Management of invasive thyroid carcinoma

Abstract

Laryngotracheal invasion is a rare occurrence in the thyroid carcinoma that demands aggressive complete removal of tumor to prevent mortality. The most common cause of death related to thyroid carcinoma is local invasion of the upper airway. The otolaryngologist-Head & Neck surgeon, trained in surgery of the larynx and trachea, is an expert in dealing with the most complex cases of thyroid cancer. However, successful treatment depends on a clear understanding of the regional anatomy with a goal of complete tumor removal with preservation of function. In most situations, this can be accomplished resulting in long-term local control of even the most aggressive locally invasive tumors. This study reviews a 30-year experience with treatment of locally invasive thyroid cancer. Although the principle of complete removal of tumor is unchanged regardless of the area of invasion, the guidelines for reconstruction vary greatly depending on the site and extent of the defect. Total laryngectomy is rarely necessary and even large defects of the subglottic larynx and trachea can be reconstructed. This article defines the regions of resection and those that do require reconstruction of rigid support of the airway. The study defines the concept of a “subglottic laryngectomy” with reconstruction, because the region can be affected by thyroid cancer. Large tracheal defects as well can be reconstructed. The basis of the reconstruction is the sternocleidomastoid myoperiosteal flap that provides skeletal support to the trachea on cricoid as needed. The surgical technique for reconstruction with the flap is described in detail. The use of tracheal stents for support during the healing phase is also described.