COMPLICATIONS OF TOTAL LARYNGECTOMY OPERATION IN ALEXANDRIA MAIN UNIVERSITY HOSPITAL

Abstract

A. Laryngeal Anatomy1) Cartilages: unpaired (thyroid, cricoid and epiglottis), paired (arytenoid, corniculate and cuneiform)2) Joints: Cricoarytenoid & Cricothyroid.3) Ligaments and membranesi. Extrinsic and intrinsic ligamentsii. Vocal and Vestibular folds 4) Musculature: Intrinsic and Extrinsic Laryngeal muscles5) Innervation: Superior laryngeal nerve, Recurrent laryngeal nerve, AnsaGaleni.B. Laryngeal Carcinoma  Second most common head and neck cancer  Surgical management: Conservative, Total laryngectomy, Extended totallaryngectomyC. Total laryngectomy Indications: i. T3, T4 carcinomas. ii. Cartilage invasion or extra laryngeal spread.iii. Involvement of Posterior commissure, arytenoids, or cricoarytenoid joint.iv. Completion laryngectomy after failure of conservative surgery.v. Recurrence after radiotherapy or chemoradiation.vi. Complications or Contraindication to conservative therapy.vii. Hypopharyngeal tumors viii. Thyroid tumors invading the larynx. Complications:i. Intraoperative: Bleeding, Injury of thoracic duct, Nerve or vessels injury, Pneumothorax, Air embolism.ii. Postoperative a) Early:1) Pharyngo-cutaneous fistula.2) Chyle leak.3) Bleeding, hematoma.4) Wound complications. 5) Flap congestion & necrosis6) Respiratory complications.7) Carotid blow out.b) Late:1) Recurrence.2) Stomal complications 3) Dysphagia.4) Complications of voice prothesis.5) Hypocalcemia and hypothyroidism.