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Total Laryngectomy
Cancer of the right Piriform Sinus
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| 1. Planning the incision. | 2. Completed right radical neck dissection with preservation of the accessory nerve. |
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| 3. Elevation of the skin flaps to continue with the laryngectomy. | 4. Dissection of the left jugular nodes. |
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| 5. Preparing to bisect the omohyoid muscle. | 6. Preparing to bisect the common facial vein. |
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| 7. Opening the carotid sheath. | 8. The superior thyroid artery (major blood supply to the larynx) is seen. |
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| 9. Dissection of the strap muscles. | 10. Ligation of the inferior thyroid veins. |
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| 11. Dissection of the muscles above the hyoid bone. | 12. Removing the greater cornu of the hyoid bone. |
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| 13. Preparation to ligate the superior thyroid artery. | 14. Cutting the inferior pharyngeal constrictor along the lateral edge of the thyroid cartilage. |
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| 15. Detachment of the lateral wall of the healthy piriform sinus from the thyroid cartilage. | 16. The process of separating trachea from the esophagus. |
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| 17. Mobilizing larynx on the right side. Dissection of the strap muscles. | 18. The lateral wall of the diseased piriform sinus. |
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| 19. Cutting the right greater cornu of the hyoid bone. | 20. Separating trachea from the esophagus. The surgeon’s glove from the other side is seen. |
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| 21. Complete mobilization of the trachea. | 22. Preparing the tracheostoma in the planned position. |
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| 23. Cutting the trachea. | 24. Suturing the trachea to the skin and entering the pharynx from the healthy side. |
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| 25. Complete removal of the larynx. The remnant of the pharyngeal wall and the feeding tube is seen. | 26. Suturing the pharynx around the feeding tube. |
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| 27. Reinforcement of the tracheostoma. | 28. Preparing to suture the wound. |
