Contralateral Laryngoplasty After Supraglottic Laryngectomy With Vertical Extension

Abstract

\s=b\ Eight patients with supraglottic carcinoma extending onto an arytenoid or true vocal cord have undergone supraglottic laryngectomy with vertical extension including the resection of an arytenoid. In these patients, the contralateral superior thyroid cornua was used to reconstruct the resulting defect. In this technique, the thyroid cornua is mobilized and greenstick fractured across the posterior commissure, maintaining its blood supply by leaving the inferior and middle pharyngeal constrictor attached. This muscle-cartilage pedicle flap provides bulk for the posterior glottis and can be anchored anteriorly to form the framework for a new vocal cord. Hypopharyngeal and pyriform sinus mucosa is then mobilized to cover the newly reconstructed hemilarynx. This reconstruction has provided a competent glottis with a good vocal baffle in every patient in this series. Preservation of airway, voice, and laryngeal sphincter is comparable with that achieved after routine supraglottic laryngectomy without resection of an arytenoid. Using this technique, the surgeon can rely on a pedicle graft with surprising accessibility, bulk, and reach.

Extended partial laryngectomy with functional preservation using the rotational crico‐thyrotracheopexy

“…Furthermore, the larynx must provide a safe sphincteric function. To enable this, at least the following three laryngeal components must be preserved or restored: the posterior glottic area to prevent aspiration; a reasonable anteroposterior diameter of the laryngeal airway and one normally mobile arytenoid cartilage 32 . Accordingly, the resection should respect the posterior midline to maintain the inferior support of the arytenoid cartilage on the healthy side of the larynx.…”

Progress in laryngeal surgery

“…In addition, modification of supraglottic laryngectomy to encompass larger tumors than can be removed with the standard approach has been associated with higher rates of local recurrence. Friedman et al 40 reported a local recurrence rate of 25% when the supraglottic laryngectomy was extended to include resection of one of the arytenoids. Contraindications to a supraglottic laryngectomy include involvement of both arytenoids, extension of cancer anterior to the circumvallate papilla of the tongue, involvement of the paraglottic space inferior to the plane of the laryngeal ventricle, and extension of cancer onto the anterior commissure or onto either true vocal cord.…”

Evolution of Laryngeal Cancer Surgery

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