“Window” Laryngoplasty: A New Combined Laser Endoscopic and Open Technique for Conservation Surgery

Abstract

Endoscopic laser resection of early laryngeal carcinoma is an increasingly used treatment modality; however, the limited exposure achieved and the alteration of vocal function are still major problems. A new surgical procedure, "window" laryngoplasty, has been devised and tested in an in vivo study in 6 canines with 50 days' survival. The right vocal cord was incised endoscopically with the carbon dioxide laser, and the en bloc specimen with adjacent thyroid cartilage was removed through a window approach made in the thyroid cartilage. A sternohyoid muscle flap based superiorly was inserted into the cartilaginous window to reconstruct a pseudocord with coverage of either mucosa or fascia. A diode laser soldering technique was used to secure the mucosal graft in place. Epithelial transplantation can be accomplished externally with precise endoscopic guidance for reliable placement of the pseudocord. The results show that the new technique, a combination of endoscopic and open approaches, may be a better treatment choice than standard vertical partial laryngectomy in selected patients. Advantages of this technique include adequate en bloc resection, including adjacent cartilage for pathologic evaluation, preservation of the integrity of most of the laryngeal framework, avoidance of tracheotomy, and better functional results.

Sternohyoid muscles for reconstruction after thyroid cartilage anterior partial resection

“…Following endoscopic excision, an external approach is performed by creating a window in the thyroid cartilage and removing the specimen en bloc. Glottic reconstruction is then carried out using the sternohyoid muscle flap by either a bipedicled muscle flap with overlying skin or a unipedicled muscle flap with a graft of free mucosa . The use of sternohyoid muscles earlier described by Ogura and Biller in 1969 following frontolateral hemilaryngectomy is a simple technique, which has been used for laryngeal reconstruction for over several decades .…”

“…Glottic reconstruction is then carried out using the sternohyoid muscle flap by either a bipedicled muscle flap with overlying skin or a unipedicled muscle flap with a graft of free mucosa. [9][10][11] The use of sternohyoid muscles earlier described by Ogura and Biller in 1969 following frontolateral hemilaryngectomy is a simple technique, which has been used for laryngeal reconstruction for over several decades. 12 The approach has also been modified by other surgeons and still proves to be a reliable technique for reconstruction.…”

Clinical Outcome of Window Partial Laryngectomy for Stage T2-3 Glottic Laryngeal Carcinoma

“…The window partial laryngectomy technique was initially tested in a live canine model before clinical application as described by Shapshay et al in 1994. 2 The main procedure of this technology is as follows: the right vocal fold is incised endoscopically with a carbon dioxide laser, and the en bloc specimen with adjacent thyroid cartilage is removed through a window approach made in the thyroid cartilage. It is believed that the advantages of this technique include adequate en bloc resection, inclusion of adjacent cartilage for pathologic evaluation, preservation of the integrity of most of the laryngeal framework, and better functional results.…”

Jako: “Laser Surgery of the Vocal Cords; An Experimental Study With Carbon Dioxide Lasers on Dogs.” (Laryngoscope. 1972;82:2204‐2216)

“…More recent applications of the CO 2 laser such as partial medial arytenoidectomy and posterior cordotomy for bilateral vocal cord movement impairment would not have been possible without the microlaser system 13,14 . Investigations are currently ongoing utilizing the microsurgical laser as an endoscopic guidance system for limited, precise external “window” excisions of T2 vocal cord cancer particularly of the anterior commissure 15 . Experiments using the CO 2 laser for excision of vocal cord and posterior commissure scarring and repair with endoscopic soldering of mucosal grafts using a diode laser with a dye/albumen solder have also been encouraging 16 …”