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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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Reach us through mail or phone

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)

Mithun Das

03:35 18 Mar 23

Its a pleasure experience with Dr. Rayappa C. We came for my wife thyroid nodules operation and testing for cancer malignancy. Doctor taken care everything with my previous diagnosis report and suggest to surgery half of thyroid infected lob.After this operation we got biopsy report that indicate still cancer not affected.Thanks to doctor and wishes him all the very best.

Saima Hasin

07:07 13 Mar 23

A sincere and dedicated doctor. He treated my husband for Oral Cancer. He gave his best efforts to overcome the disease. With patience and sincerity he handled the post surgery stages. We are so thankful to him. Expressing our gratitude to Almighty Allah and of course to Dr.Rayappa for his recovery .

Reyad Alam

16:49 16 Feb 23

Just saying ‘Thank you’ will not justify what Dr. Rayappa sir has done for us.My mom was having difficulty in breathing for merely 2 years due to thyroid enlargement.So we consulted Dr.Rayappa and he asked us to do surgery as soon as possible. It was hard for us to take the decision since a lot of risks was involved but we went ahead with it.Post surgery - My mom feels so energetic and alive, which she never felt before. Can breathe better, can talk, and just recovered in 2 days. The surgery was a success and Dr. Rayappa and his team took great for us throughout. We can’t describe the joy and happiness we’re filled with to see my mother so healthy.We give our heartfelt gratitude to Dr.Rayappa sir and his team.Dr. Rayappa is a great Otolaryngologist and we highly recommend him.

Poojha Shri

15:49 06 Feb 23

This is Vanamadevi patient of Dr.Rayappa. Dr sir is a God in the form of human. Highly blessed to be treated by him.Gave us hope in a hopeless situation. Very good service by the whole team. Thank you.

Rajiya Sultana

08:47 06 Jan 23

I am very much satisfied in your treatment. Dr.Rayappa sir is a very kind hearted man and a great doctors ever seen in my life.May Allah bless him and his family.

Total Laryngectomy + Partial Pharyngectomy + PMMC Flap