thyroid is retracted in a Greene retractor. The superior thyroid vessels are freed from
the larynx by a sharp dissection.
(6) The larynx is rotated. The inferior pharyngeal constrictor muscle is
severed from its attachment to the thyroid cartilage on each side.
(7) The endotracheal tube is removed. The trachea is transected just below
the cricoid cartilage over a Kelly or Crile hemostat previously inserted between the
trachea and esophagus. The upper resected portion of the trachea and the cricoid
cartilage are held upward with Lahey forceps. A balloon-cuffed tube (endotracheal) or a
Foley catheter is inserted in the distal trachea.
(8) The larynx is freed from the cervical esophagus and attachments by
sharp and blunt dissection. A moist pack is placed around the endotracheal tube to
help prevent leakage of blood into the trachea.
(9) The pharynx is entered. In most cancers of the intrinsic larynx, the
pharynx is entered above the epiglottis. The mucosal membranous incision is extended
along either side of the epiglottis; the remaining portion of the pharynx and cervical
esophagus is dissected well away from the tumor by means of fine-toothed tissue
forceps, Metzenbaum scissors, knife, suctioning, and fine hemostats. The specimen is
removed en massa.
(10) A nasal feeding tube is inserted through one nares into the esophagus;
closure of the hypopharyngeal and esophageal defect is begun, using continuous
inverting fine sutures of chromic gut #3-0. The nasal tube is guided down past the
pharyngeal suture line.
(11) The pharyngeal suture line is reinforced with interrupted sutures; the
suprahyoid muscles are approximated to the cut edges of the inferior constrictor
(12) The diameter of the tracheal stoma is increased by means of a knife and
heavy straight scissors. The two portions of the thyroid behind the tracheal opening are
approximated with interrupted silk sutures, thereby obliterating dead space posterior to
the upper portion of the trachea.
(13) A small Penrose drain or catheter is inserted through two separate stab
wounds on each side of the neck just below the pharyngeal suture line. If a closed
suction system is used, catheters connected to a suction apparatus are used.
(14) The edges of the deep cervical fascia and the platysma are closed
separately with interrupted fine silk sutures. When a great amount of the fascia and
platysma has been removed, the wound edges are approximated with silk sutures.