immobility of the vocal cords, or be in the extrinsic larynx and hypopharynx where there
is greater danger of metastasis. The lymphatics are often removed.
b. Psychological Aspects. Laryng-ectomy presents many psychological
problems. The loss of voice that follows this procedure is a most tragic event for the
patient and his family. The patient may be taught to talk either by using esophageal
voice or with an artificial larynx. Esophageal voice is produced by the air contained in
the esophagus rather than by that in the trachea. Speech requires a sounding air
column. With instruction and practice, the patient is able to control the swallowing of air
into the esophagus and re-introduction of this air into the mouth-with phonation. The
sounding air column is then transformed into speech by means of the lips, tongue, and
c. Patient Preparation.
(1) The patient is placed on the table in a dorsal recumbent position with his
neck extended and shoulders raised by a rubberized block or folded sheet. The table is
slanted downward to elevate the upper part of the body for the convenience of the
(2) An endotracheal anesthetic is administered. An effective suction
apparatus is most essential.
(3) The proposed operative site--including the anterior neck region, lateral
surfaces of the neck down to the outer aspects of the shoulders, and the upper anterior
chest region--is cleansed in the usual manner.
d. Operative Procedure.
A tracheostomy may be performed to control the airway.
(2) A midline incision is made from the suprasternal notch to just above the
hyoid bone. Skin flaps are undermined on each side. The sternothyroid, sternohyoid,
and omohyoid muscles (strap muscles) on each side are divided by means of curved
hemostats and a knife.
(3) The suprahyoid muscles are severed from the portion of the hyoid to be
divided. The hyoid bone is divided at the junction of its middle and lateral thirds with
bone-cutting forceps. Bleeding vessels are clamped and ligated.
(4) The superior laryngeal nerve and vessels are exposed and ligated on
each side, using long curved fine hemostats and fine chromic gut or silk ligatures.
(5) The isthmus of the thyroid gland is divided between hemostats. Each
portion of the thyroid gland-is dissected from the trachea, using fine dissection with
Stevens and Metzenbaum scissors and fine tissue forceps. The superior pole of the