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Vocal cords paralysis

Question
56 out of 58
 

Contraindication of supraglottic laryngectomy is/are: (LQ)



A Poor pulmonary reserve [pGI Nov. 09J

B Tumor involving pyriform sinus

C Tumor involving preepiglottic space

D Vocal cord fixation

E Cricoid cartilage extension

Ans. A B, D and E . Poor pulmonary reserve, Tumor involving pyriform sinus, Vocal cord fixation, Cricoid cartilage extension Ref. Dhingra 5'h/308

Ref: Current otolaryngology 2/ed pg-447-448; Pi: Dhingra 5'h/ed p 331; Logan and Turner 10'h/ed p 174; Ballenger otolaryngology and Head-Neck 16'h/ed p 1285

Supra glottic laryngectomy: Removal of the supraglottis or upper part of larynx. It should be done if following conditions are fulfilled.

For tumors with a T stage of T, T2 or T, by pre epiglottic space involvement only (Thus involvement of pre epiglottic space is not

a contraindication for supraglottic larynygectomy).

Vocal cords are mobile

Cartilage is not involved (which includes cricoid cartilage so option e is correct)

Anterior commissure is not involved

Patient has good pulmonary reserve (. Poor pulmonary reserve is a contraindication)

Base of the tongue is not involved past the circumvallate papillae

The apex of the pyriform sinus is not involved. (. involvement of pyriform sinus is a contraindication)

The FEV, is predicted to be > 50)

So if above criteria are not filled it is a contraindication of supraglottic laryngectomy. Answer is further supported by following lines of: Bellinger

"Supraglottic laryngectomy should not be attempted if there is vocal cord fixation, extensive involvement of pyriform sinus, thyroids or cricoid cartilage invasion or extensive involvement of base of tongue (to or beyond circumvallate papilla)" -Ballenger otolaryngology and Head and Neck Surgery 16th/ed pg-1285

ALSO KNOW

Supraglottic laryngectomy can be performed endoscopically using a CO2 laser or with a standard external approach.

Vocal cords paralysis Flashcard List

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