A Modified Frontolateral Partial Laryngectomy with Laryngeal Framework Reconstruction

Abstract

Objectives: Endoscopic resection and radiotherapy are organ-preservation strategies for glottic cancer because of the high local control and quality of voice after the therapy. However, frontolateral partial laryngectomy is still needed in some cases. This procedure has the complication of hoarseness. Therefore, we applied the theories of laryngeal framework surgery to partial laryngectomy with reconstruction using strap muscles and skin flap in order to improve postoperative voice qualities. Methods: We performed a modified frontolateral partial laryngectomy in three selected cases (rT1a, T3 cases). The retrospective analysis of voice qualities (PPQ, APQ, NHR, MPT) was performed in 10 frontolateral partial laryngectomy cases (7 conventional and 3 modified methods). Surgical procedure: Frontolateral vertical partial laryngectomy with tumor-free margin was performed via laryngofissure approach. After tumor resection, approximation laryngoplasty was performed using sternothyroid muscle flap that was inserted into posterior dead space to gain better contact of the posterior vocal fold on the reconstructed vocal ridge. After these procedures, a reverted sternohyoid muscle was placed inside the preserved outer perichondrium to reduce dead space and externally medialize cervical skin flap, which shaped new vocal fold. Results: No recurrence was observed in any case. No aspiration and laryngeal stenosis were observed in any case. The postoperative voice qualities were improved over pretreatment qualities in modified cases. PPQ after modifying this method was better than conventional methods. Conclusions: It is better for voice quality to treat selected glottic cancers with this modified frontolateral partial laryngectomy.