Total Laryngectomy + Partial Pharyngectomy + PMMC Flap
Total Laryngectomy + Partial Pharyngectomy + PMMC Flap
Fig.1 Horizontal skin crease incision. Mark for end tracheostoma. Subplatysmal skin flap is raised upto the level of hyoid bone.
Fig.2 Strap muscles are divided.
Fig.3 Left lobe of thyroid gland is exposed. Isthmus is divided.
Fig.4 Left lobe of thyroid gland (to be preserved) with its vascular pedicles is dissected off larynx and trachea.
Fig.5 Trachea is divided at the suitable level and the skin was sutured to the tracheal edge (white arrows) to create permanent tracheostoma. Endotracheal tube is passed through this and the anaesthesia continued.
Fig.6 Inferior constrictor muscle attached to the oblique line of thyroid cartilage is exposed.
Fig.7 Inferior constrictor muscle is divided. Posterior border of thyroid cartilage and its superior horn is exposed.
Fig.8 Hyoid bone is skeletonised
Fig.9 Suprahyoid muscles are cut.
Fig.10 Pharynx entered at vallecula. Epiglottis is held with a forceps. White arrows are pointing at the direction of the mucosal cut from vallecula towards pyriform sinus.
Fig.11 In the uninvolved side, the pyriform sinus mucosa is preserved as much as possible.
Fig.12 Green arrow points at the tumour in right pyriform fossa. Lines showing the sites of mucosal incisions. Interrupted line – postcricoid area. Continuous line – pyriform fossa.
Fig.13 Green arrow points at the mucosal incision at postcricoid area. Yellow arrow points at the mucosal incision at pyriform fossa.
Fig.14 After total laryngectomy, partial pharyngectomy and neck dissection on righe side. CCA – common carotid artery. Remaining pharynx appears narrow. Insufficient for direct closure.
Fig.15 Pharynx is reconstructed using pectoralis major myocutaneous flap (PMMC).
The Heart Of Clinic
Dr. C. Rayappa MBBS, DLO, FRCS(Edin)
SENIOR CONSULTANT
+91 44 3315 1105
Dr. C. Rayappa graduated from Madras Medical College, Chennai, India in 1982. He completed his post graduation in Otolaryngology (ENT)
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The Heart Of Clinic
Dr. C. Rayappa MBBS, DLO, FRCS(Edin)
SENIOR CONSULTANT
+91 44 3315 1105
Dr. C. Rayappa graduated from Madras Medical College, Chennai, India in 1982. He completed his post graduation in Otolaryngology (ENT)