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Vocal cords paralysis

Question
46 out of 58
 

Which of the following is not the indicati~n of near total Laryngectomy? (LQ)



A T3 stage

B Anterior commissure involvement

C Free lateral arytenoids

D Interarytenoid plane involvement

Ans. B anterior commissure involvement Ref: Current otolaryngology 21e pg-448-449

Type of Laryngectomy

Parts Removed

Indications

Comment

Hemilaryngectomy

Removal of one vertical half of larynx.

Tumor with:

• Subglottic extension < 1 cm

below the true vocal cord

• A mobile affected cord

• Unilateral involvement

• No cartilage invasion

• No extra laryngeal soft tissue involvement

• For tumors with a T stage of T" T2 orT3 by pre epiglottic involvement only Vocal cords are mobile

Vocal cord reconstruction is done in this case by transposing a flap of strap muscle or microvascular free flap to provide bulk against which the remaining unaffected of cord can vibrate.

Supra glottic

Removal of the supraglottis orthe upper part of larynx

For tumors with a T stage of T" T2 or r, by pre epiglottic involvement only

• Vocal cords are mobile

• Cartilage is not involved

• Anterior commissure is not involved

• Patient has good pulmonary status/reserve

• The base of tongue is not involved past the circumvallate papillae

• The apex of pyriform is not involved

• FEVl is predicted to be > 50%

It can be done by laser or by external approach

• Side effect - Aspiration. For this reason patients with borderline pulmonary function (FEVl < 50%) who cannot tolerate chronic aspiration are generally not considered good candidates for supraglottic laryngectomy

Supracricoid laryngectomy

It is a newer surgical technique in which voice is preserved.

The true vocal cords, supra glottis, thyroid cartilage are removed and cricoid and ary-tenoid cartilage are preserved

It is done in those in which cancer is located at the anterior glottis including the commissure or those with more extensive pre epiglottic space involvement

Pulmonary function and prior radiation candidacy criteria for supraglottic laryngectomy applies for supracricoid laryngectomy as well

Near Total laryngectomy

It is more extended partial laryngectomy procedure in which only one arytenoid is preserved and a tracheo-sophageal conduit is constructed for speech.

It should not- be offered to patients whose radiation treatment has failed, those with poor pulmonary reserve or those with tumor involvement below the cricoid ring. Patients with large T3 and T4 leison with one uninvolved arytenoid or with U/L transglottic tumors with cord fixation are candidates for this surgery.

Aspiration can occur

Pt is dependent on tracheostomy for breathing

Total laryngectomy

Entire larynx + Thyroid + cricoid cartilages are removed along with some upper tracheal rings and hyoid bone, if possible.

indications:

• T4 malignancy

• As a salvage surgery in recurrences following chemoradiation forT3 esion

• It is TOC in perichondrites larynx

Most important constraint is speech problem which can be o b t a in e d by tracheo oesophageal speech

Vocal cords paralysis Flashcard List

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