Open Access Atlas Of Otolaryngology Head Amp Neck Operative -Books Download

OPEN ACCESS ATLAS OF OTOLARYNGOLOGY HEAD amp NECK OPERATIVE

2019 | 25 views | 5 Pages | 628.55 KB

OPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY LARYNGOFISSURE / MEDIAN THYROTOMY Johan Fagan Laryngofissure, also known as median thyrotomy, refers to vertically splitting the thyroid cartilage in the midline to gain access to the endolarynx. It provides good exposure to both anterior and posterior laryngeal structures with very minor morbi-dity (Figure 1). Figure 1: Good .



Surgical technique
Because the airway is entered clean
contaminated wound the patient must
have perioperative 24hrs broad spec
trum antibiotics
Tracheostomy is done to permit surgi
cal access to the endolaryngeal structu
res and to secure the airway until
postoperative swelling has abated
Perform direct laryngoscopy to assess
the laryngeal pathology
Position the patient with neck extended
Make a transverse skin crease incision
midway between the thyroid prominen
ce and the cricoid Figure 3
Figure 4 Raphe between sternohyoid mus
cles has been divided to expose the thyroid
cartilage
Thyroid
prominence
Cricothyroid
membrane
Cricoid
Figure 3 Surface anatomy and incision
yellow line
Raise skin flaps superiorly and inferior
ly platysma is generally absent in the
midline
Incise the midline raphe between the
sternohyoid muscles to expose thyroid
cartilage Figure 4
Clear all the soft tissue off the thyroid
cartilage cricothyroid membrane and Figure 5 Thyroid cartilage cricothyroid
cricoid in the midline Figure 5 membrane and cricoid exposed in midline
Expose the cricoid cartilage and crico and cricothyrotomy incision visible
thyroid membrane
Incise thyroid perichondrium vertically Make a transverse cricothyrotomy inci
in the midline and strip it off the carti sion through the cricothyroid membra
lage to expose a midline strip of carti ne Figure 5 Anticipate some bleeding
lage from the cricothyroid artery a small
2
branch of the superior thyroid artery
which courses across the upper part of
the cricothyroid membrane and commu
nicates with the artery of the opposite
side Figure 6
Cricothyroid
artery
Figure 7 Completed thyrotomy
Figure 6 Cricothyroid artery branching
from the superior thyroid artery
Precisely determine the position of the
anterior commissure so that the thyro
tomy is made through the anterior com
missure If this is not achieved then
either vocal cord will be damaged The
position of the anterior commissure can
be determined by passing the tips of a
small curved artery forceps through the
cricothyrotomy and cephalad between
the vocal cords By elevating the thyroid
cartilage anteriorly with closed tips of
the artery forceps the artery will lodge
in the anterior commissure indicating
precisely the line in which the thyroto
my should be made
Vertically divide the thyroid cartilage in
the midline aiming for the upturned tips
of the artery forceps This can be ach
ieved with a scalpel in older people
Figure 8 Note excellent view of the false
with ossified cartilage it can be done
vocal cords ventricles true cords and
with an oscillating saw or a heavy pair
posterior larynx
of scissors Figure 7
Part the cut ends of the thyroid cartilage
and inspect the endolarynx using an
operating microscope or loupes if nec
essary Figures 8 9
3
Figure 9 Note excellent view of false vocal Figure 10 Lesion of glottis being excised
cord ventricle true cord and subglottis
A lesion of the glottis may then be exci
sed under direct vision Figures 10 11
Reattach the anterior ends of the vocal
cords to the cut edges of the thyroid car
tilage with permanent monofilament
material e g nylon to prevent retraction
and shortening of the cords
If there is a concern about webbing ac
ross the anterior commissure due to
denuding of both vocal cords a silastic
keel can now be placed and secured
Figure 2
Reapproximate the cut edges of the car
tilage accurately by using sutures or
miniplates
Suture the thyroid perichondrium
Reapproximate the strap muscles in the
midline Figure 11 Cordectomy defect
Insert a pencil or corrugated drain to
avoid surgical emphysema Complications
Suture the skin
Remove the tracheostomy tube once the Webbing of anterior commissure this is
airway is adequate due to failure to reapproximate the vo
cal cords to the anterior edges of the
laryngofissure or not inserting a silastic
keel when the opposing mucosae of the
vocal cords have been traumatised
4
Non healing thyrotomy e g following
previous radiation therapy
Laryngocutaneous fistula this generally
closes spontaneously
Malunion of the thyrotomy may cause a
poor voice
Useful reference
AfHNS Clinical Practice Guidelines
for Glottic Cancers in Developing
Countries and Limited Resource Settings
Author and Editor
Johan Fagan MBChB FCS ORL MMed
Professor and Chairman
Division of Otolaryngology
University of Cape Town
Cape Town South Africa
johannes fagan uct ac za
THE OPEN ACCESS ATLAS OF
OTOLARYNGOLOGY HEAD
NECK OPERATIVE SURGERY
www entdev uct ac za
The Open Access Atlas of Otolaryngology Head Neck
Operative Surgery by Johan Fagan Editor
johannes fagan uct ac za is licensed under a Creative
Commons Attribution Non Commercial 3 0 Unported
License
5


Related Books

This document sets out Fosun’s UK tax strategy and how the ...

This document sets out Fosun’s UK tax strategy and how the ...

Silver Cross is a leading UK nursery brand and engages in the business of designing and selling nursery product including strollers, furniture, car seats and etc. via retailer or consumer directly. As at the end of the 30 June 2018, Fosun Group indirectly held 87.2% equity interest in Silver Cross through its wholly-owned subsidiary. In the UK,

Continue Reading...
DECISION OF THE UPPER TRIBUNAL (ADMINISTRATIVE APPEALS ...

DECISION OF THE UPPER TRIBUNAL (ADMINISTRATIVE APPEALS ...

considered this appeal on 5 June 2018. (3) The Appellant is reminded that the tribunal can only deal with the appeal, including her health and other circumstances, as at the date of the original decision by the Secretary of State under appeal (namely 1 September 2017). (4) If the Appellant has any further written evidence to put before the tribunal, and especially medical evidence, this should ...

Continue Reading...
Macro-prudential Policy in an Agent-Based Model of the UK ...

Macro-prudential Policy in an Agent-Based Model of the UK ...

of the UK Housing Market Adrián Carro, Marc Hinterschweiger, Arzu Uluc OECD seminar Paris, 27 June 2018 * The views expressed in this presentation are those of the author(s), and not necessarily those of the Bank of England or its committees.

Continue Reading...
DECISION OF THE UPPER TRIBUNAL (ADMINISTRATIVE APPEALS ...

DECISION OF THE UPPER TRIBUNAL (ADMINISTRATIVE APPEALS ...

12. In the statement of reasons, dated 1 June 2018, the tribunal judge went to considerable lengths to explain why the tribunal considered the reasons given for the supersession to be inadequate; and why therefore the supersession decision was being set aside, essentially reinstating the original decision. 13. One of the net effects, however ...

Continue Reading...
Application Pack

Application Pack

Finance Manager, to [email protected] . For further information visit our website www.tsla.co.uk , alternatively please contact Lorna Johnson on 01724 842447 or via email. If you would like to discuss the role please contact the Subject Leader Lindsay Shutes on 01724 842447 or email to [email protected]

Continue Reading...
Crighton Woods Open Session - storage.googleapis.com

Crighton Woods Open Session - storage.googleapis.com

Crighton Woods Open Session June 2, 2018 at Steve’s home at 13233 Autumn Ash 10:00 a.m. I. Establish a quorum- Trevor, Lance and Steve were in attendance also in attendance was

Continue Reading...
RESOLUTION CONFERENCE 2019 KEY NOTE ADDRESS LIVING IN ...

RESOLUTION CONFERENCE 2019 KEY NOTE ADDRESS LIVING IN ...

As everyone will know the effect of the European Union (Withdrawal) Act 2018 taken together with the Withdrawal Agreement negotiated between the UK and the EU would have the effect of maintaining existing EU law in force during the transition period which is due to run up until December 2020. In that period the principal measure

Continue Reading...
Personal Independence Payment and Disability Living Allowance

Personal Independence Payment and Disability Living Allowance

Age UK factsheet 87 June 2019 Personal Independence Payment and Disability Living Allowance Page 6 of 28 4 PIP components Qualifying for either PIP component depends on an assessment of your ability to perform particular activities related to daily living or mobility. Each activity contains a range of statements (called descriptors),

Continue Reading...
Dragon NaturallySpeaking Version 11.5 Guide de l'utilisateur

Dragon NaturallySpeaking Version 11.5 Guide de l

Introduction 2 À propos de ce guide Ce guide couvre toutes les éditions Dragon, dont NaturallySpeaking et Dragon Medical. La plupart des informations présentées s’appliquent à toutes les éditions.

Continue Reading...