Figure of situation after total laryngectomy. (Voicebox is removed!) Compare this image with the image of voicebox in place.

Total Laryngectomy

Total laryngectomy includes resection of the hyoid bone, pre-epiglottic space, thyroid cartilage, cricoid cartilage, and one to four tracheal rings. The hypopharynx constrictor muscles are sectioned from the lateral edge of the thyroid cartilage and cricoid insertions. After removal of the specimen, the trachea is sutured to the skin of the neck, either in the original skin incision or in a separately made incision. The constrictor muscles are usually reconstructed in the midline to support a one or two layer mucosal closure in a effort to reduce fistula formation.7 During this procedure a myotomy and/or a unilateral neurectomy of the pharyngeal nerve plexus is performed to facilitate tracheoesophageal voice rehabilitation which is later discussed in more detail.

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