FARINGOTOMYYa (Greek pharynx, pharyngos of a drink + tome a section, a section) — surgery of opening of a gleam of a throat.
T. use as surgical access at injuries, removal of benign and malignant tumors, opukholepodobny educations and the put foreign bodys of a throat (see). Various options F. quite often are separate stages of the operative measures undertaken concerning malignant tumors of a throat (see).
T. usually precede by a tracheostomy (see) to avoid disturbance of breath at possible edematization and an acute stenosis of a throat after operation. Carry out F. under an intratracheal anesthesia (see. An inhalation anesthesia) with an intubation of a trachea through a tracheostoma (see the Intubation).
In the direction of a skin section distinguish the longitudinal, cross and combined F. K longitudinal belong side and front F. Bokovuyu F. carry out for receiving access to a sidewall of average (an oral part, T.) and lower (guttural part, T.) parts of a throat. The section of skin is made along a first line of a grudino-klyuchichnosostsevidny muscle from the level of a corner of a mandible to the upper edge of a thyroid cartilage; sometimes the section is begun above and continued to the level of bottom edge of a thyroid cartilage (fig., a). Soft tissues stratify, the throat a blunt retractor is removed by kpered and medially, and a neurovascular bunch of a neck take aside: then open a gleam of a throat. After performance of the main stage of operation (an oncotomy, the put foreign body, etc.) the wound is layer-by-layer sewn up tightly. Seldom (e.g., at doubt in reliability of seams on a wall of a throat) a wound leave open. Lobby F. — opening of a front wall of a throat midsection, has very limited indications and is applied extremely seldom.
Fig. Lines of skin cuts at
a side and cross pharyngotomy.
Cross F. apply considerably more often than longitudinal. On the relation of a section to a hypoglossal bone cross F. can be nadpodjyazychny, subhypoglossal and chrespodjyazychny. Use subhypoglossal F more often. At the same time the section is made at the level of a hypoglossal bone between front edges grudino - clavicular sostsevid-nykh muscles. In the cosmetic purposes it is better to use the arc-shaped section of skin (fig., b), to-ry gives the chance if necessary to add cross (subhypoglossal or nadpodjyazychny) F. side. Along bottom edge of a body of a hypoglossal bone cross grudino-pod-lingual and shchitopodjyazychny muscles, bare a shchitopodjyazychny membrane and open a gleam of a throat below a hypoglossal bone, between an epiglottis and a root of language. At nadpodjyazychny F. the throat is opened above a hypoglossal bone that provides the best access to a middle part of a throat, in particular to a root of language. Chrespodjyazychny F. includes removal of a hypoglossal bone and opening of a throat through a bed of this bone; this option is applied seldom.
From combined F. often apply a combination of one of cross F. (is more often subhypoglossal) with side (cross and side) F. In this case subhypoglossal F. supplement right or left side depending on localization patol. process. Cross and side F. use for removal of new growths of a back wall of a throat, an epiglottis and at a horizontal resection of a throat concerning malignant tumors of its upper part. As a separate stage of operation cross and side F. apply during removal of an upper part of a throat from top to down. In rare instances apply F to receiving broad access to a middle part of a throat. with a section or a resection of a mandible.
In the postoperative period (see) patients feed via the nosopishchevodny probe or by intravenous administration of nutritious infusional environments (see. Parenteral food). The tracheostomy tube and nanosecond-sopishchevodny the probe are deleted in 4 — 5 days after F. on condition of recovery of normal respiration and swallowing.
Bibliography: The atlas of operational otorhinolaryngology, under the editorship of V. S. Pogosov, page 320, M., 1983; Yermolaev V. G.; etc. Surgical diseases of a throat, throat, trachea, bronchial tubes and gullet, M., 1954; 3 and m about N of t of D. I., Surgery of upper respiratory tracts, t. 1, Rostov N / D., 1940. V. S. Logosov.