Experience with supracricoid laryngectomy variants

Abstract

Supracricoid laryngectomy is effective for managing laryngeal cancer. Modification of the technique to permit resection of both arytenoids is possible in select patients.

Laryngeal Reconstruction with a Sternohyoid Muscle Flap after Supracricoid Laryngectomy: Postoperative Respiratory and Swallowing Evaluation

“…Wide excision plays an important role in avoiding a permanent tracheostomy, and most patients can eventually resume oronasal breathing, with a reported successful decannulation rate ranging from 92.8% to 100%. 1,9,10 In the present study, the decannulation rate at 6 months was only 66.7% in group A, but most patients were eventually decannulated after more swallowing training or after the end of adjuvant therapy. In a previous study conducted by our department, 57 patients treated by classic SCL had an eventual decannulation rate of 98%.…”

“…When the patient can successfully swallow semisolid foods, the NGT is removed. Most patients who undergo SCL experience dysphagia in the early postoperative period, particularly for liquids 1,9 . Even though early decannulation is important for early recovery of the swallowing function, it is sensible to keep the tracheostomy tube in place to enable suction for patients with severe aspiration.…”

“…Supracricoid laryngectomy (SCL) is a well‐established organ preservation technique for the treatment of T1b, T2, and T3 glottic‐supraglottic carcinomas, which can preserve the airway and laryngeal function and avoid a permanent tracheostomy. Four types of SCL are used, named according to their reconstructive techniques: SCL with cricohyoidopexy (CHP), SCL with cricohyoidoepiglottopexy (CHEP), SCL with tracheohyoidoepiglottopexy, and SCL with tracheohyoidopexy 1 . Among these, SCL‐CHP and SCL‐CHEP are the most commonly performed.…”

“…Four types of SCL are used, named according to their reconstructive techniques: SCL with cricohyoidopexy (CHP), SCL with cricohyoidoepiglottopexy (CHEP), SCL with tracheohyoidoepiglottopexy, and SCL with tracheohyoidopexy. 1 Among these, SCL-CHP and SCL-CHEP are the most commonly performed. For all these techniques, at least 1 functional and mobile cricoarytenoid unit (arytenoid cartilage, cricoid cartilage, cricoarytenoid joint, cricoarytenoid musculature, recurrent laryngeal nerve, and superior laryngeal nerve) should be preserved to protect the airway.…”

Management of Advanced Laryngeal Cancer

“…For example, resection of one arytenoid cartilage during supracricoid laryngectomy has been shown to lead to increased risk of aspiration pneumonia, longer time to decannulation of tracheostomy tube, and poorer voice 21–25. Thus, the functional advantages of conservation surgery over non-surgical treatment may be less clear-cut.…”