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Vocal cords paralysis

Question
47 out of 58
 

A patient presents with carcinoma of the larynx involving the left false cord, left arytenoids and the left aryepiglottic folds with bilateral mobile true cords. Treatment of choice is: [AIIMS Nov. 07)



A Vertical hemilaryngectomy

B Horizontal hemilaryngectomy

C Radiotherapy followed by chemotherapy

D Total laryngectomy

Ans. B Probably 'b' . Horizontal hemilaryngectomy (ideally supraglottic laryngectomy)

35In the Patient

Involvement of unilateral false cord, aryepiglottic foldsand arytenoids with mobile cord suggest supraglottic cancer in T2 stage (morem than one subsites of supraglottis are involved).

ForT2 stage voice conservative surgery should be done. Supraglottis is excised by partial horizontal laryngectomy.

Vertical hemilaryngectomy means excission of one half of the larynx on one side, ., vertical half is removed which include vertical half of supraglottis, glottis and subglottis.

It is indicated for specific T, and T2 glottic cancer

Horizontal hemilaryngectomy is the excision of supraglottis only sparing true vocal cords and arytenoids also known as supraglottic laryngectomy.

It is indicated for specific T1 and T2 supraglottic cancers which donot involve true vocal cord.

So, it is quite obvious, in supraglottic cancer horizontal hemilaryngectomy should be done to remove supraglottis.

Note

The most significant problem with partial laryngectomies (horizontal/vertical) is aspiration and subsequent pneumonia therefore patients with good pulmonary reserve should only be selected,

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