O10 Surgery EXAM 2

Question 1

Talk about “clean borders” in terms of surgery.

Answer 1

Surgeons cut into healthy tissue along with the tissue of the tumor in order to make sure they have gotten all of the cancerous tissue.

Question 2

What is an exofittic tumor?

Answer 2

A tumor that you can feel; it is external.

Question 3

What is a lumpectomy?

Answer 3

Removal of the lump only. In a laryngectomy, the rest of the laryngeal tissue will stay intact. However, if you remove the lump from one side of the larynx, the larynx will no longer function correctly (protect the airway), causing the patient to aspirate his/her food or liquid. Therefore, a laryngectomy is the better option.

Question 4

After a lumpectomy, the tissue will be sent to a pathologist who will notify the surgeon whether or not all of the cancerous tissue was removed with the lump. If it was not, what is the next step the patient must undergo?

Answer 4

Another surgery, or radiation. However, if the patient had pre-surgery radiation, he/she will not undergo post-surgery radiation. Then, the surgeon must tell the patient that he was unable to remove all of the cancer, and that the patient only has a few more years left.

Question 5

How does a surgeon decide what to take?

Answer 5

This decision is based on the initial inspection and biopsied material of the tumor, BUT once the surgery is in progress, decisions about what to take may change because the surgeon may discover more tumor than they initially thought was present. Therefore, you won’t know ahead of time if it will be a partial or total laryngectomy.

• 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.

Question 6

What shape is the initial incision in a laryngectomy?

Answer 6

T-shaped

Question 7

What gets removed in a total laryngectomy?

Answer 7

Everything from hyoid bone down to the trachea. Hyoid, entire larynx, possibly the thyroid gland, and sometimes the top 2-4 tracheal rings.

Question 8

How long does a total laryngectomy surgery usually take?

Answer 8

About 3-5 hours (a pretty long time!)

Question 9

True or false - in a total laryngectomy, the tongue may also be removed.

Answer 9

True :/

Question 10

What shape does the inferior constrictor normally make, and what structure is it attached to?

Answer 10

Inferior constrictor makes a half-circle and is attached to the thyroid cartilage.

Question 11

After the larynx is removed, what happens to the inferior constrictor muscle?

Answer 11

It is tied to itself and brought around to make a full circle. This will maintain a circular arrangement for peristalsis (swallowing).

Question 12

What happens if the cancer has penetrated through thyroid cartilage and into the inferior constrictor muscle?

Answer 12

You’re essentially going to have to cut the throat – the pharynx cannot be saved, either. If a patient cannot use his/her pharynx, they will be forced to tube-feed for the rest of their life.

Question 13

What are the four types of partial laryngectomies?

Answer 13

1. Cordectomy - removal of a vocal fold
2. Hemilaryngectomy - take out 1/2 of larynx
3. Supraglottic laryngectomy
4. Combinations

Question 14

What are two issues with partial laryngectomies?

Answer 14

a) Larynx will no longer function correctly

b) The cancer cure rate is not good

Question 15

What are the two sphincters of the esophagus and what are their jobs?

Answer 15

1. Upper esophageal sphincter (UES) - prevents air from entering the esophagus. It’s muscle is the Cricopharyngeus.
2. Lower esophageal sphincter (LES), AKA “cardiac sphincter” - prevents food from coming up the esophagus.

Question 16

What is the muscle of the UES?

Answer 16

Cricopharyngeus - the lowest muscle of the inferior constrictor.

Question 17

If cricopharyngeus muscle remains after a laryngectomy, what does this mean for the patient? If it is removed?

Answer 17

If this muscle remains, the patient will have a good chance of being able to use esophageal speech. However, if it is removed, they will have to speak with an electrolarynx.

Question 18

How long is the esophagus? (there is no variation - it’s the same length in everyone)

Answer 18

30 cm long

Question 19

Can you see the esophagus through endoscopic eval through the mouth?

Answer 19

No. The opening of the esophagus is just posterior to the arytenoids.

Question 20

Where is the esophagus?

Answer 20

It sits just behind the trachea, sharing a wall with trachea.

Question 21

True or false - tracheal rings are closed.

Answer 21

FALSE - tracheal rings are OPEN so that the esophagus can sit right into the traceha.

Question 22

True or false -You can poke a hole through the trachea into the esophagus.

Answer 22

TRUE

Question 23

What happens if you plug your stoma with your thumb?

Answer 23

You will force the air to travel through the esophagus and come out the mouth. This can be an effective way to produce speech!

Question 24

What nerve is upper esophagus innervated by?

Answer 24

CN X - Vagus

Question 25

What nerve is lower esophagus innervated by?

Answer 25

CN IX- Glossopharyngeus; X- Vagus; XI-Accessory

But MOSTLY CN X

Question 26

Laryngectomy can cause nerve ________, which can eliminate the option of using ______ ____.

Answer 26

Laryngectomy can cause nerve DAMAGE; can eliminate the option of ESOPHAGEAL SPEECH.

Question 27

When assessing a laryngectomee for speech, what are two things to assess?

Answer 27

a) Tissue compliance - has radiation affected tissue in the mouth and throat?
b) Hearing - alaryngeal speech is quieter than normal speech so if he or his spouse are hard of hearing, it will affect their ability to communicate.
c) Plumonary function - especially if the lary was a smoker; can he/she produce enough air pressure to use thoracic compression for esophageal speech?

Question 28

What is the permanent hole in the neck that the trachea is sewn into called?

Answer 28

A “stoma”

Question 29

How does a laryngectomee breathe?

Answer 29

Through the stoma! NOT through the mouth or nose, because the trachea is no longer connected with the mouth or nose.