3/10- Surgery

Question 1

Who developed the T incision?

Answer 1

Von Langenbeck

Question 2

What is so important to do during surgery?

Answer 2

• remove every single cancer cell. If you leave one single cell there will be reproduction because it will rapidly reproduce. It is not normal so it won’t die on its own.- Go to clean borders/healthy margins. You must cut into healthy tissue to be sure you have all the cancer cells

Question 3

Who can perform a laryngectomy?

Answer 3

Surgeon, ENT, Otolaryngologist

Question 4

What is exofittic?

Answer 4

Classification- a tumor that is protruding, you can identify the lump (i.e., exofittic breast tumor).

Question 5

t/f

the less tissue that is removed, full recovery is more likely

Answer 5

false. You might not get all the cancer.

Question 6

What is the downfall (in regards to your larynx) to only doing a lumpectomy

Answer 6

Patients will choose a lumpectomy over a laryngectomy, but if you only remove the lump the larynx isn’t going to work. it will not work for voicing, and it will not fulfill its primary biological function.

Question 7

What is the biological function of the larynx?

Answer 7

protection of the airway

Question 8

What occurs when the tissue is removed during a cancer surgery?

Answer 8

the tissue is rushed to a pathologist who will do an onsite inspection and look for cancer on the edges of the tissue that has been removed. If the pathologist says the edges are clean they they close the patient up. If not, the surgeon will take out even more, or the patient will go to radiation therapy.

Question 9

t/f

If the patient has pre-surgery radiation, there will not be post surgery radiation?

Answer 9

true

It’s all about the dosage amounts (gys)

Question 10

Why is a T incision so widely used?

Answer 10

maximum opening of tissue and exposure of the structures that need to be inspected without doing more cuts.

Question 11

If a total laryngectomy is performed, what is removed?

Answer 11

From the hyoid bone to the trachea (first 2-4 rings) (sometimes the tongue can be resected/removed)

Question 12

How long does the surgery take?

Answer 12

3-5 hours

Question 13

Review pictures in surgery notes

Answer 13

.

Question 14

Why are the pharyngeal constrictors removed?

Answer 14

Because of their attachment to cricoid and thyroid cartilages. The inferior constrictor makes a half circle on the posterior aspect of the larynx, it is attached to the thyroid cartilage. After the larynx is removed the inferior constrictor will be tied to itself and be brought around to make a whole circle.

Question 15

What are issues with a cordectomy?

Answer 15

The larynx won’t work. Not a high cure rate. Cancer cells seem to be left

Question 16

What is a hemilaryngectomy?

Answer 16

Taking out 1/2 of the larynx

Question 17

What is a supraglottic laryngectomy?

Answer 17

Horizontal cut

Question 18

t/f

there are many combination for cuts and surgery types?

Answer 18

true1/4 of it, 1/2 of it. vertically or horizontally cut. The main issue is the larynx isn’t going to work

Question 19

What is the muscle that is used for the upper esophageal sphincter (UES)?

Answer 19

cricopharyngeus

Question 20

If the cricopharyngeus remains in tact, what are the person’s chances of using some esophageal speech?

Answer 20

Good. If all the cricopharyngus is removed with the laryngectomy than there is no chance at all.

Question 21

What are the two sphincters of the esophagus?

Answer 21

upper esophageal sphincter (UES) and lower esophageal sphincter (LES)

Question 22

A sphincter is in a…?

Answer 22

constant state of contraction

Question 23

What is the purpose of the UES?

Answer 23

To keep air out of the esophagus therefor the stomach

Question 24

What is the purpose of the LES?

Answer 24

keep stomach acid and food you just swallowed from coming back up again

Question 25

t/f

The UES doesn’t care about food coming back up?

Answer 25

TRUE

Question 26

t/f

The LES doesn’t care about air

Answer 26

TRUE

Question 27

Which sphincter vibrates with esophageal speech?

Answer 27

UES.

Question 28

What is the esophagus firmly attached to the trachea by?

Answer 28

Muscle fibers and a fibroelastic membrane

Question 29

How does the top of the esophagus close?

Answer 29

Like a slit. It closes horizontally

Question 30

What are effective sources of speech?

Answer 30

esophageal or TE speech (tracheal esophageal puncture/prosthesis)

Question 31

What is the upper esophagus innervated by?

Answer 31

CN X just like the larynx

Question 32

Lower esophagus is innervated by?

Answer 32

CN IX, X, and XI but mostly by X

Question 33

What is the name of CN IX?

Answer 33

Glossolpharyngeal

Question 34

What is the name of CN XI?

Answer 34

Accessory

Question 35

When assessing larngectomees for speech, what should you look at?

Answer 35

• tissue compliance (has radiation effected the tissue in the mouth and throat?)
• Hearing (potentially for his spouse too because a-laryngeal speech is quieter, and they are older patients)
• Pulmonary function (most are former smokers). Can the laryee produce enough air pressure to use thoracic compression for any type of esophageal speech?

Question 36

FYI

When you are talking about laryngeal cancer, you are talking about cancer staging. Think of these things in terms of FUNCTION!

Answer 36

.

Question 37

Are cellular changes good?

Answer 37

Cellular changes are NOT good (cells shouldn’t change to be different colors or textures).

Question 38

What does laryngeal cancer look like?

Answer 38

Cancers tend to look white in the larynx. Sometimes with purple reddish edges. More advance stages of vocal fold cancer is big white blobs and stiffness/ Laryngeal cancer is going to hold laryngeal structures in place and deem them immobile making them stiff.