Extended partial laryngectomy with functional preservation using the rotational crico‐thyrotracheopexy

Abstract

Abstract Objectives Glottic tumors with infiltration of the anterior/posterior commissure, and lesions with subglottic, cricoid, or cricoarytenoid joint infiltration have been highly controversial in the past, from the perspective of oncological safety. Although conservation laryngeal resection options exist, most are limited by the extent of resection proscribed by the technique and the postoperative functional results. Oncologically speaking, extended vertical hemilaryngectomy is often the optimal solution. However, limited reconstruction methods often compel total laryngectomy. Methods Eight patients with vocal fold malignancy, which infiltrated the anterior and sometimes the posterior commissure and with subglottic extension and resultant uni/bilateral vocal fold motion impairment, were treated by single stage extended vertical partial laryngectomy with rotational crico‐thyrotracheopexy as a functional reconstruction of the laryngeal framework. Patients were evaluated with objective and subjective function tests. Results Histologic examination demonstrated tumor‐free margins in every case. Definitive decannulation was successful in all cases within 2 weeks. All patients had a stable and adequate airway during follow‐up and reported socially acceptable voice. Oral feeding was possible in seven patients. Conclusion Rotational crico‐thyrotracheopexy, as a single stage reconstruction technique, is based on well‐vascularized, readily available, appropriately shaped local tissues, without significant donor site morbidity or need for long‐term stenting to reconstruct large laryngeal defects after extended vertical hemilaryngectomy for advanced unilateral glottic tumors and is applicable even with supra/subglottic invasion or infiltration of the contralateral vocal fold. An adequate airway can be achieved with socially acceptable voice and safe swallowing without compromising oncologic reliability. Level of Evidence 4 (retrospective case series review).

Keywords

• extended vertical hemilaryngectomy
• glottic cancer
• rotational crico‐thyrotracheopexy
• single‐stage reconstructive surgery
• tracheal graft