dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011
DESCRIPTION
TRANSCRIPT
![Page 1: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/1.jpg)
Nova Medical Centers KAILASH COLONY
©2009. Nova Medical Centers. Strictly private and confidential
![Page 2: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/2.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Laryngeal Surgery
an Overview
Dr. Lalit Mohan Parashar
Deptt of Otorhinolaryngology and
Head & Neck Surgery
Dr. Lalit Mohan Parashar Senior Consultant OTORHINOLARYNGOLOGY &
Head and Neck Surgery
(ORL&HNS)
![Page 3: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/3.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
The Problem spectrum
• Hoarseness and Voice Disorders • Breathing difficulty & stridors • Malignancies and cancers • Iatrogenic- Thyroid surgery and ICU survivers &
• Traffic and other accidents.
![Page 4: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/4.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Effective Diagnosis
• Begins at OPD • Clinched in Endoscopy Rooms • Confirmed with/ without Stroboscopy &
• Refined in Voice Lab
![Page 5: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/5.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
THE ENT OPD
![Page 6: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/6.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
THE ENT OPD
![Page 7: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/7.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Endoscopy
![Page 8: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/8.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Endoscopy Room
Normal larynx during phonation3.flv
![Page 9: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/9.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Laryngoscopy workout
• Sustained eee…. • Quiet Respiration • Glide- Sustained eee at low & High pitch • Cough / laugh
• Stroboscopic Evaluation
![Page 10: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/10.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Video –endoscopy- stroboscopy
![Page 11: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/11.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Recording and Replay
• Much More Informative.
• Longitudinal Comparison • Pre-op planning • Patient Education • Medical / Legal uses
![Page 12: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/12.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Vocal Cord Growth
![Page 13: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/13.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Dysphonia Plica Venticulare
![Page 14: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/14.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Laryngeal Surgery Kotby's classification
1. Extirpation endolaryngeal microsurgery. 2. Vocal fold augmentation. 3. Vocal fold repositioning. 4. Neurophonosurgery. 5. Glottal reconstruction after partial laryngectomy. 6. Postlaryngectomy surgery. 7. Laryngo Tracheal Trauma
![Page 15: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/15.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Micro Laryngeal Surgery
![Page 16: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/16.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Micro Laryngeal Surgery
![Page 17: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/17.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Extirpation Endolaryngeal Microsurgery conventional microsurgery(MLS)
• Indications: • Congenital Lesions: • Sulcus vocalis & vergeture. Laryngeal web • Epidermoid cysts & laryngoceles. Laryngeal
stenosis • Acquired lesions • Granulomata. :Benign neoplasm • • VF hemorrhage. • Papillomatosis. • • Dysplasia of VF. & Carcinoma in situ. •
![Page 18: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/18.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
G.A. considerations
• Oral Intubation with MLS tube ( high volume low pressure Cuff ) or
• Jet Ventilation – Sub –Glottic Ventury or -- Supra Glottic Ventury via
laryngoscope
![Page 19: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/19.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Tube Position
• Anterior Vocal cords 2/3rd :- small ETT
• Posterior Vocal Cords :- Anterior ETT or
» Jet Ventillation or
» Apneic Techniques
![Page 20: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/20.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Other Considerations
• Laser Protected ETT
• Care of Sub Glottis and • Care of tracheal Stoma
• Difficult Per Oral exposure
![Page 21: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/21.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Difficult Per Oral exposure • Short Thick Neck • Retrognathia • Trismus • Restricted Neck Extention • Lingual Hypertrophy • Poor Palatal visualisation
![Page 22: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/22.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Long list of requirements
• Largest Bore Laryngoscope + ant. & post. Comm. • Suspension Systems • Specialized Instruments • Mouth/ dental Guard • Subepithelial Infusion needle • Operating Microscope – 400mm lense • Optical Telescope – 4mm x 20 cms • Microdebrider/ laser system
![Page 23: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/23.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Microflap Excision
![Page 24: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/24.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Microdebrider
![Page 25: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/25.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Laser Assisted
![Page 26: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/26.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Robotics
![Page 27: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/27.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Vocal Fold Augmentation • Indications: • Correction of glottic incompetence due to: • Unilateral vocal fold paralysis. • Sulcui or after surgery or trauma.
• Autologous and alloplastic materials. • Transoral or percutaneous approaches. • Silicon, Teflon, Gelfoam, Autologous Fat
![Page 28: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/28.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Injection Medialisation
![Page 29: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/29.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Repositioning of the Vocal Fold
Medialization surgeries (Mediopexy) 1. Surgical augmentation 2. Arytenoid adduction Lateralization (Lateropexy) 1. Arytenoid repositioning. 2. Arytenoidectomy with posterior partial cordectomy. Sharp dissection Laser excision.
![Page 30: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/30.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Laser Assisted
![Page 31: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/31.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Thyroplasty
(Laryngeal Framework Surgery)
Altering VF position, shape and tension by manipulating the cartilagenous framework. Isshiki’s functional classification: • Type I - Medialization. • Type II - Lateralization. • Type III - Relaxation (shortening). • Type IV - Stretching (lengthening).
![Page 32: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/32.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Thyroplasty
(Laryngeal Framework Surgery)
![Page 33: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/33.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Medialisation Laryngoplasty
![Page 34: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/34.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Medialisation Laryngoplasty
![Page 35: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/35.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Medialisation Laryngoplasty
![Page 36: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/36.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Medialisation Laryngoplasty
![Page 37: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/37.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Medialisation Laryngoplasty
![Page 38: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/38.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Medialisation Laryngoplasty
![Page 39: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/39.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Medialisation Laryngoplasty
![Page 40: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/40.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Type II - Lateralization
Release the tight closure of the glottis. Approaches: • A vertical incision in the thyroid cartilage and
lateralizing the posterior segment over the anterior one.
• Two paramedian vertical incisions and interpose the lateral segments beneath the anterior segment.
Indication: • Spastic dysphonia.
![Page 41: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/41.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Type III - Relaxation (shortening)
Aimed at lowering the vocal pitch. The VF is relaxed by A-P shortening of the thyroid ala. Indications: • Males with high pitch voice, resistant to voice therapy. • Stiff VF with high pitched breathy voice. • Spastic dysphonia.
![Page 42: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/42.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Type IV - Stretching (lengthening)
CT approximation to elevate pitch. Other Techniques to elevate the pitch: • Inferiorly based anterior cartilage flap. • Superiorly based cartilage flap. • Anterior commissure advancement.
![Page 43: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/43.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Laryngeal Surgery Kotby's classification
1. Extirpation endolaryngeal microsurgery. 2. Vocal fold augmentation. 3. Vocal fold repositioning. 4. Neurophonosurgery. 5. Glottal reconstruction after partial laryngectomy. 6. Postlaryngectomy surgery. 7. Laryngo Tracheal Trauma
![Page 44: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/44.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Neurophonosurgery • Reinnervating the PCA muscle • Nerve anastomosis. Phrenic nerve /ansa cervicalis. • Phrenic nerve implantation. • Neuromuscular pedicle Transplantation. • Reinnervating the TA muscle • Ansa cervicalis to RLN anastomosis • Infrathyroid - suprathyroid techniques • Neuromuscular pedicle Transplantation.
![Page 45: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/45.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Laryngo Tracheal Trauma
![Page 46: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/46.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Laryngo Tracheal Trauma
• Increasing accidents • Time to prepare ourselves is NOW
• Minor Ones or Group I need conservative management
![Page 47: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/47.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Group II Intact endolarynx + Displaced thyroid #
• Open reduction + internal fixation ORIF
• Method
– Sutures
– Wires
– Miniplates
![Page 48: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/48.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Group II Intact endolarynx + Displaced thyroid #
• ORIF • AIM – preservation of AP diameter Maintain Normal position of cords Austin technique
![Page 49: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/49.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Group III Large mucosal lacerations
• Or even small Lacerations involving – Anterior commissure – Free margins of TVC – Exposed cartilage – Multiple # – TVC immobility
• Managed by ORIF + Open laryngeal exploration within 24 hours
![Page 50: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/50.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Group III Large mucosal lacerations
• AIM – Return all remaining tissue to appropriate location – Cover all cartilage
• FUNCTIONAL PRINCIPLES
![Page 51: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/51.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
FUNCTIONAL PRINCIPLES
• BLOOD IN CONTACT WITH CARTILAGE LEADS TO RESORPTION • CARTILAGE IN CONTACT WITH SECRETIONS LEADS TO INFLAMMATION
WHICH LEADS TO GRANULATIONS MESSEGE CARTILAGE HAS TO BE COVERED AT ALL COSTS
![Page 52: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/52.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Group III Large mucosal lacerations
• MIDLINE THYROTOMY or • Pramedian if vertical # within 3mm of midline
• Steps of MIDLINE THYROTOMY
![Page 53: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/53.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
MIDLINE THYROTOMY
• Horizontal skin incision at crico-thyriod m. • Sub platysmal flaps • Separate strap muscles & expose thyroid c. • Midline Thyrotomy saw or drill • Retract laminae laterally • Achieve haemostasis
![Page 54: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/54.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Group III Large mucosal lacerations
• Situation 1 – Primary closure is generally possible – 5-0 or 6-0 absorbable sutures – Minimal undermining to move mucosa – Dibridement should be kept to minimum – DRAIN BLOOD COLLECTIONS – Keep mucosa down by quilting sutures
![Page 55: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/55.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Group III Large mucosal lacerations
• Situation 2 – Primary closure is not possible – Rotate flaps from - Epiglottis - pyriform sinuses – Skin flaps – Mucosal grafts
![Page 56: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/56.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Group III Large mucosal lacerations
• Situation 3 • Arytenoid cartilage dislocated
– Reduce it back – Repair mucosa
![Page 57: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/57.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Group III Large mucosal lacerations
• Reconstruct anterior commissure – 4-0 absorbable sutures from anterior TVC to outer perichondrium - keel
• Close thyrotomy – Non absorbable sutures – SS wire – Wire tube tech.
• ORIF if required
![Page 58: Dr lalit-mohan-parashar laryngeal-surgery-an-overview-ncas_2011](https://reader033.vdocument.in/reader033/viewer/2022042613/5465d951af79596e458b4c75/html5/thumbnails/58.jpg)
©2
00
9. N
ova
Med
ical
Cen
ters
. St
rict
ly p
riva
te a
nd
co
nfi
den
tial
Thank You