laryngeal schwanoma

cancer oesphogous

laryngeal mass + tracheostomy

thyroglossal cyst exsion

THYROGLOSSAL DUCT CYST
Procedure


• The incision is carried through the skin and subcutaneous tissue to anterior strap muscles, which are retracted laterally to expose the cystic lesion or inflammatory mass.
• The cyst is carefully dissected free from the surrounding soft tissue and pedicled to the middle third of the hyoid bone.• Muscular attachments to the hyoid bone are divided with electrosurgery so that the hyoid bone can be visualized at its junction between the middle and lateral thirds.

• The laryngeal scissors are then used to resect the middle third of the hyoid bone and the cyst (Sistrunk procedure). An Allis clamp is used to put traction on the cyst and hyoid.

• At this point, using the nondominant hand after double gloving, the surgeon places a finger into the oral cavity and palpates the vallecula and the base of the tongue.
With an assistant holding the cyst and the hyoid bone, a core of muscular tissue, with its apex at the base of the tongue, is carefully excised without penetrating the mucosa.

• Bleeding is controlled using the electrosurgery unit. Prior to removing the surgeon’s finger from the oral cavity, a suture of 3-0 chromic is used to close the muscles in the deep space. Further closure of dead space is accomplished using interrupted sutures of 3-0 chromic after adequate hemostasis has been obtained.
• The strap muscles are replaced in their anatomic position, and a drain (generally a 1⁄4" Penrose) is placed into the wound prior to skin closure.
• The skin is closed using 4-0 Vicryl sutures in the subcutaneous and subcuticular layers. A compression dressing is applied, and the patient is awakened in the usual fashion.

Submandibular gland dissection

Submandibular Gland Excision Technique

The neck is prepared and draped in a sterile fashion. The incision is made approximately two fingerbreadths below the inferior border of the mandible in a skin crease.

The incision is carried through the platysma muscle, and subplatysmal flaps are elevated with care to avoid injury to the marginal mandibular nerve.
The superficial layer of the deep cervical fascia is divided and the anterior facial vein is divided and ligated.

Elevation of this fascia exposes the submandibular gland. The dissection is then performed superiorly, and the facial artery is dived and ligated.

The mylohyoid muscle is retracted anteriorly, and the gland is retracted posteroinferiorly, exposing the lingual nerve and Wharton duct. The submandibular ganglion is divided, freeing the lingual nerve.
Wharton duct is then divided and ligated. The hypoglossal nerve runs superficial to the hyoglossus muscle. The hypoglossal nerve is preserved as the inferior border of the gland is dissected free.
The facial artery is encountered again, and it is divided and ligated. After ensuring hemostasis, the wound is closed in layers over a drain.