Membrane incised during hemilaryngectomy is
Ans. is 'b' i.e., Cricothyroid Steps in hemlaryngectomyIndications and containdications* Ideal for bulky lesions of the membranous true vocal cord* Normal or slightly impaired vocal cord mobility* No involvement of the supraglottis* Tumor may extend as far as the apex of the ventricle* Subglottic extension of no more than 5 mm posteriorly (10 mm anteriorly)* The body of the arytenoid is a contraindication, although the vocal process is not* No more than one third of the contralateral vocal cord involved (consider supracricoid partial laryngectomy)Technical points* Administer perioperative antibotics* Re-encloscope the patient* Perform a preliminary tracheostomy* Make a horizontal skin incision over the thyroid ala.* Raise the flaps superiorly and inferiorly while avoiding the tracheostomy incision* Incise the perichondrium from the thyroid notch down the midline over the ericothyroid membrane.* Elevate the perichonadrium with the attached overlying strap muscles.* Mark the cartilage incisions while retaining a 3 mm wide posterior strip.* Out with a saginal saw* Use a headlight* Incise the perichondrium along the superior border of the thyroid ala. Incise across the petiole of the spiglotis. This will provide panoramic view of the larynx.* Incise the cricothyroid membrane along the superior aspect of the circoid cartilage.* Using a no. 15 blade, cut down to the true vocal cord and examine and cut through the one vocal cord either in the midline or in lesions that cross the anterior commissure. 2 to 3 mm behind the visible tumor.* Using hooks, open the thyroid alae like a book.* STOP. Carefully evaluate the lesion and determine the ares to be excised.* Excise the tumor by incising along the apex of the aryepiglotic fold down around the arytenoid or through the vocal process of the arytenoid, depending on the posterior extent of the tumor.* Orient and examing the surgical specimen and select sites for frozen section examination of the margins* Obtain hemostasis* Suture the contralateral cord to the anterior end of the remaining cartilage or to the external perichondrium* An epiglotopex must be performed in cases of extended vertical partial laryngectomy.* Insert a nasogastric tube for feeding* Close the perichondrium with probable suture* Inferiorly based or pedicled muscle flaps may be used reconstrict the glottis but are probably not necessary* A cricopharyngeal myotomy is not required* Close the wound in layers over a chain* Apply a neck dressing
Thyrohyoid
Cricothyroid
Aryepiglottic
Infralaryngeal
Larynx