RECONSTRUCTION OF THE LARYNX UNDER ACUPUNCTURE ANESTHESIA

Huang Heman

(EENT Hospital, Shanghai First Medical College, Shanghai)

15 cases of advanced carcinoma of the larynx in-capable of radiotherapy had been treated by total laryngectomy and reconstruction of the larynx under acupuncture anesthesia from 1981 to 1982 with favorable results.

Combining auriculo-acupuncture: "Lung", "Shenman" penetrates "sympathetic" with body points: Hegu, Heque, and the points on the both sides of the neck: Futu, Tianding, Qishe were selected during the acupuncture anesthesia. An electric stimulator was connected to the inserted needles in the auriculo-acupuncture and body points with a range of frequency 140-180 times/minute, and 500-1000 times/minute to the inserted needles in the Zopints on the neck. During anesthesia the intensity control-knob was initially adjusted to a minimum and then increased gradually until the patient had a needling sensation of soreness, numbness, distention or heaviness. The induction time of anesthesia was 20-30 min. luminal 0.1g, by mouth two hours preoperation, and Phethidine 75 mg given intramuscularly half an hour before operation as a supplementary medication.

According to the physiological function of the larynx and pharyngolarynx, and the perfect consciousness under acupuncture anesthesia of the patient, the author has improved and performed a new method of reconstruction of the larynx as follows:

(1) After performing the conventional total laryngectomy, the upper end of the severed trachea was sutured to the epiglottis and pharyngolarynx without resecting the hyoid bone and the subhyoid muscles which were used to cover the anterior of the anastomostic orifice. The upper end of the severed trachea was fixed to the inferior border of the hyoid bone, in order to protect and move the reconstructive larynx upward.

(2) On the basis of radical resection of the laryngeal cancer. One third of the laminal of thyroidcartilage was preserved as frame of the reconstructive larynx.

(3) Free and preserving the superior laryngeal nerves and it's accessory vessels for the establishment of the reflex of the reconstructive larynx.

(4) Trimming the membranes of the pharyngolarynx into two sockets instead of perform fossae for recovering the function of deglutition.

(5) Free the recurrent laryngeal nerves and partial cricoarytenoid muscles and transplant to the reconstructive glottis to perform the function of phonation.

The results of the acupuncture anesthesia are satisfactory. According to the effectiveness of anesthesia, all the 15 patients (Grade I 7 cases, and Grade II 8 cases) have recovered their functions of deglutition and phonation postoperatively.