Site

Dissection of cadaveric larynges must be performed in an area appropriate to the task. An area separate from the site of clinical care of patients is mandatory. At teaching institutions, cadaver laboratories where basic anatomy is taught can suffice, given their generally good lighting and ventilation, easily cleaned work surfaces, separation from patients, and the ease of specimen disposal. A temporal bone laboratory where otolaryngology residents practice otologic training is an ideal site that satisfies these requirements and where there is the benefit of microscopes, multiple training stations, and often a “teaching station” where the dissection is imaged using a video camera and displayed on a video monitor for the learners to follow along.

Equipment

Necessary equipment includes:

• 
  

  An appropriate site as outlined above

  
  
• 
  

  Protective eyewear and nonsterile gloves for universal precautions

  
  
• 
  

  A sharps (needles, used scalpels, etc.) disposal container

  
  
• 
  

  A sink with running water for cleaning the instruments

  
  
• 
  

  Detergents for cleaning the work surfaces and dissection station

  
  
• 
  

  “Red bag” containers for disposal of used cadaveric specimens and pieces of resected soft tissue

  
  
• 
  

  A laryngeal dissection station. These stations were conceived and built for the express purpose of this teaching exercise. They are sold at cost by the senior author, who can be contacted for further information.

  
  
• 
  

  Cadaveric specimens. Human cadaveric larynges are ideal. They can often be procured from the pathology department of a hospital after appropriate arrangements are made. Specimens are available commercially but they tend to be expensive. Canine larynges can often be procured from a veterinary school. Bovine and porcine specimens are most readily acquired from local butchers.

  
  
• 
  

  A selection of rubber corks (used as stoppers for glass flasks and available in most scientific laboratory catalogs) of different sizes to place into the tracheas of the specimens. Pushpins must also be acquired.

  
  
• 
  

  A nearby freezer for holding the specimens. Note: Once thawed, the specimen will begin to decompose and will not be usable after several hours at room temperature. Refreezing the specimen is possible but is accomplished at some cost to the anatomic veracity of the tissue.

  
  
• 
  

  Suture material appropriate to the focus of the chapter. Expired suture material from the operating room serves as an excellent low-cost source of this necessary component. Of note, 3–0 Prolene suture (Ethicon, Somerville, NJ, USA) functions particularly well for suspension of the cadaveric larynx on the dissection station for open dissection.

  
  
• 
  

  Surgical instruments that might be found on a “major head and neck” tray. These include scalpels, hemostats, forceps, and various scissors. Other useful instruments are a Freer elevator and some otologic microinstruments, such as Bellucci scissors and round elevators.

  
  
• 
  

  Microlaryngeal instruments used for microlaryngoscopy. These include left and right heart-shaped grasping forceps, right and left scissors, a micro-laryngeal suction, and a blunt dissector.

  
  
• 
  

  An oscillating saw and an otologic drill with a selection of blades and drill bits. Suction is helpful if available.

  
  
• 
  

  A 350-mm lens for the microscope. Most microscopes in temporal bone laboratories have 250-mm lenses, which are ideal for otologic dissection but have a focal distance too short to allow for introduction of microlaryngeal instruments into the lumen of the laryngoscope. The higher-focal-length lens will allow easy passage of these instruments. In cases where the microscope is mounted onto the work surface and the lens is not replaceable, a free-standing microscope will need to be used.

  
  
• 
  

  Chapter-specific equipment. For example, nerve anastomosis requires microvascular instruments. Many items used in the operating room from commercial sources can be fashioned from less expensive material; for example, Gore-Tex (W. L. Gore & Associates, Elkton, MD, USA) can be simulated using silk tape folded on itself. Creativity is encouraged to reduce costs for otherwise expensive items.