c. Operative Procedure.
(1) A tracheostomy is performed, and an endotracheal tube is inserted. A
general anesthetic is administered, or the surgeon may elect to do the procedure with
local anesthesia.
(2) A transverse incision is made through the skin and first layer of the
cervical fascia and platysma muscles, approximately 2 cm above the sternoclavicular
junction or in the normal skin crease by means of a knife handle #3 with a blade #10.
The upper skin flap is undermined to the level of the cricoid cartilage; then the lower flap
is undermined to the sternoclavicular joint.
(3) Bleeding vessels are clamped with mosquito hemostats and ligated.
The strap muscles are elevated and incised in the midline.
(4) The thyroid cartilages are cut with a Stryker saw, and the true vocal
cords are visualized through an incision into the cricothyroid membrane. The true vocal
cords are divided in the midline (anterior commissure), and the interior of the larynx is
exposed.
(5)
The tracheostomy tube must be left in place postoperatively to ensure
an airway.
1-42. PARTIAL LARYNGECTOMY
a. General. This operation involves the removal of a portion of the larynx. It is
done to remove superficial neoplasms that are confined to one vocal cord or to remove
a tumor extending up into the ventricle on the anterior commissure or a short distance
below the cord. Cancers confined to the intrinsic larynx are generally of a low grade of
malignancy and tend to remain localized for long periods.
b. Preparation of the Patient. The patient is placed on the table in a dorsal
recumbent position. The operative site is prepared and the patient draped with sterile
sheets, as described for thyroidectomy.
c. Operative Procedure.
(1) A tracheostomy is performed as previously described and an
endotracheal tube is inserted.
(2)
A vertical incision or a thyroid incision with elevation of a flap may be
employed.
(3) The sternothyroid muscles are separated in the midline and retracted by
means of loop retractors.
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