Laryngectomies

The first recorded laryngectomy ever done was performed on a dog, in 1829 by H. Albers. The dog survived nine days. Later in 1866, Patrick Watson preformed the first laryngectomy on a man. The patient’s larynx was being devastated by syphilis; he survived the operation, but later died of pneumonia, and because of this the surgery was condemned. The first successful laryngectomy took place in 1873, by Billroth. The patient had to have a tumor removed from one of the vocal folds, but because the growth had spread the entire larynx had to be removed. He survived for one year but later died due to reoccurrence. Of t

The consumption of all types of alcohol can have cancer-causing effects. In the Third National Cancer Survey (1975) 112 (in which most of the other carcinogenic variables were controlled), the relative risk of alcohol drinkers (compared with non-drinkers) developing laryngeal carcinoma was increased 2.2-fold (Koufman & Burke, 1999). Interestingly, the rate of laryngeal cancer in France dropped during the Second World War, mirroring a fall in the consumption of alcohol, despite no change in tobacco use (Koufman & Burke, 1999). However, it is known that the combination of alcohol and tobacco increases the risk for cancer.

The Treatment and Surgical Procedure

One cause for removal of the larynx is when it is damaged, due to a traumatic impact, and the results are beyond repair. The main cause of laryngectomies is cancer. In the United States, laryngeal cancer accounts for approximately 1% of all new cancer diagnoses, but less than 1% of all cancer deaths. Many patients who develop laryngeal cancer are men with a ratio of 5:188. (Koufman & Burke, 1999) There are many etiologies to carcinoma; this paper will just include tobacco, alcohol, occupational risk factors, and diet and vitamin deficiency.

According to David Terris M.D., ”…there is a horizontal cervical incision at the level of the thyroid cartilage with a separate incision for the stoma at least a fingerbreadth below. Subplatysmal flaps are raised, and the cancer-bearing side of the larynx is dissected as for a routine laryngectomy, with inclusion of the Delphian node, resection of the ipsilateral thyroid lobe, removal of the hyoid bone, and skeletonization of the thyroid cartilage. The contralateral dissection differs in that the strap muscles are preserved with their neurovascular supply, and the recurrent laryngeal nerve is likewise preserved. The greater horn of the hyoid bone is left intact. Ideally, the larynx is entered at the contralateral ventricle, as described by Pearson and DeSanto, since it should never be involved with cancer; however, in a departure from this method, the authors commonly enter the larynx at the vallecula, given it is free of cancer. One reason is that most practicing head and neck surgeons are familiar with the approach. Furthermore, although entering in the contralateral ventricle is safe in every instance, that approach provides a technical challenge that usually is unnecessary. The site of entrance into the larynx may, therefore, be dictated by the disease. Once the larynx is entered, perform the remaining cuts with the tumor under direct visualization. Preserve the posterior border of the contralateral thyroid cartilage to aid in maintaining the integrity of the recurrent laryngeal nerve on that side. Make a horizontal cut along the base of tongue toward the cancer-bearing side; this significantly improves the exposure. Then make a vertical cut through the larynx on the noncancer side, preserving as much of the contralateral true vocal cord as possible, depending on the extent of the cancer. Divide the cricoid and perform partial cricoidectomy. Preservation of uninvolved subglottic mucosa is desirable, but nearly all of the cricoid cartilage should be removed to minimize the chance of an excessively patent shunt that leads to aspiration. Divide the interarytenoid area, and make the remaining cuts with preservation of as much pyriform mucosa as possible. The most difficult aspect of the NTL is the reconstruction, specifically the formation, of the shunt. Generally, the mucosa between the pharynx and the trachea that remains at the end of the ablation (provid

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