharyngeal fistula, bleeding in wound

Total laryngectomy

general anesthesia.

Preparation before total laryngectomy

1. Comprehensive inspection, pay attention to distant transfer.

2. Learn more about the condition of the throat, CT or MRI, B-ultrasound to determine the extent of the tumor, and whether the cervical lymph nodes are metastatic.

3. Clean and disinfect the skin before surgery and prepare skin.

4. Fast and water for 6 hours before surgery.

Indications for total laryngectomy

1. Glottic cancer has developed to the contralateral vocal cords, invading the upper or lower glottic regions, with limited or fixed vocal cord activity on one side.

2. Supraglottic cancer invades epiglottis, tongue root or downward vocal cord or former joint

3. Subglottic laryngeal carcinoma invades the vocal cords with limited or fixed vocal cord movement on one side.

4. Laryngeal cancer invades the anterior epiglottic space or perforates the thyroid cartilage plate and the thyroid membrane and involves the soft tissue of the larynx.

5. Laryngeal dehiscence or partial laryngectomy or radiotherapy, cancer recurrence after laser surgery, there is no evidence of partial laryngectomy

6. Recurrence or insensitivity to radiotherapy after radiation therapy, tumors continue to develop.

Contraindications for total laryngectomy

1. There are already distant transferers.

2. The tumor has penetrated outside the throat, and the neck has spread subcutaneously, invading the anterior cone fascia.

3. Extremely poor general conditions, cachexia, and severe cardiopulmonary dysfunction.

General procedure of total laryngectomy

1. Routine disinfection and draping of the surgical field.

2. Make a vertical midline incision from the upper edge of the hyoid bone to the sternal notch, and make "T" and "U" incisions.

3. Open the broad neck muscle, cut the deep neck fascia along the midline of the neck, and separate the band muscles.

4. Cut the hyoid bone and periosteum to separate, ligate, and cut off the sternohyoid muscle, pectoralis, thyroglossus, and suprahyoid muscle group. After the hyoid bone is exposed, the entire hyoid bone is excised.

5. Separate the superior laryngeal artery and vein on the outside of the tongue's nail membrane and cut off the ligation. Isolate or cut the upper corner of the thyroid cartilage, cut the pharyngeal contractile muscle along the posterior edge of the thyroid cartilage plate, and peel the piriform fossa mucosa from the medial side of the thyroid cartilage plate.

6. Separate the thyroid isthmus with a stripper and a small gauze ball, then clamp it with blood vessel forceps, cut off at the midline, and use a medium-sized needle to thread the broken end through a No. 4 silk suture.

7. First cut between the annular cartilage and the first tracheal ring with a knife, and then separate the upper trachea from the esophagus. The tracheal site should be determined according to the location of the tumor. If the circular cartilage is retained, the incision can be made in the cricothyroid membrane, and the trachea is sutured at the neck stoma.

8. Isolate the muscles and soft tissues on both sides of the larynx, and separate the larynx from the esophagus from the back of the larynx until the upper margin of the iliac cartilage and the submucosa of the piriform fossa on both sides. Cut the mucosa of the intercondylar area horizontally, enter the pharyngeal cavity, and cut the mucosa of the anterior wall of the piriform fossa along the lateral sides of the epiphyseal epiglottis.

9. Use a sterilized gastric tube, coated with paraffin oil at the front end, put it slowly from the nostril, reach the esophagus through the pharynx, fix it with adhesive tape outside the nose, or leave the gastric tube before surgery.

10. Suture the laryngeal mucosa, check carefully, ligate the hemostasis, filament or absorbable thread, small looper to turn the mucosa of the pharynx inward, suture intermittently, and then reinforce and suture two layers under the mucosa.

11. Place a negative pressure drainage tube on both sides of the neck, suture the incision, insert a full laryngeal tracheal cannula, and use a dressing to dress the wound under pressure.

Complications of total laryngectomy

1. Wound infection.

2. Pharyngeal fistula.

3. Lower respiratory tract infection.

4. The trachea is narrow.

5. Intracranial bleeding.

6. Subcutaneous or mediastinal emphysema.

Precautions for total laryngectomy

1. When freeing the trachea, do not damage the front wall of the esophagus.

2. When freeing the laryngeal body, keep as much bilateral piriform crypt mucosa as possible to avoid hypopharyngeal stenosis.

3. Subcutaneous negative pressure drainage and pressure dressing after the wound.

Nursing after total laryngectomy

1. Lying in a supine or semi-sitting position, head slightly bent forward to reduce wound tension. Dressing was changed 24 hours after surgery.

2. Use antibiotics to prevent infection. Keep your mouth clean, strengthen supportive therapy, and nasal feeding for more than 2 weeks.

3. The drainage tube can be removed 48 hours after surgery, and the suture can be removed 7 days.