Johan Fagan

Laryngofissure, also known as median thyrotomy, refers to vertically splitting the thyroid cartilage in the midline to gain access to the endolarynx. It provides good exposure to both anterior and posterior laryngeal structures with very minor morbidity (Figure 1) .

Fig 1
Figure 1: Good exposure to both anterior and posterior laryngeal structures

Indications for laryngofissure

Laryngofissure has largely been supplanted by transoral microsurgery. Yet it remains relevant in settings where endolaryngeal approaches are not possible due to lack of suitable microlaryngeal instrumentation and/or CO2 laser capabilities. Other indications include the following:

Fig 2 a, b Fig 2 a, b
Figure 2 a, b: Laryngeal keel for anterior web

Relative contraindications

Surgical technique

Fig 3
Figure 3: Surface anatomy and incision (yellow line)
Fig 4
Figure 4: Raphe between sternohyoid muscles has been divided to expose the thyroid cartilage
Fig 5
Figure 5: Thyroid cartilage, cricothyroid membrane and cricoid exposed in midline and cricothyrotomy incision visible
Fig 6
Figure 6: Cricothyroid artery branching from the superior thyroid artery
Fig 7
Figure 7: Completed thyrotomy
Fig 8
Figure 8: Note excellent view of the false vocal cords, ventricles, true cords and posterior larynx
Fig 9
Figure 9: Note excellent view of false vocal cord, ventricle, true cord and subglottis
Fig 10
Figure 10: Lesion of glottis being excised
Fig 11
Figure 11: Cordectomy defect


Author and Editor

Johan Fagan MBChB, FCORL, MMed
Professor and Chairman Division of Otolaryngology
University of Cape Town
Cape Town
South Africa