Epidermoid carcinoma of the supraglottic larynx: Role of neck dissection in initial surgical treatment

Abstract

Epidermoid carcinoma of the supraglottic larynx is defined as carcinoma that arises on the laryngeal surface of the epiglottis, aryepiglottic folds, arytenoids, ventricular bands, and ventricular cavities. Such tumors may extend inferiorly to involve the vocal cords or subglottic region. More often they spill over the superior margins of the laryngeal box to invade adjacent sites outside the larynx such as the base of the tongue, vallecula, pyriform sinus, and postcricoid region. These tumors may also infiltrate beneath the laryngeal mucosa to involve underlying structures causing fixation of the larynx or even infiltrate deeply to extend outside the larynx. The most common mode of metastases of these tumors is through the lymphatics to cervical lymph nodes. One of the questions that face the clinician is whether lymbhatic metastasis has taken place and, if so, to what extent. On the basis of this information the plan of treatment is formulated. Unfortunately no preoperative tests of any clinical value are available to ascertain the presence of metastases in the absence of palpable cervical lymph nodes, and thus the clinical findings at initial examination must be relied on. It is dbvious that in the presence of clinical cervical metastases there is no controversy as to the type of surgery advocated. However, when the cervical nodes are clinically negative for metastases, the dilemma arises as to whether elective neck dissection should be performed at the time of init,ial surgery of the