Judul : Teknik Operasi Laringotomy pada Hewan (Bedah Thoraks)
link : Teknik Operasi Laringotomy pada Hewan (Bedah Thoraks)
Teknik Operasi Laringotomy pada Hewan (Bedah Thoraks)
Definition of laryngotomy operation
Laryngotomy is a pharyngeal operation in which the pharyngeal wall is cut through a laryngotomy. A laryngotomy is performed when the animal's upper airways are blocked by, for example, a foreign object or an obstruction that makes it difficult for the animal to breathe. A laryngotomy operation to facilitate breathing can be permanent or temporary.
Indications for laryngotomy are laryngeal swelling and inflammation, infection, foreign bodies, laryngeal obstruction, laryngeal collapse, epiligotic valve disease, which may be characterized by frequent coughing, choking or breathing difficulties. Partial soft palate resection, arytenectomy, pharyngeal lymphoid hyperplasia, dorsal soft palate displacement, laryngeal ventriculectomy, laryngopharyngeal dehiscence, partial laryngotomy and temporary tracheotomy for airway protection.
The advantage of laryngotomy is that operations can be performed on the horse while standing, which makes the operation easier and minimizes the risk of complications.
However, disadvantages of laryngotomy include the need for an endotracheal tube or tracheal intubation through a tracheostomy and limited access to the pharynx and cranial larynx.
Some types of laryngotomy include:
a. Partial laryngectomy (laryngotomy-thyroidotomy)
Partial laryngectomy is recommended for early-stage glottic cancer when only one vocal cord is affected. The healing rate of this move is very high.
In this operation, the vocal cord is removed and all other structures are left intact. The patient's voice may be hoarse, the respiratory tract remains intact, the patient has difficulty swallowing.
b. Supraglottic laryngectomy (horizontal)
Supraglottic laryngectomy is used in the treatment of supraglottic tumors. The hypoid bone, glottis and false vocal cords are removed.
The cricoid vocal cords and trachea remain intact. During the operation, radical neck pain is performed on the spot. A tracheostomy tube is placed in the trachea until the airway is restored.
After a few days, the tracheostomy tube is removed and the stoma is allowed to close on its own. During this time, the animal is fed through a nasogastric tube until it recovers and there is no longer a risk of aspiration.
After surgery, the client may have difficulty swallowing for the first 2 weeks. The main advantage of this process is that the voice returns to normal.
c. Hemivertetic laryngectomy
This is done when the tumor extends beyond the vocal cords but is less than 1 cm and is limited to the subglottic area.
In this procedure, the thyroid cartilage is cut in the midline of the neck, and parts of the vocal cords (true vocal cords and false vocal cords) are removed as the tumor grows.
The arytenoid cartilage and half of the thyroid cartilage are removed. During the operation, the patient is given a tracheostomy tube and a nasogastric tube.
Patients are at risk of postoperative complications. Some changes in sound quality and projections may occur.
However, breathing and walking function remain unchanged.
I mean. Total laryngectomy
This procedure is used when cancer has spread beyond the vocal cords, such as the hyoid region, epiglottis region, cricoid region, and two or three tracheal loops. This space can be deleted at the same time
While the tongue, throat wall and trachea remain in place. Total laryngectomy requires a permanent tracheal stoma.
This stoma prevents food and liquid from entering the lower airway because the pharynx that protects the sphincter is no longer present.
The patient no longer has a voice, but his function is normal. A total laryngectomy changes the use of airflow for breathing and speaking. .
Laryngotomy Surgical anesthesia
(a) In cows
Animals were anesthetized with xylazine HCL 0.1-0.2 mg/kg body weight intramuscularly and local infiltration anesthesia (lidocaine 2 percent) or lignocaine 15-25 ml/2 cent subcutaneously in the neck region.
It can also be administered under general anesthesia, inhalation anesthesia with halothane, and in the supine position.
b) in horses
An equine laryngotomy was performed under general anesthesia, the horse was first treated with 0.1 mg/kg iv midazolam, and then anesthetized with 2.2 mg/kg ketamine hydrochloride iv.
Anesthesia was then maintained by instillation and inhalation of halothane in oxygen. and animals lie on their backs
Intravenous injection of 3-6 mg/kg body weight phenylbutazone under local anesthesia in the surgical field can also be performed in a standing anesthetized animal.
c) dogs and cats
13.2–26.4 mg/kg body weight with intravenous thiopental. Premedication with acepromazine 0.01–0.05 mg/kg IM followed by butorphanol 0.05 mg/kg IV followed by maintenance inhalation of isoflurane (1.5–2%). The advantage of using the above anesthetics is not to cause laryngeal movement.
There are several other options: iv propofol, iv ketamine plus diazepam, iv acepromazine and iv thiopental, or iv
For cats it is enough to use ketamine and xylase, atropine suggests, the dose of anesthesia is adjusted according to the type of animal, body weight and preparation of anesthesia.
Surgical technique of laryngotomy
The laryngotomy procedure (technique) in several animals is accompanied by the following cases:
(a) Laryngotomy operation in cattle
- First, the skin is cut diagonally and the oval edge of the skin is opened to expose the throat.
- Then the laryngeal cartilage is divided by the sternohyoid muscle division technique and the thyroid gland is closed. The cricothyroid membrane is opened and the cricoid cartilage is removed together with the first 3 rings of the trachea.
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| Intersection between cricothyroid membrane and cricoid cartilage (A,B,C) |
- With additional openings or incisions, the thyroid cartilage can be dissected again.
- The resulting small wound was pulled to the side so that the pharynx could be seen better.
- If necrotic or hypergranulated tissue is observed, the tissue is removed with a curette.
- If there is an abscess, the abscess is cleaned and cleaned, in some cases partial resection affects the vocal cords and arytenoid cartilage while this operation is performed.
- The cartilage is then sutured until the skin is cut through with a simple suture pattern. Vicryl 2/0 or Mercilene thread.
- The cut cartilage is left intact for better cartilage and skin formation. Local or systemic antibiotics at the end of the operation.
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The incisions of the cricothyroid membrane and cricoid cartilage are cut and sutured to the cartilage. |
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| Observe the laryngeal cartilage attached with marginal oblique sutures (A) connecting the laryngeal mucosa and dermis. |
b) laryngotomy in dogs/cats
- Back seat for dog/cat. An incision in the ventral midline of the neck (along the thyroid and coccygeal cartilages).
- Cut through the thyroid cartilage and cricothyroid ligament (Fig. 4).
- Then the endotracheal tube is removed and the vocal cords are cut.
- The endotracheal tube is then reinserted and dissected laterally.
- Attach the folded and undisturbed thyroid cartilage to the basihyoid cartilage with 5-0 polyethylene suture.
- The mucosa and skin are attached with non-absorbable sutures.
- After the operation, an extubator was used to evacuate the dog/cat.
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| An incision in the throat of a dog (left) and the resulting incision is sutured to the bashyoid bone between the thyroid and thyroid cartilage (right) |
(c) Laryngeal surgery in horses
- The skin is cut approximately 10 cm long, from the surface of the cricoid cartilage to the outer layer of the thyroid cartilage. until it forms the letter "V".
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| V-shaped cutting edge |
- In some cases, an angular recess between the thyroid and cricoid cartilage can be felt before the incision, if it does not support the central area of skin cut in a horizontal line in the area connecting the mandibular rami. the neck
- A midline skin incision is made between the sternothyroid muscles and the cricothyroid membrane is divided with scissors to expose it. After division with scissors, the muscle can be pulled to the side. Then the cricothyroid membrane is cleared of fatty tissue, and at this point vascular ligation can be performed in the surgical field.
- Then the cricoid membrane is cut, starting with a knife cut, until it penetrates the laryngeal muscle. The incision is then extended from the caudal cricoid cartilage to the cranial thyroid cartilage junction. Then the thyroid cartilage flap is removed with clamps.
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| Skin incisions are made in the midline of the pectoral muscle. |
- If a small-diameter endotracheal tube can be used, it can be ventricularized with an endotracheal tube. When the tube does not allow the opening of the pharynx (pharynx) and the removal of the ventricle.
- The ventral larynx is found by sliding a cranial finger past the edge of the vocal cords (focal band) and moving it with another finger laterally to the base of the ear toward the ventricle.
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| Dilation of incisions with an endotracheal tube |
- The wool from the larynx is placed as deep as possible into the ventricle and twisted to hold the mucous membrane. When the surgeon is sure that the mucosa has been drilled, the ventricle is carefully separated from the ventricle using the true mucosa.
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| The vocal cords of the throat are drilled |
- Forceps should be used at this stage to prevent mucosal separation. If the mucous membrane is used with forceps, the wool can be removed.
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| Laryngeal bore that identifies the vocal cords |
- With Ochsner forceps or similar instruments placed over the pocket, the mucosa is cut with scissors and completely closed without damaging or injuring the cartilage.
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| Removal of the larynx with forceps and subsequent cutting |
- Because the airway mucosa is not aseptically prepared for infection, laryngotomy incisions are not sutured but remain open, and secondary contamination can occur and abscess formation is a potential problem.
- Laryngotomy wounds received secondary resuscitation. Therefore, wound suturing was not considered. During recovery from anesthesia, an endotracheal tube or tracheostomy tube is used instead of a laryngotomy.
d). Endolaryngeal Surgery
In addition to the third operation, laryngectomy, some animals also have throat operations, namely laryngectomy. Work steps include:
- Schematic view of the larynx 2 cm to the right of the lobe of the thyroid gland, 3-5 mm from the midline and from the lower edge of the lobe.
- Open the partition before and until the interior is visible
- make an incision along the thyroid muscle to the lower edge of the ventricle
- Open abdomen, direct view of left hemilarynx. Once this area is open, cut the upper and outer perichondral sections and insert an endoscope with a light source for endolar visualization with a 300 bend to help identify the bottom and other aspects. The ventricle was then opened from outside to inside with a curved knife. Then the rim is retracted and the laryngeal lumen appears enlarged. Here you can see the opposite sides of the larynx, such as the vocal folds and the ventricles and ventricles. From the commissure to the arytenoid, from the supraglottis to the subglottis.
- Closure of ventricle, mucosa and thyroid muscle with 4-0 Vicryl suture
- Cartilage closure with 2-0 nylon sutures against the skin
Postoperative care
There are several postoperative follow-up procedures that are useful in recovery after laryngotomy in animals.
(a) Postoperative care in horses
- The horse rested for 4 weeks
- Take anti-inflammatory drugs for 3 days
- 1 week of systemic antibiotic therapy
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