(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
(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
(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.
1-43. SUPRAGLOTTIC LARYNGECTOMY
This procedure is the excision of the laryngeal structures above the true vocal
cords. It is indicated in cancer of the epiglottis and false vocal cords. It is designed to
remove the cancer, yet preserve the phonatory, respiratory, and sphincteric functions of
the larynx. A neck dissection is always performed.
1-44. TOTAL LARYNGECTOMY
a. General. This procedure involves the complete removal of the cartilaginous
larynx, the hyoid bone, and the strap muscles-connected to the larynx and possible
removal of the pre-epiglottic space with the lesion. The tumor may have produced