Vocal cords paralysis
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)
|C||Radiotherapy followed by chemotherapy|
In 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.
The most significant problem with partial laryngectomies (horizontal/vertical) is aspiration and subsequent pneumonia therefore patients with good pulmonary reserve should only be selected,