Laryngology Surgery

Station 1:

murphy.jpg

Name the structure pointed out by the arrow.

What is its use ?

It is known as the Murphy's eye.

It allows ventilation of the lung even when the bevel of the endotracheal tube is occluded.
This event commonly occurs when the bevel is in contact with the tracheal wall.

Station 2:

tracheo_1.jpg

Shown here is a very important step in tracheostomy.
What is it ?
Why is it being performed ?

Identification of trachea.

This is done by injecting and withdrawing. If air bubbles could be seen inside the syringe
on withdrawal of the piston, it confirms that the needle is inside trachea.
The syringe contains 2 % xylocaine. A few drops of it can be instilled into the trachea in order
to suppress the cough reflex, which commonly occurs during tracheal incision.

Station 3:

tracheo_2.jpg

Where is the exact site of tracheal incision ?

What surgical blade is optimal for this purpose ?

Incision is sited between the 2nd and 3rd tracheal rings.

11 or 15 blade is preferred

Station 4:

bjork.jpg

What is the name of the flap created ?

What is its advantage ?

It is known as Bjork flap. It is an inferior based flap.

Creation of this flap during tracheostomy helps to prevent tracheal stenosis

Station 5:

gluck.jpg

Name the incision

What is its advantage?

This is Gluck Sorenson's incision used to perform total laryngectomy.
This incision serves to separate the air passage from pharynx. The
vascularity of the flap is not compromised.

Station 6:

sub_plat.jpg

What is the plane of dissection in Gluck Sorenson's incision?

The dissection is performed in a subplatysmal plane. Staying within this plane helps
to preserve the vascularity of the graft.

Station 7:

sm.jpg

What is the muscle seen in this picture?

It is the sternomastoid muscle. Under this muscle lie the carotid sheath and jugular group of nodes.

Station 8:

omo.jpg

Name this muscle.

It is the omohyoid muscle. This muscle should be sectioned to expose the larynx.
This muscle should ideally be sectioned close to its sternal end.

Station 9:

mont.jpg

What is the name of this tube?
Where do you use it?
What are its advantages?

It is a Montgomery - T tube. This tube is made of silicone. It does not irritate soft tissues.
It is commonly used to stent the airway after tracheal reconstruction. This tube can be used
for long term stenting of airway without any danger of tissue reaction / extrusion.
It has a speaking valve, and when the horizontal limb is closed the patient will be able to breath
normally through the nose and speak well.

Station 10:

lazy_s.png

Name the incision shown in the picture.

Name the surgery in which this incision is used.

This image shows a Lazy Man S incision.

This incision is used while performing superficial / total parotidectomy

Station 11:

facial_n.png

Name the structure indicated with an asterix in the above figure

It is the facial nerve seen in the parotid bed after removal of superficial lobe of parotid gland.

It is this nerve which separates the two portions of parotid gland (superficial and deep portions).

Station 12:

external_jugular.JPG

Name the structure indicated with an astrix

It is the external jugular vein. This vein can be avoided if the plane of dissection is deep to the
deep portion of the superficial layer of cervical fascia.

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