Frontoanterior supracricoid laryngectomy with epiglottoplasty

Year 2019, Volume: 29 Issue: 2, 86 - 93, 03.06.2019

Nermin Başerer

Abstract

Objectives: In this study, we aimed to investigate the efficacy and safety of a modified technique, namely frontoanterior supracricoid laryngectomy FASCL with epiglottoplasty. Patients and Methods: A total of eight male patients mean age 55 years; range, 53 to 68 years with glottic cordo-commissural cancer underwent FASCL with epiglottoplasty between 2007 and 2018. Oncologic safety was ensured through the whole thyroid cartilage resection in the form of supracricoid partial laryngectomy SCPL . Early laryngeal rehabilitation was given to all patients postoperatively. Results: Five patients were in Stage T1a-b and three patients were in Stage T2. Five patients with Stage T1a-b cordo-commissural cancer underwent FASCL with bilateral cordectomy. The postoperative period was uneventfully in all patients with early decannulation and nasogastric tube removal took place on the second postoperativ day. Functional rehabilitation duration of Stage T2 cancer was slightly prolonged due to wider endolaryngeal resection. In three patients staged T2 cordocommisural cancer decannülation was performed after 4 days and nasogastric tube was removed within the first weak du to larger endolaryngeal tissu resection in this stage. Conclusion: Our study results suggest that this modified technique followed by early laryngeal rehabilitation yields satisfactory postoperative laryngeal functions. In the laryngeal reconstruction, preservation of the thyroid's external framework maintenance of laryngeal situation and glottic reconstruction play the most important rol for functional rehabilitation. Total resection of thyroid cartilage provide oncological safety of this technique. Removal of the thyroid cartilage resection does not cause any laryngeal functional rehabilitation problem in the neo larynx.

Keywords

Cordo-commissural cancer, epiglottic laryngoplasty, frontoanterior partial laryngectomy, laryngeal preservation surgery, thyroid cartilage resection.

References

• Kirchner JA, Fischer JJ. Anterior commissure cancer- -a clinical and laboratory study of 39 cases. Can J Otolaryngol 1975;4:637-43.
• Kirchner JA. Fifteenth Daniel C. Baker, Jr, memorial lecture. What have whole organ sections contributed to the treatment of laryngeal cancer? Ann Otol Rhinol Laryngol 1989;98:661-7.
• Andrea M, Guerrier Y. The anterior commissure of the larynx. Clin Otolaryngol Allied Sci 1981;6:259-64.
• Rucci L, Gammarota L, Borghi Cirri MB. Carcinoma of the anterior commissure of the larynx: I. Embryological and anatomic considerations. Ann Otol Rhinol Laryngol 1996;105:303-8.
• Tillmann B, Paulsen F, Werner JA. Structures of the anterior commissure of the larynx. Biomechanical and clinical aspects. Laryngorhinootologie 1994;73:423-7. [Abstract]
• Barboza R, Fox JH, Shaffer LE, Opalek JM, Farooki S. Incidental findings in the cervical spine at CT for trauma evaluation. AJR Am J Roentgenol 2009;192:725-9.
• Chone CT, Yonehara E, Martins JE, Altemani A, Crespo AN. Importance of anterior commissure in recurrence of early glottic cancer after laser endoscopic resection. Arch Otolaryngol Head Neck Surg 2007;133:882-7.
• Krespi YP, Meltzer CJ. Laser surgery for vocal cord carcinoma involving the anterior commissure. Ann Otol Rhinol Laryngol 1989;98:105-9.
• Stephenson KA, Fagan JJ. Transoral laser resection of glottic carcinoma: what is the significance of anterior commissure involvement? J Laryngol Otol 2017;131:168-72.
• Shimm DS. Early-stage glottic carcinomas: effect of tumor location and full-length involvement on local tumor recurrence after radiation therapy. Radiology 1994;192:873-5.
• Zohar Y, Rahima M, Shvili Y, Talmi YP, Lurie H. The controversial treatment of anterior commissure carcinoma of the larynx. Laryngoscope 1992;102:69- 72.
• Bouche J, Freche C. Epiglottoplasty in the treatment of vestibular stenosis in adults. Ann Otolaryngol Chir Cervicofac 1964;81:5-11. [Abstract]
• Sedlácek K. Reconstructive anterior and lateral laryngectomy with the use of the epiglottis for the pedicle graft. Cesk Otolaryngol 1965;14:328-34. [Abstract]
• Kambic V, Radsel Z, Smid L. Laryngeal reconstruction with epiglottis after vertical hemilaryngectomy. J Laryngol Otol 1976;90:467-73.
• Tucker HM, Benninger MS, Roberts JK, Wood BG, Levine HL. Near-total laryngectomy with epiglottic reconstruction. Long-term results. Arch Otolaryngol Head Neck Surg 1989;115:1341-4.
• Kennedy Thomas L. Epiglottic laryngoplasty. Oper Tech Otolayngol Head Neck Surg 1992;3:199-201.
• Schröder U, Eckel HE, Jungehülsing M, Thumfart W. Indications, technic and results following Sedlacek- Kambic-Tucker reconstructive partial resection of the larynx. HNO 1997;45:915-22. [Abstract]
• Başerer N. Horizontal vertical laryngectomy in transglottic cancer. Ann Otolaryngol Rhinol 2017;4:1190-5.
• Oysu C, Aslan I. Cricohyoidoepiglottopexy vs near- total laryngectomy with epiglottic reconstruction in the treatment of early glottic carcinoma. Arch Otolaryngol Head Neck Surg 2006;132:1065-8.
• Laccourreye H, Laccourreye O, Weinstein G, Menard M, Brasnu D. Supracricoid laryngectomy with cricohyoidopexy: a partial laryngeal procedure for selected supraglottic and transglottic carcinomas. Laryngoscope 1990;100:735-41.
• Bron L, Brossard E, Monnier P, Pasche P. Supracricoid partial laryngectomy with cricohyoidoepiglottopexy and cricohyoidopexy for glottic and supraglottic carcinomas. Laryngoscope 2000;110:627-34.
• Çelik M, Doruk C, Başaran B. Unilateral arytenoidectomy for intractable aspiration following supracricoid laryngectomy. A case of surgical dilemna. J Ist Faculty Med 2018;81:99-101.
• Akbas Y, Demireller A. Oncologic and functional results of supracricoid partial laryngectomy with cricohyoidopexy. Otolaryngol Head Neck Surg 2005;132:783-7.
• Pinar E, Imre A, Calli C, Oncel S, Katilmis H. Supracricoid partial laryngectomy: analyses of oncologic and functional outcomes. Otolaryngol Head Neck Surg 2012;147:1093-8.
• Basaran B, Unsaler S, Ulusan M, Aslan I. The effect of arytenoidectomy on functional and oncologic results of supracricoid partial laryngectomy annals of otology. Rhinology & Laryngology 2015;124:788-7.