Vertical Partial Laryngectomy Research Articles

Surgery in the Management of Laryngeal and Hypopharyngeal Carcinoma

Currently, a multitude of treatment options are available for laryngeal and hypopharyngeal carcinoma. Surgery should be considered a viable option in the definitive management of almost all laryngeal and hypopharyngeal tumors, regardless of stage. The characteristics of the primary tumor, as well as the status of the at-risk regional lymph nodes, are critical in the development of a treatment plan. In addition to the patient’s history and physical examination, a comprehensive staging evaluation is required that includes endoscopy, biopsy, and imaging. A patient’s comorbidities and functional status are also important factors to consider during the development of a treatment plan. Surgery as a single modality therapycanbeofferedforearly-stagedisease,andthecombination ofsurgery with adjuvanttherapy(radiotherapywithorwithout chemotherapy) should be used for advanced-stage disease. Surgery also plays a critical role in the management of recurrent or persistent disease, especially after initial nonoperative management. Because survival differences do not exist between surgical and nonsurgical therapies for most clinical scenarios, each patient should undergo a multidisciplinary evaluation to discuss all options before therapy. During the assessment of a laryngeal cancer, the tumor should be classified as either glottic or supraglottic, with isolated subglottic primaries rarely seen. Defining the site of origin, as well as clearly delineating the extent of tumor, is mandatory in developing a surgical plan. Deciding on the surgical options for the primary tumor, as well as whether to address the regional nodal basins, is determined from these tumor characteristics. In general, early glottic tumors are amenable to partial laryngeal resection. Regional metastases are uncommon at presentation and the potential for occult nodal disease is low, making neck dissection usually unnecessary.Moreadvancedglotticprimaries mightstill beamenable to partial laryngeal resection, but total laryngectomy and neck dissection could be required. Supraglottic tumors are also frequently amenable to partial laryngeal resection, but, again, in some instances, total laryngectomy might be required. Most supraglottic tumors, regardless of T stage, require therapy directed to the regional lymph nodes, given the high risk of regional spread. Neck dissection for the regional nodal basin is usually required bilaterally, given the richlymphatics of the supraglottisand the relatively infrequent occurrence of well-lateralized supraglottic primary tumors. Selected laryngeal, as well as hypopharyngeal, carcinomas are best managed by total laryngectomy (with postoperative adjuvant therapy) as the initial treatment. The most common scenario requiring definitive total laryngectomy is a case in which extensive cartilage erosion or extralaryngeal extension of the tumor is present. Patients with these extensive tumors have been shown to have worse disease control when treated by radiotherapy alone compared with surgery and postoperative radiotherapy (1). In the recent multimodality nonoperative organ preservation trials, patients with these extensive T4 tumors were more likely to need salvage laryngectomy or were excluded from participation in the trial (2, 3). The other clinical scenario in which total laryngectomy should be considered is for patients who have life-threatening aspiration at diagnosis. Several surgical organ preservation options exist for laryngeal tumors. These options can beclassified as either openvs. endoscopic procedures. Historically, open laryngeal preservation surgery for glottic tumors included cordectomy or vertical partial laryngectomy and, for supraglottic tumors, included horizontal partial laryngectomy. Near-total laryngectomy has been used for organ preservation in more advanced glottic and supraglottic tumors. Currently, with the success of tracheoesophageal prostheses for speech restoration after total laryngectomy and the success of extended partial laryngeal resection for more advanced tumors, this procedure is rarely performed. More recently, supracricoid laryngectomy and endoscopic laser resection have gained significant popularity in the management of both glottic and supraglottic carcinomas.

Aktueller Stellenwert der offenen Larynxteilresektion unter besonderer Berücksichtigung der suprakrikoidalen Teilresektionen

Open partial laryngectomies include a broad variety of vertical or horizontal partial or supracricoid laryngectomies. Especially in Germany the excellent results of the transoral approach in combination with the CO2 laser surgery radically have diminished the indications of the open surgical techniques for laryngeal cancer staged cT1-2. In patients with laryngeal cancer staged cT3 the role of open organ-preservation surgery remains to be defined in the context of extended treatment options for endolaryngeal CO2 laser surgery and conservative larynx-preservation approaches with concurrent chemoradiation or induction chemotherapy followed by radiation therapy. With regard to the reviewed literature this manuscript will discuss current indications and future roles of open partial laryngectomies with special emphasis given to the supracricoid laryngectomies.

Sultan Pradhan: Voice conservation surgery for laryngeal and hypopharyngeal cancer

Dr. Pradhan is a head and neck oncologist and surgeon who tries to cover diVerent aspects of this special tumour entity. The book is well-balanced and clearly organized. But being a European laryngologist and oncological head and neck surgeon I was amazed and rather disappointed about the missing references to several important European laryngologists especially to Oskar Kleinsasser, who is not mentioned in this book. He is the originator of microlaryngoscopy and endolaryngeal microsurgery. Besides, the names of other European authors who are mentioned are incorrectly written. Chapter 1 presents a historical survey listing up various milestones with a special focus on the development of partial and total laryngectomy. In chapter 2 the author proceeds with clear but simplifying explanations of the basics of laryngeal anatomy and patterns of tumor spread, providing a fundamental knowledge indispensable to the treatment of laryngeal and hypopharyngeal cancer. The text is supported by several illustrations which help to understand the described zones. In the third chapter on diagnosis and staging the author brieXy addresses the clinical basic and routine laryngological examination and presents the advantages of imaging techniques (CT/MRI) in larger tumours. An evaluation of voice quality before and after voice conservation in spite of the topic suggested by the title is missing. The authors' opinion that laryngologists should be “discouraged” from performing excisional biopsy during microlaryngoscopy before the patient is referred to a head and neck surgeon does not seem to be compatible to present European standards. Treatment strategies for laryngeal carcinoma have undergone important changes with the development of a much wider range of treatment options in recent years. The presented photos in this, but also in other chapters, are of varying quality. In chapter 4 Dr. Pradhan lists up important factors that inXuence treatment decision, e.g. T-stage or site of the primary. He points out that treatment decision is also inXuenced by the patient’s preferences (shared decision making). Several clear but often too simple algorithms in decision-making can be of some help for the treating physician. Chapter 5 deals with open partial laryngectomy describing procedures for glottic cancer where resection is carried out in the vertical plane across the glottis, for early supraglottic cancer with resection in the horizontal plane above the glottis, and for glotto-supraglottic cancer with a combination of vertical and horizontal partial laryngectomies which includes supracricoid partial laryngectomy with crico-hyoidopexie and three-quarter laryngectomy. Once more the sketches do not show the real extend of the tumours and its necessary resection margins. The drawings are not a suYcient help how to perform the surgery. The author always summarizes international, mostly Anglo-American experience in diVerent treatment options for each stage of the disease before giving a personal view. Reconstruction of the glottis is not mentioned in a suYcient way to point out its importance of providing voice quality to continue life even as a professional speaker. Chapter 6 which I would have set as chapter 5 informs about transoral endoscopic resection for carcinoma in situ and early cancer of the glottic and supraglottic level including oropharyngeal and hypopharyngeal cancers. These operations are performed with laser only. Set-up and safety measures are described and the indications and limitations demonstrated. Chapter 7 presents the near-total laryngectomy where voice as well as nasal respiration is H. K. Glanz (&) Head and Neck Surgery, University Hospitals Giessen and Marburg GmbH, Campus Giessen, Giessen, Germany e-mail: hiltrud.k.glanz@hno.med.uni-giessen.de

前側方喉頭垂直部分切除術を施行した喉頭癌７４例の臨床的検討―根治照射後救済手術としての有用性―

This study was designed to analyze the surgical (postoperative course, mortality, morbidity), oncological (local control, survival rate) and functional (maximum phonation time: MPT) results of frontolateral partial vertical laryngectomy (FLPVL), in order to evaluate the advantages and disadvantages of salvage FLPVL after a full course of radiotherapy (FRT). A retrospective analysis of the results in the 74 patients (of whom 61 had previously received FRT) was undertaken. The median follow up was 68 months (range 12-290 months). No significant influence of the prior FRT was noted on the deglutition, respiration, or duration of hospitalization. The frequency of complications after discharge, but not of that during hospitalization was significantly higher in the prior FRT group. Speech (MPT) was significantly shorter (poor effect) in the prior FRT group with standard extirpation. Recurrence developed in 8 patients: in the larynx only in 7 cases, and in both the larynx and neck in the remaining one case. One patient with control of the primary showed relapse in the neck and lung. Subsequent surgery was successful in salvaging 5 of the 8 cases with local failure. One died refusing TL, and two because of uncontrolled neck recurrence. Hence, the overall laryngeal preservation rate following salvage FLPVL was 85% (52/61). Salvage FLPVL results in good tumor control and incompletely satisfactory functional results and may be recognized as a safe procedure.

Obstructive sleep apnea in patients undergoing supracricoid horizontal or frontolateral vertical partial laryngectomy

To assess obstructive sleep apnea (OSA) in patients undergoing supracricoid horizontal partial laryngectomy (SCPL) or frontolateral vertical partial laryngectomy (VPL) for the treatment of laryngeal carcinoma and correlate it with age, body mass index, physical examination, and upper airway evaluation. A prospective study was carried out involving 22 patients between 50 and 80 years of age divided into 2 equal groups. The patients underwent SCPL and VPL, and were evaluated by anamnesis, otolaryngologic examinations, nasopharyngolaryngoscopy, and polysomnography. A significant direct correlation was observed between the apnea/hypopnea index (AHI) and age of the patients. An inversely proportional relation was found between glottic opening and AHI. The presence of OSA was 81% in SCPL and 91% in VPL. We observed a high incidence of OSA in patients undergoing SCPL and VPL.

184 POSTER New ways of repairing of vocal function after vertical partial laryngectomy

184 POSTER New ways of repairing of vocal function after vertical partial laryngectomy

Options for salvage after failed initial treatment of anterior vocal commissure squamous carcinoma

Persistence or recurrent cancer in the anterior commissure (AC) after primary radiotherapy may remain localized to its pretreatment anatomical site. If so, endoscopic CO(2) laser excision, in experienced hands, may achieve complete tumor excision and result in cure for many patients. Occasionally, second and third recurrences may be similarly salvaged by further endoscopic surgery. The use of the vertical hemilaryngectomy is an alternative treatment for similar localized lesions, with a higher first time surgical tumor eradication rate, but with a more protracted hospitalization and a less satisfactory voice and swallowing outcome. In both types of such surgical salvage, CT scanning must demonstrate no evidence of cartilage invasion or destruction. When there is evidence of minimal thyroid cartilage invasion, then the supracricoid partial laryngectomy is an alternative conservation option, and is likely to result in a cure, with the retention of a voicing larynx without a stoma. When the tumor has increased in size from the original pretreatment dimension and/or site, then imaging must be used to identify possible cartilage invasion, in which case the likelihood of tumor eradication by endoscopic or external vertical partial laryngectomy is highly unlikely. The indications for the routine use of total laryngectomy for the treatment of recurrent or persistent cancer involving the AC must be reviewed; there is current evidence that cure can be achieved by a less radical procedure. However, total laryngectomy may remain the only treatment option for advanced or aggressive first time recurrence, or in patients who develop subsequent recurrence following previous less aggressive surgery (endoscopic or external).

Carcinomes différenciés de la thyroïdeavec envahissement laryngo-trachéal

Analyze the diagnosis and treatment of differentiated thyroid carcinomas with laryngo-tracheal invasion. Among the 117 patients operated for a differentiated thyroid carcinoma in the ENT department of Tours Hospital (France) between January 1990 and December 2003, seven presented laryngo-tracheal invasion and were included in this retrospective study. Laryngo-tracheal resection resulted in a thyroid cartilage-shaving in two patients. We performed a resection of one side of the thyroid cartilage in one patient, a thyro-tracheal resection-anastomosis with a partial cricoidectomy in one patient, a partial vertical laryngectomy extended to the first tracheal ring in one patient and a total laryngectomy in one patient. No laryngo-tracheal resection was done in one patient. Early complications were swallowing disorders (n = 2), transitory hypoparathyroidism (n = 1), definitive recurrent nerve paralysis (n = 2), subcutaneous emphysema and hematoma (n = 1) and Claude Bernard-Horner's syndrome (n = 1). Locoregional recurrences (n = 2) and distant metastasis (n = 2) were discovered six months to four years after the laryngo-tracheal resection. With a mean follow-up of 40 month, four patients were alive (two disease free) two patients had died and one was lost of follow-up at three months. The frequency of locoregional recurrences and distant metastasis is higher for the differentiated thyroid carcinomas with laryngo-tracheal invasion than the others. In these cases, we performed macroscopic carcinological surgery preserving laryngeal functions as much as possible.

進行喉頭癌および再発例に対する垂直喉頭部分切除術

進行喉頭癌および再発例に対する垂直喉頭部分切除術

The Current Role of Vertical Partial Laryngectomy and Open Supraglottic Laryngectomy

The Current Role of Vertical Partial Laryngectomy and Open Supraglottic Laryngectomy

Frontolateral Vertical Partial Laryngectomy without Tracheotomy for Invasive Squamous Cell Carcinoma of the True Vocal Cord: A 25-Year Experience

On the basis of an inception cohort of 270 patients with a previously untreated invasive squamous cell carcinoma of the true vocal cord (232 T N0M0, 35 T2N0M0, and 3 T3N0M0) and a minimum of 3 years of follow-up, the authors analyze the oncological and functional outcomes following frontolateral vertical partial laryngectomy without tracheotomy. The 5-year Kaplan-Meier actuarial survival estimate ranged from 83.1% for T1 tumors to 67.2% for T2 tumors (p = .005). On univariate analysis, a significant statistical relationship was noted between reduced survival and the following variables: increased age, increased Charlson comorbidity index score over grade 0, increased tobacco intake, increased alcohol intake, increased T stage, local failure, nodal failure, and development of a metachronous second primary cancer. The hospital mortality rate was 0.4%. A significant postoperative surgical complication was noted in 49 patients (18.1%). The predominant significant surgical complication was wound infection (19 patients; 7%), followed by seroma and major subcutaneous emphysema. No significant statistical relationship was noted in a comparison of each, significant postoperative complication (including postoperative death) with the variables under analysis. The incidence of secondary tracheotomy was 0.4%. The incidence of completion laryngectomy due to functional problems was 0%. The 5-year Kaplan-Meier actuarial local control estimate was 91% for T1 tumors and 68.7% for T2 tumors (p <.0001). Within the T1 tumors, the 5-year Kaplan-Meier actuarial local control estimate ranged from 96.2% for tumors without anterior commissure involvement to 74.7% for tumors with anterior commissure involvement (p = .0002). On univariate analysis, a significant statistical relationship was noted between an increase in local recurrence and the following variables: increased T stage, anterior commissure involvement, and pathological margin involvement. The overall disease control rate and laryngeal preservation rate were 92.9% and 93.3%, respectively.

The management of early laryngeal cancer: options for patients and therapists

To evaluate the optimal treatment of early laryngeal cancer and to highlight new developments. The use of hyperfractionation and acceleration of radiotherapy may result in improved outcomes for patients with respect to cancer cure and preservation of the larynx. Options for surgical treatment include endoscopic resection and open partial laryngectomy. The use of endoscopic vertical partial laryngectomy may overcome the difficulties encountered in exposure with transoral laser resection of anterior commissure tumors. The microdebrider may be a useful alternative to CO(2) laser in endoscopic resection in selected cases. A further treatment option that shows promising results is photodynamic therapy, which has some important advantages over the other treatment modalities. Further larger studies are needed to assess the efficacy of these treatment modalities to ascertain the treatment modality of choice. Different treatment modalities are available for early laryngeal cancer. The treatment choice should take into account the likely post-treatment morbidity, quality of life, patient preference, and voice quality. The cost of treatment, not only to the treating institution but also to the patient and those involved in the patient's care at home, is also an important issue. Well-designed randomized multicenter controlled trials are now necessary to influence patients' and clinicians' decision in the choice of the most effective and predictable treatment plan.

QUALITY OF LIFE AND DEPRESSION IN PATIENTS UNDERGOING TOTAL AND PARTIAL LARYNGECTOMY

The surgical treatment of head and neck cancer, primarily laryngeal cancer, causes sequelae and can change the patient's quality of life. The purpose of this study was to investigate the impact of laryngectomy on the quality of life regarding the functional, physical, psychological, and social aspects. Fourteen patients underwent total laryngectomy and 16 underwent vertical partial laryngectomy. The Quality of Life Core Questionnaire (QLQ-C30) and Head and Neck (H&N35) questionnaire from the European Organization for Research and Treatment of Cancer (EORTC) were used for quality of life evaluation, while the Beck Depression Inventory questionnaire was used for the depression screen. In the total laryngectomy group, reported adverse effects were worsened, social and emotional function (21.3%), olfaction and taste changes (85.6%), cough (71.3%), speech difficulty (100%), and dysphagia (64.3%). Most of the patients (85.5%) judged their quality of life to be reasonable. In the partial laryngectomy group, reported adverse effects were worsened, emotional function (71.4%), speech difficulty (100%), and dysphagia (31.3%). However, most of the patients judged their quality of life to be above the general average. Despite being different surgeries, both groups experienced similar difficulties but at different levels. The quality of life was judged worse in the patients who underwent total laryngectomy.

Laryngeal reconstruction by platysma myofascial flap after vertical partial laryngectomy

Many methods of glottic reconstruction have been described for patients undergoing vertical partial laryngectomy to reestablish the glottic integrity. Fifteen patients with T2 squamous cell carcinoma of the glottis were included in this prospective clinical trial. All patients were treated by vertical partial laryngectomy with laryngeal reconstruction by platysma myofascial flap. The surgical procedure and flap design were described. Vocal function was assessed by videolaryngostroboscopy and subjective and objective voice analysis before and after surgery. Complete neoglottic closure and acceptable voice quality were obtained by platysma myofascial flap in all cases. No statistically significant difference was found between the preoperative and postoperative acoustic parameters. Platysma myofascial flap provides the basic requirements for laryngeal reconstruction with its own favorable characteristics and also allows complete glottic closure without interfering with respiration and deglutition. This technique may be an effective alternative achieving an acceptable quality of voice.

Perichondrial flap to prevent chondritis and cartilage necrosis in salvage vertical partial laryngectomy for recurrent glottic carcinoma after irradiation: A new procedure

ConclusionWe conclude that our new closure method using the posterior- and inferior-based perichondrial flap may diminish the chance of development of chondritis in salvage vertical partial laryngectomized patients with recurrent glottic cancer.ObjectivePost-radiation laryngeal chondritis with resultant cartilage necrosis is one of the most dreaded complications of radiotherapy treatment of glottic carcinoma. In the case of salvage vertical partial laryngectomy, the risk of its development may be increased. We introduce a new posterior- and inferior-based perichondrial flap procedure to prevent postoperative chondritis after salvage vertical partial laryngectomy.Material and methodsThe perichondrium is incised along the midline and upper border of the thyroid cartilage, but not along the inferior border, unlike the conventional method. Then, the posterior- and inferior-based perichondrial flap, along with the cricothyroid muscle fascia, is elevated from the midline. For closure of the pharyngeal lumen, the outer perichondrium of the lesion side is sutured to the inner perichondrium of the contralateral side to protect the larynx from pharyngeal secretion. The utility of this procedure is reviewed retrospectively in 10 patients with locally persistent or recurrent squamous cell carcinoma of the vocal cord after failed laryngeal radiation therapy between 1994 and 2001.ResultsNone of our patients developed chondritis postoperatively. The interval between the operation and removal of the tracheostomy tube ranged from 8 to 23 days (mean 12 days). Patients were able to swallow without aspiration within 7–22 days of the operation (mean 10 days). Discharge from hospital was possible after a mean recovery period of 11 postoperative days.

Análise funcional da laringe pós-cordectomia, reconstruída com retalho de prega vestibular

Várias técnicas para a reconstrução da laringe, pós laringectomias parciais verticais, são citadas na literatura, algumas utilizando estruturas da própria laringe, como a prega vestibular, porém, poucas dão destaque à análise das funções laríngeas após estas reconstruções. Este estudo teve como objetivo avaliar as funções laríngeas em pacientes submetidos à cordectomia completa (tipo IV), reconstruídos com retalho de prega vestibular. FORMA DE ESTUDO: Estudo de coorte transversal. MATERIAL E MÉTODO: Dez pacientes, nove do sexo masculino e um do sexo feminino, com idades entre 45 e 75 anos, e média de 64,5, com carcinomas glóticos tratados por cordectomias totais ou completas (tipo IV) e reconstruídos com retalho de prega vestibular, foram submetidos a videolaringoestroboscopia, onde se avaliou a permeabilidade laríngea, o posicionamento do retalho, o fechamento laríngeo, a movimentação das aritenóides e a característica da fonte sonora: vibrátil ou friccional, e quando vibrátil, a localização e as estruturas que a compunham. A qualidade vocal foi analisada por avaliação perceptiva auditiva e objetiva computadorizada. A função de proteção das vias aéreas durante a deglutição foi realizada pela avaliação endoscópica da deglutição. RESULTADOS: Os resultados evidenciaram que não houve necessidade de manter a traqueostomia no pós-operatório tardio, pois a luz laríngea reconstruída mantinha-se pérvia. A função de proteção estava mantida em todos os casos, a coaptação completa em 30% e somente um paciente teve a movimentação da aritenóide limitada devido à imobilidade do lado operado. Evidenciaram, também, que havia fonte sonora vibrátil em 90% dos casos e que em todos a prega vestibular participava da sua composição. Em sete pacientes a fonte sonora vibrátil se localizava na região glótica. A análise computadorizada revelou freqüência fundamental média de 177,5 Hz, jitter médio de 1,11% e shimmer de 7,04%. Pela escala GRBAS, um paciente apresentou voz normal e 4 tiveram disfonia discreta. CONCLUSÕES: A reconstrução laríngea pós-cordectomia realizada com o retalho da prega vestibular tornou possível emissão de voz normal (freqüência fundamental 205 Hz, jitter 0,13%, shimmer 1,16%), proporcionando coaptação completa em 30% dos casos, fonte sonora vibrátil na região glótica em 70% e participação do retalho como estrutura vibrátil em 90%, além de preservar as funções laríngeas de respiração e proteção das vias aéreas durante a deglutição.

Endoscopic vertical partial laryngectomy.

To explain the significant difference between microlaryngoscopy with cordectomy and endoscopic vertical partial laryngectomy (EVPL), to describe the efficacy of EVPL on T1b and T2 glottic squamous cell carcinoma, and to evaluate EVPL with postoperative irradiation in T2 glottic cancer with impaired true vocal cord mobility. Retrospective review. Twenty-six patients seen at the University of Utah Health Science Center between 1987 and 2000 with bilateral T1 (T1b) or T2 squamous cell carcinoma of the glottic larynx underwent EVPL. T2 cancers were classified as follows: a = unilateral disease, b = bilateral disease; i = impaired mobility. T1b and T2a glottic cancer patients received surgery alone, whereas impaired mobility patients (T2ai + T2bi) patients received surgery followed by planned postoperative irradiation. Patients were assessed for primary site control, perioperative and long-term complications, and ultimate cancer control. RESULTS Survival in the total group was 88.5%, with local control at 92.3%. The two recurrent patients were salvaged by total laryngectomy. For the whole group, anterior commissure involvement was present in 57.7% (15 of 26). Thirteen T2 (5 T2ai + 8 T2bi) carcinoma patients underwent combined therapy, with 8 (61.5%) of these patients having anterior commissure involvement. Two of these patients were upstaged at surgery, one to T3 and one to T4. Local control was 84.5%. Thirteen patients were treated by surgery only, with five of these patients having failed previous irradiation. Survival was 92.3% and local control 100%. This group included two T2bi patients, two patients upstaged to T4 on the basis of extension beyond the subglottis to the anterior wall of the trachea, 3 T2b, and 6 T2a patients. Anterior commissure involvement was seen in 7 (53.8%) of these patients. EVPL alone controlled all T1b and T2a glottic cancer patients, even in the presence of greater than 50% anterior commissure involvement. The significant difference between EVPL and classical microlaryngoscopy with cordectomy was carefully described. EVPL with planned postoperative irradiation resulted in an 85% local control rate in clinically staged T2ai and T2bi cancer patients, including the three upstaged patients.

Summary Repair of Traumatic Laryngeal Injury using S-shaped Incision and Vertical Partial Laryngectomy -A Case Report-

Usually, the primary treatments of traumatic laryngeal injuries including scar tissue removal by median laryngotomy, transposition of mucosa, T-tube placement, and cartilage graft require quite complicated surgical techniques or repeated surgeries. We applied techniques of a vertical partial laryngectomy with an S-shaped anterior cervical incision used for laryngeal cancer treatment to traumatic laryngeal injuries in adults, and formed laryngeal fistula. These procedures enable us to preserve the voice function and to close the trachea stoma. This surgical method is an effective tool for traumatic laryngeal injuries in adults as we can reconstruct the inner surface of the larynx easily and consistently.

Vocal analysis after vertical partial laryngectomy.

It is generally believed that a reconstruction of the glottic region after a vertical partial laryngectomy (VPL) can improve the glottic and supraglottic function. However, there is a paucity of reports on secondary healing without a glottic reconstruction after a VPL. The aim of this study was to obtain objective phonatory data after a VPL without a glottic reconstruction. From 1993 to 2001, 13 patients, who had been treated with VPL without a glottic reconstruction, were enrolled in this study. Patients with a postoperative follow up of less than 12 months were excluded. Seven lesions were classified as T1 glottic cancer and six as T2 glottic cancer- standard VPL (11 cases) and frontolateral VPL (2 cases). Acoustic ((fundamental frequency, Fo), jitter, shimmer, the noise to harmonic ratio (NHR)), aerodynamic (maximal phonation time (MPT), mean flow rate (MFR)) analysis and videostroboscopy were performed to evaluate the voice. There were significant differences in the Fo, jitter, shimmer, NHR, MPT and MFR between the VPL group and normal control group. In videostroboscopy, the following tendencies were observed in many cases: incomplete glottic closure, a decreased and irregular mucosal wave and amplitude, supraglottic voicing, abnormal arytenoid movement and anterior commissure blunting. Objective phonatory data after VPL without a glottic reconstruction was obtained. The voice quality after a VPL without a glottic reconstruction was somewhat unsatisfactory. A further comparison with other different surgical techniques of a VPL would help determine a better way of improving the voice quality in these patients.

Salvage vertical partial laryngectomy for radiation failure in early glottic carcinoma.

Partial laryngectomy after failure of radiotherapy for early glottic cancer is an accepted surgical salvage procedure. However, there have been only a few studies on recurrent disease or long-term survival. Twenty-one patients who were treated with salvage partial vertical laryngectomy (PVL) following failure of primary radiotherapy were prospectively studied. Median follow up was 69 months (range 24-204 months). Patients were seen at two- monthly intervals for the first 24 months and then 3-4 monthly for 5 years after their partial surgery or until death. Local control was 71.4% (15/21). Among the six patients who recurred within the larynx, two patients developed a second primary; one on the ipsilateral false cord at 24 months and the other on the contra-lateral vocal cord at 10 years. The no evidence of disease rate following salvage PVL was 95%, 85% and 73% at 12,24 and 36 months, respectively, with a mean disease free interval of 34.9 months (range 7-120). Survival was 90%, 85% and 80% at 12, 24 and 36 months,respectively, with a median survival of 152 months for the group. Three patients died of their disease and four from other causes. Four local recurrences occurred within 32 months. Two developed neck metastases and died of their disease. Four patients were treated successfully with completion laryngectomy. Only one of these died, but this was due to a second primary squamous cell carcinoma in the lung. Three of the four patients with local recurrence shad an extended procedure. Partial vertical laryngectomy is an excellent alternative to total laryngectomy for salvage following failure of -radiation. Although local recurrence occurred more frequently in those patients having an extended partial procedure, this was not statistically different.