Total Laryngectomy: A Review of Surgical Techniques

Abstract

Since the first total laryngectomy was performed in the late 18th century, several improvements and variations in surgical techniques have been proposed for this procedure. The surgical techniques employed in total laryngectomy have not been comprehensively discussed to date. Thus, the main objective of this article was to address controversial aspects related to this procedure and compare different surgical techniques used for a total laryngectomy procedure from the beginning to the end.Although the management paradigms in laryngeal and hypopharyngeal squamous cell carcinomas have shifted to organ-preserving chemoradiotherapy protocols, total laryngectomy still plays a prominent role in the treatment of advanced and recurrent tumors. The increased incidence of complications associated with salvage total laryngectomy has driven efforts to improve the surgical techniques in various aspects of the operation. Loss of voice and impaired swallowing are the most difficult challenges to be overcome in laryngectomies, and the introduction of tracheoesophageal voice prostheses has made an enormous difference in postoperative rehabilitation and quality of life. Advancements in reconstruction techniques, tumor control, and metastatic management, such as prophylactic neck treatments and paratracheal nodal dissection (PTND), as well as the use of thyroid gland-preserving total laryngectomy in selected patients have all led to the increasing success of modern total laryngectomy. Several conclusions regarding the benchmarking of surgical techniques cannot be drawn. Issues regarding total laryngectomy are still open for discussion, and the technique will continue to require improvement in the near future.

COVID-19 in patients with total laryngectomy

“…[4] The upper respiratory tract is disrupted in total laryngectomy patients, and their trachea and lower respiratory tract are directly connected to the environment. [18] Based on this, we hypothesized that patients with total laryngectomy less frequently have SARS-CoV-2 disease; in addition, COVID-19 has a more severe clinical picture in the total laryngectomy patients since the lower respiratory tract and lungs are directly exposed to the virus. In the COVID-19 guideline of the Ministry of Health of the Republic of Türkiye, RT-PCR, which is primarily studied with a naso/oropharyngeal swab sample, is recommended for the diagnosis of SARS-CoV-2.…”

Hybrid primary puncture in stapler‐assisted total laryngectomy

“…In Video S1, Supporting Information the long Apron skin incision 10 is performed to provide lateral neck good exposure. Flap is elevated superiorly in the subplatysmal plane, until exposure extends above to the upper border of the hyoid bone and below to the cervical trachea.…”

Incidence of Pharyngocutaneous Fistula After Total Laryngectomy and Its Relationship With the Shapes of Mucosa Closure: A Meta-Analysis

“…Several issues regarding surgical techniques for pharyngeal reconstruction have been studied. For example, recent studies have shown that the use of continuous sutures is associated with lower fistula rates than interrupted sutures in mucosal repair, and nonclosure of the pharyngeal constrictor muscle is not associated with a higher rate of fistula formation [ 2 , 30 ]. However, the relationship between shapes of pharyngeal closure and fistula outcome is not well-established and the study aims to address this.…”

“…Previous radiotherapy, T-stage, flap reconstruction, and underlying health conditions such as smoking, anemia, and malnutrition, are known risk factors for post-operative fistula [ 1 ]. Surgical techniques during neopharyngeal reconstruction may affect the occurrence of the fistula, but this has not been thoroughly researched [ 2 ].…”

“…The mucosal repair in primary closure can be either straight (vertical or horizontal) or a T (or Y)-shaped line. The best pharyngeal reconstruction technique and the shapes of pharyngeal closure to be used remain disputed [ 2 ].…”