Tracheoesophageal Diversion and Laryngotracheal Separation Procedures for Radiotherapy-Related Intractable Aspiration Pneumonia in Nasopharyngeal Carcinoma

Figure 1

Surgical procedures of the tracheoesophageal diversion and laryngotracheal separation. (a) Schematic diagram of surgical procedure (sagittal position); black arrow indicates the trachea fistula. (b) Schematic diagram of surgical procedure (coronal position), the trachea is divided between the 4th and 5th tracheal rings, the upper end of the divided trachea is anastomosed to the anterior wall of the esophagus, and the lower end is sutured with the skin to create a stoma; black arrow indicates tracheoesophageal anastomosis. (c) Representative intraoperative picture of surgical area after tracheal separation; black arrow indicates the upper end of the divided tracheal and white arrow indicates the anterior wall of esophagus. (d) Representative intraoperative picture of the tension-free anastomosis between the upper end of the divided trachea and the anterior wall of the esophagus; black arrow indicates the thyroid cartilage, and white arrow indicates the tracheoesophageal anastomosis. TC: thyroid cartilage; UT: upper trachea; E: esophagus; LT: lower trachea).

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