Outline 10 Surgery

Question 1

In surgery it’s important to remember what about clean borders?

Answer 1

you cut into healthy tissue along with the tissue in order to make sure you’ve gotten all of the cancerous tissue

Question 2

What is an Exofittic laryngeal tumor?

Answer 2

you can feel it; external

Question 3

what is a Lumpectomy?

Answer 3

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

Question 4

Remember the main biological functionof the larynx is?

Answer 4

protection of the air way

So, lumpectomy is not always the wisest choice

Question 5

After surgery the client will have 3 different types of results, what are they?

Answer 5

1. the patient will undergo another surgery (if the whole tumor wasn’t removed)
2. radiation
3. If the patient had pre-surgery radiation, he/she will not undergo post-surgery radiation–hospice
4. they got it all yay!

Question 6

What to remove is based on what?

Answer 6

Initial visual inspection and biopsied material of the tumor

Question 7

In the Initial visual inspection it may show what two outcomes?

Answer 7

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

Question 8

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.

Answer 8

True

Question 9

Initial incision is ___ shaped

Answer 9

Initial incision = t-shaped

Question 10

what is t-shaped good?

Answer 10

o Maximum opening of tissue

-Maximum exposure of structures

Question 11

When do you have a total laryngectomy?

Answer 11

If cancer extensive

Question 12

In a total laryngectomy that include from ____ to _______

Answer 12

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

Question 13

Surgery may take ____ hours.

Answer 13

3-5 hours

Question 14

In surgery what happens to muscles attachments?

Answer 14

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

Question 15

The inferior constrictor makes a half-circle and is attached to thyroid cartilage. Why is this constrictor important in regards to therapy?

Answer 15

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)

Question 16

o BUT if the laryngeal cancer has penetrated through thyroid cartilage and into the inferior constrictor what cannot be saved?

Answer 16

pharynx cannot be saved, either

Question 17

If you cannot use your pharynx then, you’re going to be ______ for the rest of your life

Answer 17

• tube-feed for the rest of your life

- SO, once the cancer has gone through the constrictor muscles, it is potentially lethal (Stage 4)

Question 18

o Once you cut free the larynx they’ll remove the intubation tube from the patients mouth and stick it in the _________

Answer 18

trachea

Question 19

If they don’t take out the pharynx how do they repair the pharynx?

Answer 19

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

Question 20

What happens with trachea in surgery?

Answer 20

• 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

Question 21

What is a stoma?

Answer 21

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

Question 22

What happens in a partial laryngectomy?

Answer 22

•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

Question 23

Does a partial laryngectomy have a high cure rate ?

Answer 23

no, there seems to always have left over cancer cells

Question 24

What is a Cordectomy ?

Answer 24

partial laryngectomy cure rate is not good.

•Tumor is sitting between false and true VF

Question 25

What is a Hemilaryngectomy ?

Answer 25

take out ½ of the larynx

•One vertical half is removed

Question 26

What is a Supraglottic laryngectomy ?

Answer 26

Horizontal

Question 27

What happens in a combination surgery?

Answer 27

Take out a quarter, half of it vertical or horizontal

Question 28

What is the main issue in partial laryngectomies?

Answer 28

Larynx will not work!

Question 29

The esophagus is split into two things… what are they?

Answer 29

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

Question 30

What is the main function of UES?

Answer 30

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

Question 31

_______ is the primary muscle of UES

Answer 31

•Cricopharyngeus (lowest muscle of inferior constrictor)

Question 32

If cricopharyngeus REMAINS, then

Answer 32

the individual has a good chance of being able to use esophageal speech

Question 33

If cricopharyngeus is REMOVED

Answer 33

you will be an electro-pharynx speaker (no natural speech sounds)

Question 34

lower esophageal sphincter (LES) AKA “cardiac sphincter” does what?

Answer 34

Prevents acid and food from coming up the esophagus

Question 35

What are some characteristics of the esophagus?

Answer 35

•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

Question 36

what is the Issue w/esophagus with laryngectomys?

Answer 36

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!

Question 37

Upper esophagus innervated by

Answer 37

CN X

Question 38

Lower E. innervated by what 3 things?

Answer 38

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.

Question 39

part of this branch comes out in surgery

Answer 39

Recurrent laryngeal branch –

Question 40

when you are assessing a lary for speech, look for

Answer 40

1. Tissue compliance- has radiation affected tissue in mouth and throat?
2. Hearing for a laryngectomee and potentially his spouse because alaryngeal speech is quieter than normal speech
3. 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?

Question 41

assess larngectomees for pulmonary function as most are

Answer 41

former smokers