Vocal cords paralysis
A case of carcinoma larynx with the involvement of anterior commissure and right vocal cord, developed perichondritis of thyroid cartilage. Which of the following statements is true for the management of this case? [AIIMS May 06)
|A||He should be given radical radiotherapy as this can cure early tumours|
|B||He should be trated with combination of chemotherapy and radiotherapy|
|C||He should first receive radiotherapy and if residula tumour is present then should under go laryngectomy|
|D||He should first undergo laryngectomy and then post-operative radiotherapy|
Ref. Dhingra 51e pg- 328,330,337; 61e 3 7 0-37 7 Perichondritis of thyroid cartilage in a patient of Ca larynx suggests invasion of thyroid cartilage l.e, stage T 4.
Stage T 4 lesions glottic cancer are managed by total laryngectomy with neck dissection for clinically positive nodes and post opera¬tive radiotherapy if nodes are not palpable.
Indication of Total laryngectomy in Ca larynx
- Current Otolaryngology 21e pg-449; Dhingra 51e, pq- 330, 61e p 370
• ,T3 lesions (, with cord fixed) not amenable to chemoradiation or partial laryngectomy procedures
• All T41esions
• Invasion of thyroid or cricoid cartilage
• Bilateral arytenoid cartilage involvement
• Lesions of posterior commissure
• Failure after radiotherapy or conservation surgery
• Transglottic cancers . tumors involving supraglottis and glottis across the ventricle, causing fixation of the vocal cord.
Remember: Total laryngectomy is contraindicated in patients with distant metastasis.