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Total Laryngectomy

Cancer of the right Piriform Sinus

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