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