The hyoid bone and its preservation in the framework of supraglottic partial resection of the larynx

BACKGROUND: Whether to remove the hyoid bone as part of the horizontal partial laryngectomy is a question which is discussed controversially. Pathohistological examination of the region involved should help to answer this question. MATERIAL AND METHODS: Regarding the involvement of the hyoid bone, 71 surgical specimens of supraglottic carcinoma invading the pre-epiglottic space were studied by whole-organ serial sections. RESULTS: Only four specimens demonstrated mandatory resection of the hyoid bone because of its proximity to the advancing border of the tumor. In these cases, large tumor masses were palpable directly under the thyrohyoid membrane after the strap muscles had been dissected during the operation. DISCUSSION: Except for these rare cases in which the tumor was already palpable from outside the larynx, preservation of the hyoid bone during horizontal supraglottic laryngectomy is oncologically safe. It provides a more secure closure of the pharyngotomy and promotes earlier return of the swallowing function because of the maintenance of the normal position of the larynx and pharynx.     

Pathomorphological aspects of transoral resection of hypopharyngeal carcinoma with preservation of the larynx. Patient selection, treatment results

BACKGROUND: In primary surgery of hypopharyngeal cancer, transcervical resection was chosen in order to preserve the larynx. This treatment produces good oncological results but also a high degree of morbidity so that in recent years transoral resection has been recommended. For wider application of this method it is very important to apply clearly defined criteria for selection of patients. MATERIAL AND METHODS: To define the criteria for selection for transoral microsurgical resection, we analyzed step serial sections of 33 whole organ specimens of hypopharyngeal squamous cell cancer (SCC) after primary radical surgery, mostly carcinoma of the piriform sinus. Criteria concerning the primary and the involvement of the neck nodes were differentiated. Twenty of 84 patients with hypopharyngeal cancer of different stages were treated by transoral resection and delayed neck dissection between 1994 and 1996. Most of the patients were irradiated postoperatively because of neck metastases. The therapeutic results after a minimum period of 24 months follow-up is listed according to Kaplan-Meyer. RESULTS: Three types were defined according to their site, growth, and spread into the larynx: Type I comprises limited exophytic, highly differentiated SCC with a minor tendency for metastasis originating in the upper half of the sinus. These tumors are well suitable for transoral resection. Type II includes tumors spreading superficially without deeper invasion of the larynx, especially of the laryngeal framework. These can be totally resected and the larynx preserved in spite of extended metastasis. Type III, the most frequent type, grows with ulceration and deeply infiltrates into the larynx and the neck. These tumors cannot be resected transorally. Primary radical resection is indicated. Up to 25% of all hypopharyngeal SCC could be treated by transoral resection, mostly with delayed neck dissection and postoperative irradiation. Functional results were excellent in all cases. Eating, voice, and air passage were normal. Oncological results with 80% disease free five-year survival rate were very good. Three patients died because of recurrences in the neck, only one because of a recurrence in the larynx. The rate of patients with a second primary, however, was extremely high (50%). CONCLUSIONS: By strictly following the pathological and clinical criteria for selection, about 25% of the SCC of the hypopharynx can be treated by transoral resection combined with neck dissection and postoperative irradiation with good oncological and excellent functional results, preserving the larynx without endangering the life of the patients.     

A method of combined horizontal resection of the larynx with removal of the arytenoid cartilage and its primary reconstruction]

A modified technique of combined laryngeal resection in vestibular cancer T3-T4 (involvement of the arytenoid cartilage) was tried in 8 patients. To compensate for laryngeal separative function after the radical surgery, the reconstruction of the posterior laryngeal wall was performed by mobilization of the upper corniculum of the thyroid cartilage. In satisfactory functional results the method did not contribute to the disease aggravation.     

Esophageal reconstruction with larynx preservation using forearm-free flap

Surgery for cervical esophageal malignancy frequently involves comcomitant total laryngectomy carried out because of either oncologic or functional concerns. Though uncommon, preservation of the larynx has, in recent years, been described in patients undergoing cervical esophagectomy with reconstruction of the resulting circumferential esophageal defect achieved using either free jejunal flaps or gastric pullup procedures. The use of tubed-free cutaneous flaps for circumferential cervical esophageal reconstruction, however, has been rarely described in situations where the larynx has been preserved. We describe successful use of a tubed radial forearm-free flap for reconstruction of a circumferential cervical esophageal defect with preservation of the larynx. Use of the radial forearm flap in this situation resulted in minimal donor site-related morbidity, avoided the need for laparotomy and excellent voice and swallowing function were maintained. As such, use of tubed cutaneous free flaps can be considered an option for cervical esophageal reconstruction when the larynx has been preserved.     

Alveolar soft part sarcoma of the larynx

Alveolar soft part sarcoma (ASPS) is a rare malignancy. It has generally a poor prognosis. Survival depends on the presence of metastases. Approximately, one-fourth of the cases are encountered in the head and neck region, mostly in the orbits and tongue. Surgery is accepted as the most effective treatment, radiotherapy and chemotherapy may be used as adjuvant treatments. Since it is a highly vascular tumor, profuse bleeding may occur during surgery. In this article, we report a case of ASPS occurring in the larynx, an extremely rare location for this rather unusual tumor. To our knowledge, only three cases of laryngeal ASPS have been previously reported in the English literature.     

侧开式喉镜下喉动力系统切除会厌囊肿46例

会厌囊肿是由于会厌黏膜的黏液腺管阻塞、黏液潴留而形成［1］,常发生于会厌的舌面,囊肿较小时患者多无明显不适,多因其他疾病检查时发现,但有时并发感染发生急性会厌炎;囊肿巨大时可压迫会厌遮盖喉入口,易导致喉梗阻而危及生命,若并发感染则更加危险。直接喉镜下咬除囊肿［3］手术难度较大,完全切除囊壁较难,复发率高,且术中出血多,对正常会厌黏膜损伤较大,故术后患者咽喉疼痛明显,再出血可能性大;囊肿复发概率高,有时需数年后再次手术,患者痛苦增加。2011年1月至2014年5月,我们应用喉动力系统（美敦力公司,美国）对直径超过1．0 cm 的会厌囊肿患者46例,行手术切除,效果满意,报告如下。     

声门癌T_3病变术后的修复

为完善Ｔ３喉癌术后功能保全的方法，将会厌下拉与残留甲状软骨板及环状软骨构成新喉软骨支架，双侧带状肌肌瓣修复术腔创面，形成声门的扩约作用。共行４０例。结果：重建的新喉发音清晰易辩，进食无明显呛咳，功能满意。３年生存率８２．５％（３２／４０），５年生存率７２．９％（２７／３７）。结论：会厌软骨及双侧带状肌瓣与喉为同一术野，血运良好，易于成活，可修复范围广泛，为理想的喉修复材料。     

声门癌T3病变术后修复

为完善Ｔ３喉癌术后功能保全的方法，将会厌下位与残留甲状软骨板及环状软骨构成新喉软骨支架，双侧带状肌肌瓣修复术腔创面，形成声门的扩约作用。共行４０例。结果：重建的新喉发音清晰易辩，进食无明显呛咳，功能满意。３年生存率８２．５％（３２／４０），５年生存率７２．９％（２７／３７）。结论：会厌软骨及双侧带状肌瓣与喉为同一术野，血运良好，易于成活，可修复范围广泛，为理想的喉修复材料。     

支撑喉镜下自制改良电刀切除会厌囊肿43例

正会厌囊肿的一般治疗方法为支撑喉镜下喉刀将囊肿壁大部切除,但该方法术中容易出血,导致术野不清,术时长、舌麻木。若不完全切除,术后易出血、复发率高。2011年1月至2015年6月,我科运用改良电刀行支撑喉镜下会厌囊肿切除43例,方法简单、安全、有效、无复发,报告如下。     

Carcinoma of the posterior wall of the hypopharynx: surgical treatment with larynx preservation

IntroductionPosterior pharyngeal wall is the most rare subsite for hypopharyngeal carcinomas. Because of its rarity, there are few studies published in the literature specifically concerning posterior pharyngeal wall carcinoma.ObjectivesTo report our functional results in patients with the carcinoma of the posterior wall of the hypopharynx after surgical treatment by resection via a lateral or infrahyoid pharyngotomy approach, with the preservation of the larynx and reconstruction with a radial forearm free flap.MethodsThe study included 10 patients who underwent surgery for a carcinoma of the posterior wall of the hypopharynx over a 6 year period. The associated postoperative morbidity was investigated and functional results were analyzed.ResultsNine patients had T3 lesions and one patient had a T2 lesion. The preferred approach to access the hypopharynx was a lateral pharyngotomy in 5 patients and lateral pharyngotomy combined with infrahyoid pharyngotomy in 5 patients with superior extension to oropharynx. The pharyngeal defects were reconstructed successfully with radial forearm free flaps. Four patients received adjuvant radiotherapy only, and 4 patients with N2b and N2c neck diseases received adjuvant chemoradiotherapy. The mean duration of hospitalization was 15.6 days (range, 10–21 days). All patients achieved oral intake in a median time of 74 days (range, 15–180). Decannulation was achieved in all patients and the median time for decannulation was 90 (range, 21–300 days). The mean followup duration was 38.3 months (range, 10–71 months) and 8 patients survived. One patient died due to regional recurrence in the retropharyngeal lymph nodes and 1 patient died due to systemic metastasis.ConclusionPrimary surgery is still a very effective treatment modality for the carcinoma of the posterior wall of the hypopharynx and does not permanently compromise the swallowing and laryngeal functions if pharyngeal reconstruction is performed with a free flap.     

Functional evaluation after partial resection in patients with carcinoma of the larynx

This paper presents the results of conservative operations on patients with laryngeal carcinoma in the ENT Department of the University Hospital “Dr. Mladen Stojanovic,” Zagreb, Yugoslavia, during the last 20 years. The authors have evaluated the functional results after partial vertical and horizontal surgical interventions on the larynx and after the reconstruction of the larynx following these operations. Functional analysis of the voice was performed by stroboscopic, indirect microlaryngostroboscopic and sonagraphic examinations of the laryngeal function, as well as by the spirometric analysis of the respiratory potential of these patients, especially the degree of obstruction of the upper respiratory tract and changes on the cardiovascular system. Attention has been given likewise to the examination of the act of swallowing, especially after horizontal partial resections of the larynx. Radiography and radiocinematography was used for these examinations. Based on this research the authors have formulated new conceptions and opinions about the voice generator.