Outline 10 Surgery Flashcards
In surgery it’s important to remember what about clean borders?
you cut into healthy tissue along with the tissue in order to make sure you’ve gotten all of the cancerous tissue
What is an Exofittic laryngeal tumor?
you can feel it; external
what is a Lumpectomy?
o Removal of the lump only, with the rest of the laryngeal tissue staying intact
•But if you remove the lump from one side of the larynx he larynx will no longer work – will not protect the airway
Remember the main biological functionof the larynx is?
protection of the air way
So, lumpectomy is not always the wisest choice
After surgery the client will have 3 different types of results, what are they?
- the patient will undergo another surgery (if the whole tumor wasn’t removed)
- radiation
- If the patient had pre-surgery radiation, he/she will not undergo post-surgery radiation–hospice
- they got it all yay!
What to remove is based on what?
Initial visual inspection and biopsied material of the tumor
In the Initial visual inspection it may show what two outcomes?
May show they got it all or whether or not they need to take more
Decision about what to take may change depending on the report on visual inspection and biopsied material vs. in surgery
T/F If you’re going to counsel a patient on laryngectomy surgery, you need to address that the plan might change once the surgery is in progress so they need to be prepared for a total removal.
True
Initial incision is ___ shaped
Initial incision = t-shaped
what is t-shaped good?
o Maximum opening of tissue
-Maximum exposure of structures
When do you have a total laryngectomy?
If cancer extensive
In a total laryngectomy that include from ____ to _______
Everything from
o Hyoid bone down to trachea is removed
Hyoid bone, entire larynx, (possibly thyroid gland), and sometimes the top 2-4 tracheal rings removed
Surgery may take ____ hours.
3-5 hours
In surgery what happens to muscles attachments?
Cutting off a lot of muscle attachments
Remove pharyngeal constrictors because of their attachment cricoid cartilage
Inferior constrictor has to be cut away from thyroid cartilage
The inferior constrictor makes a half-circle and is attached to thyroid cartilage. Why is this constrictor important in regards to therapy?
After the larynx is removed, the inferior constrictor is going to be tied to itself and brought around to make a whole circle.
Will be sewn together to maintain a circular arrangement for peristalsis (for swallowing)
o BUT if the laryngeal cancer has penetrated through thyroid cartilage and into the inferior constrictor what cannot be saved?
pharynx cannot be saved, either
If you cannot use your pharynx then, you’re going to be ______ for the rest of your life
- tube-feed for the rest of your life
- SO, once the cancer has gone through the constrictor muscles, it is potentially lethal (Stage 4)
o Once you cut free the larynx they’ll remove the intubation tube from the patients mouth and stick it in the _________
trachea
If they don’t take out the pharynx how do they repair the pharynx?
All the pharyngeal constrictors have to be sewn back together, so they will work to get food into the esophagus
UNLESS the esophagus has been eradiated and is stiff
What happens with trachea in surgery?
- Is going to be turned anteriorly—90 degrees to the person’s chin
- Since it does not attach to anything they will turn it forward and make a hole in the neck
- Literally sewn into the external skin of the neck
What is a stoma?
the permanent hole
•that the trachea is sewn into and opening in the neck
•that a laryngectomee will breath through the neck
-There is no way of closing this
What happens in a partial laryngectomy?
•Thyroid gland is cut in half
-Epiglottis is pulled forward, slicing more muscles off, the intubation tube from the mouth and stick it in the trachea
Does a partial laryngectomy have a high cure rate ?
no, there seems to always have left over cancer cells
What is a Cordectomy ?
partial laryngectomy cure rate is not good.
•Tumor is sitting between false and true VF
What is a Hemilaryngectomy ?
take out ½ of the larynx
•One vertical half is removed
What is a Supraglottic laryngectomy ?
Horizontal
What happens in a combination surgery?
Take out a quarter, half of it vertical or horizontal
What is the main issue in partial laryngectomies?
Larynx will not work!
The esophagus is split into two things… what are they?
upper esophageal sphincter (UES)
and
lower esophageal sphincter (LES)
What is the main function of UES?
UES prevents air from going down your esophagus
o needs to vibrate with esophageal speech, and…
o Sphincter has a high tone at rest so whatever is opening when sphinctering remains closed = constant state of contraction
_______ is the primary muscle of UES
•Cricopharyngeus (lowest muscle of inferior constrictor)
If cricopharyngeus REMAINS, then
the individual has a good chance of being able to use esophageal speech
If cricopharyngeus is REMOVED
you will be an electro-pharynx speaker (no natural speech sounds)
lower esophageal sphincter (LES) AKA “cardiac sphincter” does what?
Prevents acid and food from coming up the esophagus
What are some characteristics of the esophagus?
•The esophagusis 30 cm in length FOR EVERYONE
•The esophagus is firmly attached to the trachea
•The inner layer of muscle of the esophagus is circular, the outer layer is horizontal.
•The top, when closed, looks more like a slit than a circle.
•You cannot see the esophagus through an endoscopic eval through the mouth
o The opening of the esophagus is just posterior to the arytenoids
what is the Issue w/esophagus with laryngectomys?
because it can be a source of speech
oRemember that esophagus and trachea share a wall with each other
oRemember that tracheal walls are not complete; tracheal rings are open so that the esophagus can sit right into the trachea
oYou can poke a hole through the trachea into the esophagus.
oIf you plug the stoma with your thumb so that air cannot get through it, the air will go into the esophagus and come out the mouth – can be effective for speech!
Upper esophagus innervated by
CN X
Lower E. innervated by what 3 things?
CN IX -Glossopharyngeal, CN X - Vagus CN XI - Accessory (but mostly CN X) oLaryngectomy can cause nerve damage, which may also take out the option of esophageal speech.
part of this branch comes out in surgery
Recurrent laryngeal branch –
when you are assessing a lary for speech, look for
- Tissue compliance- has radiation affected tissue in mouth and throat?
- Hearing for a laryngectomee and potentially his spouse because alaryngeal speech is quieter than normal speech
- Laryngectomy can result in a quiet household
oAssess pulmonary function (esp. if lary was a smoker) → can he/she produce enough air pressure to use thoracic compression for esophageal speech?
assess larngectomees for pulmonary function as most are
former smokers
