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Laryngectomy


Medical editor Kjell Brøndbo MD
Otolaryngologist
Oslo University Hospital

General

Curative treatment for laryngeal cancer is primarily radiation therapy, except for T1a tumors which are removed by laser surgery.

Laryngectomy includes removal of the larynx and hyoid bone.

Laryngectomy for T4

  • Elective surgery - laryngectomy is performed 4-6 weeks after the last radiation therapy. 
  • Primary surgery - is performed only in acute situations due to airway obstruction. 

Indication

  • Laryngeal cancer

Goal 

  • Curative resection of tumor

Equipment

  • Universal set
  • Basic tray
  • Laryngectomy tube
  • Nutrition tube 

Preparation

  • The area of the surgical field is shaved.
  • The surgery is performed under general anesthesia.
  • The patient lies supine.
  • Pillows are placed under the patient's shoulders and neck to extend the cervical spine (struma position).

Implementation

  • A U-shaped incision is made from the hyoid bone via the jugulum, to the hyoid bone through the skin, subcutaneous tissue and platysma. 
  • The skin flaps are dissected.
  • The sternal adherences of the sternocleidomastoid muscle are cut. 
  • The strap muscles are cut from below. 
  • The vessels on the thyroid flap on the side of the tumor are clamped and ligated to accompany the main specimen. 
  • The contralateral thyroid flap is resected from the trachea.
  • The larynx is resected above.
  • The trachea is devided between the 2nd and 3rd ring.
  • The tube is moved down to the trachea.
  • The larynx is resected completely after entering the hypopharynx at the height of the vallecula. 
  • During resection, as much mucosa is spared as possible. 
  • The larynx is removed, opened, and sent for histological examination.
  • Myotomy is performed of the cricopharyngeal muscle. 
  • A horizontal anastomosis is done.
  • Two suction drains are inserted.
  • The subcutaneous tissue, stoma, and skin are closed in layers.
  • The nasal nutrition tube is inserted peroperatively. 

Follow-up

Observe for:

  • hematoma
  • infection

Fistula from the pharynx to the stoma occurs in some cases. This causes swallowed content to spill into the airways. The patient must then continue with a feeding tube for a period. Only in exceptional cases is it necessary to perform plastic surgery or PEG.

Expected outcome: 

  • The drain is removed on the second postoperative day.
  • From the second postoperative day, use of a moisture/heat filter is aimed for.
  • The feeding tube is removed on the 14th postoperative day.
  • The sutures are removed on the 14th postoperative day if the area is treated with radiation (otherwise the 10th postoperative day). 
  • The patient should have a follow-up visit in which a speech prosthesis is inserted, if necessary. 
  • The speech prosthesis is inserted 3-6 weeks postoperatively if desired by the patient.

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