Abstract
Partial laryngectomy is used in the treatment of laryngeal cancer. Structural alterations of the upper airway arising from partial laryngectomy can cause obstructive sleep apnea (OSA). ObjectiveTo compare the prevalence and severity of OSA in patients submitted to horizontal and vertical partial laryngectomy and assess the role of spirometry for these patients. MethodCross-sectional clinical study with individuals offered partial laryngectomy. The included patients were assessed through interview, upper airway endoscopy, polysomnography, and spirometry. ResultsFourteen patients were evaluated and 92.3% were found to have OSA. The apnea-hypopnea index was significantly higher among patients submitted to vertical laryngectomy (mean = 36.9) when compared to subjects offered horizontal laryngectomy (mean = 11.2). The mean minimum oxyhemoglobin saturation was 85.9 in the horizontal laryngectomy group and 84.3 in the vertical laryngectomy group. Spirometry identified extrathoracic upper airway obstruction in all patients with OSA. ConclusionThe studied population had a high incidence of obstructive sleep apnea. OSA was more severe in patients offered vertical laryngectomy than in the individuals submitted to horizontal laryngectomy. Spirometry seems to be useful in the detection of cases of suspected OSA, as it suggests the presence of extrathoracic upper airway obstruction.
Highlights
Partial laryngectomy has been used in cases of non-advanced laryngeal cancer to preserve some of the larynx’s vital functions, by sparing the natural airways, protecting the lower airways, and preserving the patients’ voice
The studied population had a high incidence of obstructive sleep apnea
obstructive sleep apnea (OSA) was more severe in patients offered vertical laryngectomy than in the individuals submitted to horizontal laryngectomy
Summary
Partial laryngectomy has been used in cases of non-advanced laryngeal cancer to preserve some of the larynx’s vital functions, by sparing the natural airways, protecting the lower airways, and preserving the patients’ voice. In HPL, as in supraglottic laryngectomy, the entire supraglottis - including the epiglottis, the vestibular folds, Morgagni’s ventricles, and the hyoid bone - is removed. In supracricoid laryngectomy - a horizontal procedure - the entire supraglottis is removed, along with the vocal folds, the pre-epiglottic and paraglottic areas, and the thyroid cartilage. The neoglottis is relocated to the cricoid In these cases, the area of the cricoid cartilage and remaining arytenoid is elevated and fixated against the epiglottis, in a reconstruction procedure called cricohyoidoepiglottopexy (CHEP). When the epiglottis is removed, the reconstruction is carried out by suturing the cricoid and arytenoids to the hyoid, in a procedure called cricohyoidopexy (CHP). In VPL, the vocal folds, the laryngeal ventricle, the vestibular fold, and the lamina of the thyroid cartilage on the side of the lesion are resected, sparing at least one portion of the thyroid cartilage to preserve laryngeal support. The external perichondrium of the resected thyroid cartilage is used in the reconstruction of the affected area, to produce a new laryngeal wall[3]
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